Knee pain can result from a variety of conditions, including overuse. The knee is a vulnerable joint that bears a great deal of physical stress, especially among people who are more physically active. In fact, today’s increasingly active society has seen an increase in the number of knee problems.
Athletes who run or play sports that involve jumping or quick pivoting are more likely to experience knee pain and problems. However, knee pain is most often associated with general wear and tear from aging and daily activities like walking, bending, standing, and lifting.
Knee pain has a wide variety of specific causes and treatments. But whether an individual’s knee pain is caused by aging or injury, it can be a nuisance and even debilitating.
Knee pain is a common condition that can affect any of the parts of the knee joint. The knee is the largest and most complex joint in the body consisting of multiple bones, ligaments, cartilage, and tendons.
The knee is formed by the following bones:
Tibia. This is the shin bone or larger bone of the lower leg.
Femur. This is the thighbone or upper leg bone.
Patella. This is the kneecap.
Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. The bones are held together by muscles, ligaments, and tendons, which provide stability and movement of the joint.
The kneecap is a thick, round bone that covers and protects the front portion of the knee. A layer of cartilage surrounds the underside of your kneecap to protect it from grinding against the femur.
When the cartilage softens and breaks down, it can cause knee pain. This is partly due to repetitive stress. The stress irritates the lining of the joint, which causes pain in the underlying bone.
What Causes Knee Pain?
Often, knee pain is the result of the aging process and continual wear and stress on the knee joint (e.g., arthritis). Being active is one of the best things you can do for your joints. However, injuries can happen, and they often involve the knees. Several different overlapping causes can contribute to knee pain, including:
Overuse of the knee joint.
Damage to small nerves in the region.
Damage to the retinaculum, a ligament-like structure, which holds the patella in place.
Degeneration of the bone beneath the cartilage.
Inflammation in the soft tissues around the patella.
Some of the more common causes of knee pain include injury, mechanical problems, types of arthritis, and other problems.
A knee injury can affect any of the ligaments, tendons, or fluid-filled sacs (bursae) that surround the knee joint, as well as the bones, cartilage, and ligaments that form the joint itself. Some of the more common knee injuries include:
ACL injury. A tearing of the anterior cruciate ligament (ACL), one of four ligaments that connects the shinbone to the thighbone. The injury is particularly common in sports that require sudden changes in direction (basketball, soccer, and similar sports).
Fractures. The bones of the knee, including the kneecap (patella), can be broken during motor vehicle collisions or falls. Anyone with bones weakened by osteoporosis is more susceptible to knee fractures.
Torn meniscus. The meniscus is a tough, rubbery cartilage that acts as a shock absorber between the shinbone and thighbone. It can be torn by suddenly twisting the knee while placing weight on it. The rough edges of cartilage can become stuck in the joint causing pain and swelling. Often, this tear causes the sensation of “catching” when the joint moves.
Knee bursitis. Some knee injuries cause inflammation in the bursae (small fluid-filled sacs) that cushion the outside of the knee, allowing tendons and ligaments to glide smoothly. Overuse, falls, or repeated bending and kneeling can irritate the bursa on top of the kneecap which can lead to pain and swelling (prepatellar bursitis also called ”preacher’s knee”).
Sprains and strains. A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking.
Some examples of mechanical problems that can cause knee pain include:
Loose body. Injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement.
Iliotibial band syndrome. This occurs when the tough band of tissue that extends from the outside of the hip to the outside of the knee (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to this condition.
Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee (patellar dislocation). Should the kneecap stay displaced, it is possible to see the dislocation through the skin.
Hip or foot pain. This type of pain can change the way you walk in an effort to avoid pain. However, the altered gait may place more stress on the knee joint causing knee pain. In some cases, hip or foot problems can refer pain to the knee.
Osgood-Schlatter disease. In children, when bones and other parts of the knee are still changing, overdoing exercises can cause a painful bump below the knee where a tendon from the kneecap connects to the shin. Irritation at the bottom of the knee (tibial tubercle) often causes pain in this area. The ache, especially prevalent in teenagers, may come and go over time.
Types of Arthritis
Of the many different types of arthritis, the ones most likely to affect the knee include:
Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis and a primary cause of knee pain in people over the age of 50. It’s a wear-and-tear condition that occurs when the cartilage in the knee deteriorates with use and age. Joints affected by osteoarthritis can also be stiff early in the day.
