All You Need to Know About Knee Pain

The knee copes with a great deal of forceful impact. Hence, knee pain is a common complaint that affects people of all ages. With today’s increasingly active society, the cases of knee problems are increasing. Knee pain may result from an acute injury, an overuse injury, or underlying medical conditions (e.g., arthritis, pseudogout).

Knee pain can be localized to a particular area of the knee or be diffuse throughout the knee. Physical restrictions often accompany it.

Treatment of knee pain will vary depending on the underlying cause. Most cases of minor knee pain will respond to self-care measures. While the prognosis is usually promising, severe knee pain may require surgery or other interventions.

Know thy knee

The knee is the largest joint in the body. It comes in three parts:

  • Medial compartment (the inner part of the knee)
  • Lateral compartment (the outer part of the knee)
  • Patellofemoral compartment (the front of the knee between the thighbone and kneecap)

The primary function of the knee is to bear body weight as well as bend, straighten, twist, and rotate. It also flexes up to 135 degrees and extends to 0 degrees. To perform these actions, the knee relies on an amalgamate of bones, ligaments, tendons, and cartilage.

Bones

The femur (thighbone), tibia (shinbone), and patella (kneecap) make up the knee bones. The knee joint keeps these bones in position.

The femur joins the tibia, constituting the primary knee joint. The patella rides along the front of the femur and connects the femur to form a third joint, termed patellofemoral joint.

Femur (thighbone)

The femur is the upper bone of the leg. The head of the femur forms a ball-and-socket joint with the hip at the acetabulum, being held in place by surrounding ligaments. The neck of the femur connects the head and shaft at a 125˙ angle, which is ideal for walking. Internally, the femur has arcs of bone (trabeculae) that efficiently transmit pressure and resist stress. The femur is capable of resisting compression forces of 1,800-2,500 pounds.

Tibia (shinbone)

The tibia bone is an inner lower leg bone. It constitutes the inner protuberance of the ankle below and the lower half of the knee joint above. The upper part consists of two flat-topped condyles (prominences) that articulate with the condyles of the femur above. The attachment of the ligament of the patella to the tibial tuberosity in front completes the knee joint.

Patella (kneecap)

The patella is the kneecap portion that rides along the front of the femur. It is the thick, flat, triangular sesamoid bone that resides within the quadriceps tendon. It sits on top of the anterior surface of the femoral condyles.

The primary function of the patella is to facilitate the smooth movement of the knee extension and flexion. It also protects the anterior surface of the knee joint.

Ligaments

There are four primary ligaments in the knee, which connect the femur to the tibia and hold it together. It includes:

Anterior cruciate ligament (ACL)

The anterior cruciate ligament (ACL) is a cruciate ligament that runs through the front of your knee joint and connects your shinbone to the thighbone. It controls forward movement and rotation of the tibia. It also helps stabilize the knee joint by limiting excessive motion.

Posterior cruciate ligament (PCL)

The posterior cruciate ligament (PCL) is located at the back of the knee, where it connects the tibia to the femur. This configuration allows the PCL to control the backward movement of the tibia. It lies deep within the knee joint, where it stabilizes the articulating bones, particularly the femur and tibia, during movement. The PCL prevents the femur from sliding off the edge of the tibia and also prevents the tibia from displacing posterior to the femur.

During knee joint movement, the PCL rotates, such as its anterolateral section stretches in knee flexion but not in knee extension, and the posteromedial section stretches in extension rather than flexion.

Medial collateral ligament (MCL)

The medial collateral ligament (MCL) is located on the medial (inner) side of the knee joint. Its principal function is to resist outward turning forces on the knee and to give stability to the inner knee.

Lateral collateral ligament (LCL)

The lateral collateral ligament (LCL) is located on the lateral (outer) side of the knee. It gives stability to the outer knee.

Tendons

Tendons are fibrous bands that connect muscles to bones. There are two essential knee tendons: quadriceps tendon and patellar tendon.

Quadriceps tendon

The quadriceps tendon is a thick, rigid tendon just above your kneecap. It connects the quadriceps muscles in the front of the thigh to the patella. It is part of the extensor mechanism that allows the straightening of the knee. When the quadriceps muscle contracts, force is transmitted via the quadriceps tendon, across the patella, through the patellar tendon, and the knee is straightened.

Patellar tendon

The patellar tendon joins the patella to the tibia. It is a crucial part of the extensor mechanism of the lower extremity. It works with the quadriceps muscles at the front of the thigh to extend your knee so that you can run, jump, and kick.

Cartilage

The knee joint has two different types of cartilage: articular cartilage and meniscus.

