Knee Pain

Knee pain or knee injuries are extremely common, and there are many causes. It is important to make an accurate diagnosis of the cause of your knee pain or injury so that appropriate treatment can be directed at the cause. Knee pain can arise from soft tissue injuries eg ligament sprains and muscle strains, bone conditions eg knee arthritis, Osgood Schlatters, and biomechanical dysfunction eg Patellofemoral syndrome. It may even be referred from yoursciatica!

Knee pain has many causes and your knee treatment varies considerably depending on an accurate diagnosis. Treatment can involve simple knee mobilisation techniques, massage, taping, stretches or strengthening exercises all the way through to a thorough rehabilitation protocol post knee reconstruction or knee replacement.

Please consult your physiotherapist or doctor for the most accurate diagnosis and best treatment for your knee pain.

cause

Knee pain is an extremely common complaint, and there are many causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have knee pain, some common causes include:

  • Knee Arthritis
    Arthritis is among the most common causes of knee pain, and there are many treatments available.
  • Ligament Injuries
    Ligament injuries commonly occur during athletic activities and can cause discomfort and instability.

    • Anterior Cruciate Ligament (ACL) Injury
    • Posterior Cruciate Ligament (PCL) Injury
    • Medial Collateral Ligament (MCL) Injury
    • Lateral Collateral Ligament (LCL) Injury
  • Cartilage Injuries | Meniscal Tear
    Cartilagetears are seen in young and old patients alike, and are also an extremely common cause of knee pain.

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  • Patellar Tendonitis
    Tendonitis around the joint is most commonly of the patellar tendon, the large tendon over the front of the knee.
  • Chondromalacia Patella
    Chondromalacia causes knee pain under the kneecap and is due to softening of the cartilage. It is most common in younger patients (15-35 years old).
  • Dislocating Kneecap
    A dislocating kneecapcauses acute symptoms during the dislocation, but can also lead to chronic knee pain.
  • Baker's Cyst
    A Baker's cyst is swelling in the back of the joint, and is usually a sign of another underlying problem such as a meniscus tear.
  • Bursitis
    The most common bursa affected around the joint is just above the kneecap. This is most common in people who kneel for work, such as gardeners or carpetlayers.
  • Plica Syndrome
    Plica syndrome is an uncommon cause of knee pain, and can be difficult to diagnose. The diagnosis is usually made at the time of arthroscopy.
  • Osgood-Schlatter Disease
    Osgood-Schlatter disease is a condition seen in adolescents and is due to irritation of the growth plate just at the front of the joint.
  • Osteochondritis Dissecans
    Osteochondritis dissecans (OCD) is another condition seen in adolescents due to the growth of the bone around the joint.
  • Gout
    Gout is an uncommon cause of knee pain. However, in patients who have a diagnosis of gout, it must be considered as a cause for new onset knee pain.

When do you need to call your doctor about your knee pain?
If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of knee pain must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

    • Inability to walk comfortably on the affected side
    • Injury that causes deformity around the joint
    • Knee pain that occurs at night or while resting
    • Knee pain that persists beyond a few days
    • Locking (inability to bend) the knee
    • Swelling of the joint or the calf area
    • Signs of an infection, including fever, redness, warmth
    • Any other unusual symptoms

Symptoms and Diagnosis

Here are some of the common knee pain symptoms that are experienced by patients, and what these symptoms may mean about the cause of your knee pain.

Location of Pain:

  • Front of Knee:Pain over the front of the knee is most commonly related to the knee cap.
  • Inside of Knee:Pain on the inside, or medial side, of the knee is commonly caused by medial meniscus tears, MCL injuries, and arthritis.
  • Outside of Knee:Pain on the outside of the knee, or lateral side, is commonly caused by lateral meniscus tears, LCL injuries, IT band tendonitis, and arthritis.
  • Back of Knee:Pain in the back of the knee can be due to the collection of fluid, called a Baker's Cyst.

Timing of Pain:

  • While going down stairs:Pain while walking down steps is very commonly associated with kneecap problems, such as chondromalacia.

  • Morning pain:Pain after first waking in the morning that quickly resolves with gentle activity is typical of early arthritis.

