Every time you want to move from A to B, you are on your feet and legs are in motion. Without knees working well, this can be painful or impossible. They are the joints that act like a hinge, moving to allow us to twist and turn, stand and sit, walk and run. At all times, they carry our increasing body weight, absorbing the impact as that weight hits the ground through the legs. If anything goes wrong. . . Well, what can go wrong? More than a million people are carried into ERs every year with severe knee trauma. In most cases, this is tied into the work place, exercise or sport. Every time we lift something heavy or start training for that marathon, there's a risk of damaging the joint. This may be a strain on the tendon that holds the joint together, or the cartilage designed to support the joint may be damaged.

As people age, disease can inflame the joint or damage the bone. In this, how vigorously you exercised when young can come back to haunt you. The cartilage is one of the last parts of the body to finish growing. In many men, growth is not complete until they are in their twenties. So, if they are training for and playing serious competitive sport, there can be early damage. Most will work through the pain when young but, if there is too much stress on the joint, it can cause problems for the over-fifties as the cartilage naturally begins to lose its flexibility and power to cushion impact.

What then causes knee pain? The most common problem is arthritis - a slow degeneration of the cartilage that fails to absorb friction from the leg bones as they move. Pain is less when the body is still. The remainder tend to be related to injuries. The most common is overexertion that can strain or sprain the tendons or ligaments, or tear the cartilage. This can cause a sharp pain with swelling, making it difficult to walk.

What is the process for diagnosis? We have an impressive range of technology to look inside the joint from outside. The most commonly used for the knee are X-rays, MRI and CT scans. Increasingly useful when the scans are inconclusive is the use of arthroscopy which inserts a small camera into the joint, giving the surgeon a first-class view of any problems.

Once you have the diagnosis, it may just be a case of using ice packs, resting and using a crutch to support the body weight and protect the joint while walking. There are also a range of leg braces and knee supports that can strengthen the joint while it heals. NSAIDs can reduce inflammation and swelling, and steroid injections can relieve more severe pain from arthritis. All this goes hand-in-hand with physical therapy and surgery where repairs are necessary. If the pain grows more severe, Ultram is the first response drug. It controls the pain while the body heals. Remember, even though it may be painful, exercising the knee to regain muscle tone and strength is essential. If this exercise is painful, take Ultram during the early stages of the therapy.