Articular cartilage

The articular cartilage forms a smooth layer that covers the bone ends. More specifically, it covers the end of the femur, the top of the tibia, and the back of the patella.

Meniscus

The meniscus acts as a shock absorber between the bones. It sits between the bone ends to cushion the knee joints to allow it to glide smoothly across each other as you bend or straighten your leg. Each meniscus evenly loads the surface during weight-bearing and also aids in disbursing joint fluid for joint lubrication.

Synovial membrane

The synovial membrane of the knee is located in the inner aspect of the knee capsule. It produces synovial fluid to facilitate the lubrication of the knee joint. It also lubricates the articular ends of the femur, tibia, and patella.

Bursae

The knee bursae are the fluid-filled sacs that surround the outside of the knee joint. It is filled with synovial fluid that allows tendons to glides smoothly over the joint.

Prepatellar bursae

The prepatellar bursa lies at the tip of the knee, in front of the patella. It is a superficial bursa layered with a thin synovial lining.

Pes anserine bursae

The anserine bursa is a submuscular bursa located deep within the pes anserinus approximately 2 inches below the joint along the inner medial side of the knee.

Infrapatellar bursae

The infrapatellar bursa is located underneath the patellar.

Muscles

The muscles of the knee include the hamstrings, quadriceps, and calf muscles. These muscles work in clusters to stabilize, flex, and extend the knee.

Quadriceps

The quadriceps are four muscles that extend along the front of the thigh. They work together to extend (straighten) the knee.

Hamstrings

The hamstrings are three muscles located at the back of the thigh. They work together to flex the leg and bend the knee.

Calf muscles

The gastrocnemius muscle extends from the outer part of the femur via the Achilles tendon to the calcaneus of the heel. It forms the posterior muscular wall of the knee and acts as a flexor of the knee.

Symptoms

Knee pain can be classified into sudden (acute) or long-term (chronic). Acute knee pain may be due to an acute injury or infection. Chronic knee pain is often from inflammation (e.g., arthritis) or injuries but can also be caused by infection. The type and location of knee pain may vary depending on the underlying cause.

Causes of knee pain Severity Location of pain
Acute knee pain
Runner’s knee Dull, aching pain Around or behind the kneecap
ACL injury Intense pain with loud “pop.” Center of the knee
PCL injury Sharp or dull pain Deep inside the knee
MCL injury Intense pain with loud “pop.” Inside edge of the knee
LCL injury Mild or severe Outside of the knee
Prepatellar bursitis Pain with activity In front of the kneecap
Pes anserine bursitis Inner knee pain when bending Inside the knee, just below the joint
Infrapatellar bursitis Pain and inflammation Below the kneecap
Septic bursitis Potentially dangerous Immediately above the knee
Meniscal injuries Painful especially when touched Well-localized
Fracture Severe pain with deformity In front of the knee
Tendon rupture Disabling pain Directly under the kneecap
Kneecap dislocation Severe pain with a popping sensation In front of the knee
Chronic knee pain
Knee osteoarthritis Pain with activity Around the joint
Patellar tendinitis Pain only with activity Between kneecap and where the tendon attaches to the shinbone (tibia)
Popliteal tendinopathy Acute onset of pain On the outside of the knee
Patellofemoral pain syndrome (PFPS) Gradual pain On the front of the knee, around, and under the kneecap
Iliotibial pain syndrome (ITBS) Nagging pain On the side of the knee
Osgood-Schlatter disease Painful bony bump In the front lower part of the knee
Baker’s cyst Bulge and tightness Behind the knee

Causes of acute or sudden knee pain

Acute knee pain may result from a sudden injury (e.g., torn ligament) or infection (e.g., septic bursitis).

Runner’s knee

Albeit its name, the runner’s knee doesn’t only happen to runners. Also, it isn’t a specific injury. Instead, the runner’s knee is a broad term to describe the repetitive strain injuries that cause the cartilage in the kneecap to wear down. When the cartilage is depleted, the knee bones rub against each other.

Runner’s knee commonly results from motion or mobility issues in the hip or low back. Or it can be due to instability as a consequence of a lack of core engagement. Athletes are more vulnerable because running, squatting, and jumping exerts more force on the knee.

Symptoms of runner’s knee include:

  • Dull, aching pain behind the kneecap
  • The knee gives out or buckles randomly
  • Weakness in the knee and leg
  • Crackling or grinding sensation when the knee bends
  • Popping sound
  • Restricted movement in the knee and leg

It generally worsens when you run uphill or downhill (or up and down the stairs). In severe cases, the affected knee may swell.