Rheumatoid arthritis. The most debilitating form of arthritis, this autoimmune condition can affect almost any joint, including the knees. Although it is a chronic disease, rheumatoid arthritis tends to vary in severity and may even come and go.
Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
Septic arthritis. Sometimes the knee joint can become infected, leading to swelling, pain, and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.
Patellofemoral pain syndrome is a general term for knee pain that occurs around the kneecap (patella) and the underlying thighbone (femur). The condition arises from a muscle imbalance, tightness, or alignment problem of the legs. It’s common in athletes and young adults, especially those who have a slight maltracking of the kneecap. It is also found in older adults who develop the condition as a result of arthritis of the kneecap. The condition causes knee pain and occasionally the sudden inability to bear weight (“buckling”)—this condition, when not the result of an injury, is more common in women than men.
What are the Symptoms of Knee Pain?
Obviously, knee pain hurts! But the type of pain and where it is felt can vary, depending on the cause. Knee pain is characterized by a dull, aching pain in the front of the knee, in the area under and around the kneecap. The pain may start quickly or slowly.
The pain may be worse when squatting, running, or after sitting for a long time. Sometimes it may feel like the knee is “giving out” or is not strong enough to support you. The symptoms may be in one or both knees.
If the pain continues after a week of home treatment and over-the-counter anti-inflammatory pain medication, you should schedule an appointment with your doctor to evaluate the pain. You should call your doctor if any of these symptoms accompany the knee pain:
The inability to fully straighten out the knee, or problems moving the knee.
If the knee buckles or “locks,” or there is a general weakness or instability.
There is pain when bending or straightening the knee (including walking down stairs).
There are “popping” or “crunching” noises when moving the knee.
The knee has signs of redness and feels warm to the touch.
There is swelling in the knee.
The patient has a fever, in addition to redness, pain, and swelling in the knee.
There is pain when putting weight on the knee.
There is an obvious deformity in the leg or knee.
If you cannot put weight on your knee, and feel sick, have a fever, or if your knee is red and hot, you should consider going to the Emergency Room because of the possibility of a fracture or infection. Other signs and symptoms that the emergency room should evaluate include:
Pain that does not improve with rest.
Pain that wakes you.
How is Knee Pain Diagnosed?
Even in today’s world of modern technology, doctors still rely on a patient’s detailed medical history and a physical exam. In addition to a medical history, the doctor will ask about other medical problems as well as the current pain symptoms and activities that aggravate the knee pain. The medical exam of the knee will include motion and strength tests, and an assessment of knee alignment. The doctor will also check for areas of tenderness, swelling, warmth, and any visible bruising. The doctor wants to rule out other causes of the pain, such as arthritis or instability.
Should the diagnosis be unclear, the doctor may want to do imaging tests, like an X-ray or magnetic resonance imaging (MRI), to rule out other possible causes of the pain. The types of imaging tests include:
X-ray. Among the first imaging tests to help detect bone fractures and degenerative joint disease.
Computerized tomography (CT) scan. CT scanners combine X-rays taken from many different angles to create cross-sectional images of the inside of the body. CT scans can help diagnose bone problems and can detect loose bodies.
Ultrasound. This technology uses sound waves to produce real-time images of the soft tissue structures within and around your knee and how they are working.
Magnetic resonance imaging. An MRI uses radio waves and a powerful magnet to create 3-D images of the inside of your knee. This test is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage, and muscles.
If an infection is suspected, the doctor may also conduct blood tests or an arthrocentesis test (removal of a small amount of fluid from within the knee joint with a needle) for laboratory analysis.
How is Knee Pain Treated?
Minor knee pain responds well to self-care measures. Several factors are taken into consideration when planning treatment for knee pain, including the nature, severity, and location of the pain. Additionally, the patient’s age, activity level, type of work, and general health must be considered. The primary treatment goal involves reducing or alleviating knee pain and improving function.
Depending on the cause of the pain, several different treatment strategies may be employed to help relieve symptoms. These might include:
Avoiding activities that make the pain worse, and then a gradual return to activity.
Icing the outside of the knee when it causes pain.
Taking over-the-counter pain medications.
Wearing a knee brace or taping the knee to support it.
Wearing special shoe inserts to help keep feet in proper alignment.
Specific exercises to stretch and strengthen the muscles around the hip and knee.
Home Care for Knee Pain
In many cases, treatment can be done at home by the patient. Home treatments can include cold packs, rest, and braces, along with the use of over-the-counter medication. Treatment may require prescription medications to treat underlying conditions, such as rheumatoid arthritis or gout. Often, physical therapy is beneficial.