Swelling:

Swelling of the knee is common with several different knee problems. When there is an effusion immediately after a knee injury, a possible cause is severe injury to an internal joint structure, like the anterior cruciate ligament or a fracture of the top of the shin bone.

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When swelling develops gradually over hours to days after an injury, it is likely to be something less severe, like a tear of the meniscus or a ligament sprain.

Swelling that occurs without the presence of a known injury can be due to osteoarthritis(common), gout (less common),inflammatory arthritis, or a joint infection(uncommon).

Mobility:

Mobility of the knee can be affected by a number of common conditions. If mobility is chronically limited, often the cause is arthritis. When the surface of the joint becomes irregular as a result of the arthritis, the mobility of the joint may become limited.

If the mobility is limited after an acute injury, there is likely swelling limiting the motion, or a torn structure that is limiting the mobility.

Instability/Giving Way:

The stability of the knee is provided by the ligaments that connect the shin bone (tibia) to the thigh bone (femur). When the ligaments are stretched or torn, the knee may feel as though it is giving way beneath the patient. A sensation that the knee may give out from beneath you is a common symptom of ligament injury.

Popping/Clicking/Crunching/Grinding:

Popping and snapping within the knee is common, and often not a symptom of any particular problem. When the pops are painless, there is usually no problem, but painful pops and snaps should be evaluated by your doctor. A pop is often heard or felt during an injury when a ligament, such as the ACL, is torn.

Grinding or crunching is a common symptom of cartilage problems. If the cartilage is damaged -- a condition called chondromalacia -- a crunching sensation is often felt by placing the hand over the kneecap and bending the knee. A similar grinding sensation may be felt with knee arthritis.

Locking:

Locking is a symptom that occurs when a patient cannot bend or straighten their knee. The locking can either be due to something physically blocking motion of the knee, or by pain preventing normal knee motion.

One way to determine if there is something physically blocking knee motion is to inject the knee with a numbing medication. After the medication has taken effect, you can attempt to bend the knee to determine if pain was blocking the motion or if there is a structure, such as a torn meniscus, that is blocking normal motion.

How do physicians diagnose knee pain?

A health-care professional will begin by asking questions related to the person's general health and then specifically to the nature of the knee pain (how long, how severe, does anything make it feel better or worse, etc.).

Next, an examination of the knee will be performed. This will include bending the knee through the full range of motion, checking for stability of the ligaments, and evaluating for any tenderness and swelling. It is often helpful to compare the results of the examination of the painful knee with the other knee. Frequently, this is all that is required to make a diagnosis and start treatment. In several research studies, it has been found that an experienced examiner is as reliable as X-ray examination.

 Knee Pain  treatment

1) Exercise

Once upon a time people were told that exercise made arthritis worse.  Nothing could be further from the truth.  Studies have consistently shown that one of the best knee arthritis treatment options is exercise. Ideally you want a combination of aerobic exercises like swimming and cycling combined with strengthening and movement exercises.

If you are a keen runner and suffer from arthritis,  its best to avoid hard running surfaces like pavements.  Instead, opt for a treadmill, cross trainer, or grass

2) Knee Braces

Knee braces can be worn to help stabilise the knee and reduce the pressure going through the knee joint. They are really good if the knee is feeling weak and wobbly.

3) Heat/Ice

Heat: warmth to an arthritic joint can be very soothing and is a lovely, natural knee pain treatment. The heat sensation helps to block out any pain sensations, and it also helps increase blood flow to the area which helps bring in all the chemicals and nutrients that the joint needs whilst at the same time taking away the waste products that can be contributing to the knee pain. Get a hot water bottle (ensuring it has a fluffy cover) on or a towel wrapped around it and place it on the knee for about 15-20 minutes

Ice: ice can be a really useful knee arthritis treatment tool to help reduce arthritis pain and swelling. Click the link to find out how to safely and effectively use ice or visit the Ice Wraps section for the best ways to apply ice

4) Keep Moving

Joints need movement. The knee joint contains fluid which works to lubricate the joint – think of it like the oil in your car keeping everything moving smoothly. The fluid is pumped into the joint with movement of the knee.