Ligament injury

Anterior cruciate ligament injury

The anterior cruciate ligament (ACL) is very susceptible to injury. An ACL injury is usually a sports-related injury due to a sudden twisting motion and abrupt stops. Athletes who participate in high-impact sports like soccer and basketball are more likely to injure their ACL.

An ACL injury may occur concurrently with damage to other structures in the knee, such as the meniscus, articular cartilage, or other ligaments.

You may hear a popping sound when you tear your ACL. Afterward, your knee may hurt and swell up. You might have trouble moving your knee and feel pain when you walk. Your knee may also give way or become unstable.

Posterior cruciate ligament injury

The posterior cruciate ligament (PCL) is more rigid than the ACL and is much less commonly injured.

PCL injury may occur if you take a hard blow to the front of your knee while the knee is bent, such as in car accidents and contact sports. This is why a PCL injury is frequently linked to other ligament and bone injuries in the knee.

Symptoms of PCL injury include:

  • Knee pain and swelling
  • Stiffness in the knee when bending
  • A weakness of the knee
  • Trouble walking

Medial collateral ligament injury

Medial collateral ligament (MCL) injuries are commonly caused by a direct blow to the outside of the knee, such as in contact sports. It may happen when there has been excessive twisting and tearing of the MCL.

Symptoms of an MCL injury include:

  • Immediate swelling and pain
  • Instability while standing or walking
  • Locking knees
  • A popping sound upon impact

Lateral collateral ligament injury

A lateral collateral ligament (LCL) injury could include spraining, straining, and tearing any part of that ligament. Because of its location, injury the LCL commonly occurs along with other knee ligaments.

The primary cause of LCL injuries is blunt-force trauma to the inside of the knee. This exerts pressure on the outside of the knee and causes the LCL to tear or stretch.

If the ligament injury is mild, you may not experience any symptoms at all. For an LCL tear, your symptoms include:

  • Pain or ache on the outside of the knee
  • Swelling on the outer part of the knee
  • Instability of the knee joint
  • Stiffness that can cause locking of the knee

Knee bursitis

Knee bursitis is inflammation of a bursa in the knee joint. It can become swollen as the bursa fills with blood from injury or overuse. Bursitis of the knee commonly occurs at the front of the kneecap (patellar bursitis) and on the inside of the knee (anserine bursitis). Symptoms include swelling, pain, warmth, stiffness, and limited mobility of the knee.

Prepatellar bursitis

Inflammation of the prepatellar bursa can occur from direct blow or irritation to the front of the kneecap. This may happen when maintaining a prolonged or constant kneeling position, whereby the prepatellar bursa is irritated. Athletes who participate in contact sports, such as basketball, wrestling, or football, are at higher risk for the condition. Other people who are susceptible to the condition include those with rheumatoid arthritis or bacterial infection.

Prepatellar bursitis occurs in people who work o their knees. It’s often referred to as the:

  • Housemaid’s knee
  • Carpet layer’s knee
  • Roofer’s knee
  • Preacher’s knee
  • Plumber’s knee
  • Gardener’s knee

Pes anserine bursitis

Inflammation of the pes anserine bursa is known as pes anserine bursitis.

Symptoms include:

  • Pain in the inner knee when bent or straightened, such as when going up or down the stairs
  • Weakness or knee-buckling
  • Swelling over the inner side of the knee
  • A decrease in knee range of motion

Infrapatellar bursitis

Inflammation of the infrapatellar bursa is termed infrapatellar bursitis. Symptoms may include knee pain, redness, and swelling just below the kneecap. It could be complicated by patellar tendonitis.

It may be brought on by frequent kneeling, crawling, squatting, running, or jumping. Other conditions that mimic infrapatellar bursitis include patellar tendonitis and prepatellar bursitis.

Septic bursitis

When a bursa becomes infected, it is called septic bursitis. It is a potentially dangerous medical condition, and immediate medical attention is necessary.

If a bursa is infected, you may experience the following symptoms:

  • Joint swelling and tenderness
  • Skin that is warm to the touch
  • Skin redness
  • Fever
  • A general feeling of being sick

In the knee, septic bursitis is most likely to occur in the prepatellar bursa at the kneecap.

Meniscal injuries

A meniscus injury occurs when you damage or tear the cartilage between the bones of the knee joint. It may happen with the shearing forces of rotation that are applied to the knee during abrupt motions while bearing full weight on it.

Meniscal injuries are especially common in sports requiring reactive movements. However, it can also happen while doing something as mundane as climbing stairs or getting up from a squat too abruptly. As you age, your meniscus weakens and degenerates and is more likely to tear with any twisting motion.