The body’s natural response to injury is inflammation; therefore, treating many types of knee pain requires breaking the inflammatory cycle. However, when the injury and subsequent inflammation is not resolved, inflammation can become a chronic issue, leading to further inflammation and additional damage.
The key to controlling inflammation at home and helping to break the inflammatory cycle is protection, rest, ice, compression, and elevation (PRICE):
PROTECT the knee from further trauma with padding or a splint.
REST the knee to reduce repetitive strains from activity, which also helps prevent further injury.
ICE the knee to reduce swelling 2 to 3 times a day for 20-30 minutes each time.
COMPRESS the knee with a knee brace or wrap to help reduce swelling.
ELEVATE the knee to help reduce swelling and keep fluid from accumulating around the knee.
Over-the-counter pain medicine: Common pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), play a role in the treatment of knee pain by acting as anti-inflammatory agents and helping break the inflammatory cycle.
Strengthening the knee muscles will make it more stable. A physical therapist will most likely focus on the muscles on the front of the thigh (quadriceps) and the muscles in the back of your thigh (hamstrings).
In many cases, correcting improper movement patterns can be helpful. For example, when a sports injury is the cause of the pain, a therapist can help establish good techniques to avoid repeated injury. Exercises to improve balance are also important. In some cases, shoe inserts can help shift pressure away from the side of the knee. And in certain conditions, different types of braces may be used to help protect and support the knee joint.
In some cases, the injection of medications or other substances directly into the knee joint can help reduce pain. Examples include:
Corticosteroids. Injections of this type may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. These injections aren’t effective in all cases.
Hyaluronic acid. The injection of a thick fluid, similar to natural joint lubricant, can help improve mobility and ease the pain. Relief from one or a series of shots may last as long as six months.
In some cases, the knee may require surgery; however, it is usually not necessary to have the operation immediately. Surgical options include:
Arthroscopic surgery. Depending on the injury, this type of surgery requires a few small incisions. It is best for removing loose particles from the knee joint and reconstructing torn ligaments.
Partial knee replacement surgery. Only the most damaged portion of the knee is replaced with parts made of metal and plastic. The surgery can often be performed through small incisions, which heal more quickly than a total knee replacement.
Total knee replacement. The surgeon cuts away damaged bone and cartilage and replaces it with an artificial joint made of metal alloys, high-grade plastics, and polymers.
Is It Possible to Prevent Knee Pain?
Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage, and disability if left untreated. Furthermore, having even a minor knee injury makes future injuries more likely.
People with an increased risk of knee pain include those who:
Exercise heavily or have recently increased workout intensity.
Have a body mass index greater than 25.
Have poor alignment of the patella.
Walk with feet turned overly outward or inward.
Have weakness in surrounding muscle groups, such as the inner quad or hip adductor muscles.
Have excess tightness in surrounding muscle groups, such as the hamstrings or iliotibial band.
Have a recent history of trauma to the area.
Unfortunately, many of these risk factors cannot be modified. However, losing weight and correcting excess muscle tightness or muscle weakness can help decrease the risk of knee pain.
Although it’s impossible to prevent all injuries and eliminate all knee pain, the following suggestions may help forestall injuries and joint deterioration:
Be in shape to play your sport. Take time for conditioning to prepare your muscles for the demands placed on the body by the sports you play. Work with a coach or trainer to ensure that your technique and movements are the best they can be.
Be smart about exercise. If you have osteoarthritis, chronic knee pain, or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics, or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities provides knee pain relief.
Learn how to stretch before and after exercise properly. If you want to make your workout more intense, always do so gradually.
Get strong, stay flexible. Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. In addition, balance and stability training help the muscles around your knees work more effectively.
Stretch your legs before and after physical activity. Tight muscles can contribute to injury, so stretching is essential. Try to include flexibility exercises in your workouts. Support your knees as recommended by your doctor or physical therapist.
Keep extra pounds off. Maintain a healthy weight. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
Practice perfectly. Make sure the technique and movement patterns you use in sports and overall activities are the best they can be. Lessons from a professional can be beneficial.
Replace running shoes regularly.
Stop exercising if you feel pain in your knee.
Use kneepads. Kneepads help prevent bursitis, especially if you have to kneel a lot.
Wear proper fitting shoes. Shoes that fit well and offer enough support help support the knees.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating knee pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.