5) Acupuncture

There have been a number of studies which show that acupuncture can be a really useful arthritis knee treatment option. I have definitely had success with it myself. However, I personally believe that acupuncture is most useful in the short term to help relieve pain to enable you to do exercises to build up the strength and flexibility of your muscles as the long term solution

6) Weight Loss & Diet

Research has shown us that a 5% to 10% reduction of body weight can dramatically reduce knee pain and improve your ability to exercise. There are also certain foods that it is worth avoiding with arthritis as well as some that can help.  By making good food choices, you can help reduce inflammation and pain.

8) Walking Aids

Sometimes people find it helpful to use a stick or crutches. A stick doesn’t really take any weight off the knee but it does help us to balance. Crutches can be used to reduce how much weight is going through the knee when we walk.

If you are using just one stick or crutch, always use it on the opposite side to where the pain is eg if it's your left knee that is sore, hold the stick in your right hand. The reason for this is that when we walk normally we swing our opposite arm with our opposite leg (think of the army marching). This is the most efficient way for our body to move, so we want to mimic that when using a walking aid.

10) Pacing

Pace your activities through the day – don’t try and do all the strenuous jobs at once. Alternate between physical activities and more gentle ones. Keep using your knee, but rest it when it becomes painful. This is a very simple knee arthritis treatment option, but can be very effective.

11) Footwear

Wear shoes with low heels and soft cushioned soles. High heeled shoes change the way the forces act on the knee putting increased pressure on the knee joint, so avoid! Cushioned soles will help reduce the forces going through the knee by acting as shock absorbers.

12) Stairs

Arthritis sufferers often complain of pain when going up and down the stairs.  Use the hand rail to take some of the weight off your knees. Doing one step at a time can also reduce the pain - the most comfortable way is to lead with your good leg on the way up, and your bad leg on the way down.  This is a really simple knee arthritis treatment but can make a big difference in day to day life.

Medication for Arthritis

lots of pills on a white background

 lots of pills on a white background

1) Pain Relief

This may be over-the-counter treatment or prescription medications. I know a lot of people don’t like taking pills but they can be really useful. It is much better to take pain relief short term so that you can do your arthritis knee exercise programme than it is to battle through pain while your knee gets weaker and more painful. This is one of the most important knee arthritis treatment options available.

2) Anti-Inflammatory Medication

The ones most commonly used for knee arthritis treatment are Non-Steroidal Anti-Inflammatory Drugs (NSAID). Some are available over the counter eg ibuprofen and stronger ones are available on prescription. NSAIDs work by reducing swelling and pain.

2-Z

3) Injections

There are 2 types on injections that can be used for knee arthritis treatment.
Corticosteroid injections are a mixture of local anaesthetic and steroid that is injected into the knee to help decrease arthritis knee pain and swelling.
Joint lubricant injections, such as synvisc, involve injecting a natural gel-like substance found in normal joints into the knee to help lubricate it.

Physical Therapy: Knee Exercises

Quad Sets3-Z

Injured knee is straight. Flex foot up, push back of knee into bed and tighten the muscles on top of the thigh. Hold for 5 seconds and relax.
Straight Leg Raises

4-Z

Injured knee is straight. Flex foot up, tighten muscles on top of thigh and slowly raise leg off bed approximately 4-6 inches. Hold for 5 seconds and slowly return to starting position.
Short Arc Quads

5-Z

Place rolled towel or pillow under injured knee. Slowly raise the foot until the knee is straight. Hold for 5 seconds and slowly return to starting position.
Hip/knee Flexion and Extension

6-Z

Injured knee is straight. Slowly slide foot of injured knee back towards buttock, bending the knee and hip. Hold for 5 seconds and slowly return to starting position.
Quad Sets with Stool

7-D
Injured knee on stool or chair. Flex foot up, pus back of knee down and tighten muscles on top of the thigh. Hold for 5 seconds and relax.
Sitting Knee Flexion

8-D

Sit on chair with injured knee slightly bent. Slowly bend injured knee back and at the same time, slide buttock forward to edge of chair and end knee further back. Hold for 5 seconds and slowly return to starting position.