Common symptoms of a meniscal tear include:

  • Sharp pain in the knee, especially when twisting or rotating
  • A popping sensation upon injury
  • Knee feels locked in a particular position
  • Clicking or grinding through its range of motion
  • A piece of the meniscus tears off and float in the knee joint
  • The knee may give way suddenly
  • Stiffness in the knee or difficulty moving it over its full range of motion
  • Swelling and weakness
  • Difficulty bending and straightening your knee fully
  • Sense of imbalance

At first, the injury might not hurt. You might even push through the injury. But after the inflammation sets in, the knee can become more painful.

Fracture

A knee fracture is a break/crack in one or more of the bones in the knee joint. It may be merely a bend or small crack in the knee bone, or the bone may shatter or break into pieces. Some fractures may protrude out through the skin.

Knee fractures can happen in many ways, such as car accidents, falls, direct hits to the knee, or sports activities.

Symptoms include:

  • Pain, bruising, tenderness, or swelling that happens right after the injury
  • The pain made worse by movement
  • Pain when the area is touched or when you put weight on the affected leg
  • Trouble bending the knee
  • A grating sensation when the affected leg is moved and the broken knee bones grind against each other
  • A change in the shape of the leg
  • Muscle spasms

Tendon rupture

Both the quadriceps tendon and patellar tendon are susceptible to rupture. A quadriceps tendon rupture typically occurs in middle-aged recreational athletes. On the other hand, patellar tendon rupture usually occurs in younger people who have had prior tendonitis or steroid injections to the knee.

Tendon rupture causes pain, especially when you try to kick or extend the knee. The kneecap is also often out of place either upward (with patellar tendon rupture) or downward (with quadriceps tendon rupture).

Kneecap dislocation

Kneecap dislocation happens when the kneecap (patella) slips out of position, usually outwards. The kneecap may also stay displaced, and you may be able to visualize the dislocation. The dislocation may compromise blood flow to the leg. You may have difficulty flexing or extending your knee.

Causes of chronic knee pain

Knee osteoarthritis

Pain in the back of the knee

Osteoarthritis is the most common type of arthritis in the knee. Otherwise known as degenerative arthritis, it’s a wear-and-tear condition that occurs when the cartilage breaks down over time. As a consequence, the cartilage becomes frayed and rough, and the space between the bone depletes. This can cause a bone to rub against adjacent bone and produce painful bone spurs.

Knee osteoarthritis causes inner knee pain while putting pressure on your joint, such as when walking up and down stairs or sitting down in a chair. In its extreme form, the menisci (cartilage) may be entirely eroded, and the femur may rub on the tibia bone-on-bone.

Symptoms of knee osteoarthritis include:

  • Pain that increases when you’re active, but gets a little better with rest
  • Stiffness in the knee, especially in the morning or after sitting for a while
  • Decrease in mobility, making it challenging to move around
  • The creaking, crackly sound when moving the knee
  • Swelling
  • Warm sensation in the knee joint

Tendinitis

Inflammation of the knee-tendon can occur in the front of the knee below the kneecap at the patellar tendon (patellar tendinitis) or in the back of the knee at the popliteal tendon (popliteal tendinitis).

Patellar tendinitis (Jumper’s knee or Runner’s knee)

Patellar tendinitis, also known as the runner’s knee or jumper’s knee, is an injury or inflammation of the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia).

It is most common in athletes who participate in sports that involve frequent running or jumping – such as volleyball or basketball. The repetitive stress on the knee creates tiny tears in the tendon that, over time, inflame and weaken the tendon.

Symptoms of patellar tendinitis include:

  • Localized pain at the base of your kneecap, especially as you jump or kneel
  • Swelling and burning sensation in the kneecap

It can interfere with daily activities, such as sitting or climbing stairs.

Popliteal tendinopathy

Popliteal tendinopathy, also known as the popliteal syndrome, refers to an overuse injury of the popliteal tendon.

Causes of popliteal tendinopathy include:

  • Overuse of the popliteus muscles
  • Chronic instability around the knee
  • Traumatic knee injury
  • Muscle imbalances in the lower limb
  • Incorrect exercise technique

Common symptoms of popliteal tendinopathy include:

  • Pain that begins on the outer aspect of the knee, which may also spread to the back of the knee
  • Pain when bending the knee from a fully straightened position
  • Pain when straightening the knee
  • Swelling and redness over the outer side of the knee
  • Weakness in the knee
  • Clicking sound

Patellofemoral pain syndrome (PFPS)

Pain on the FRONT of the knee

Patellofemoral pain syndrome (PFPS) refers to pain arising between the kneecap (patella) and the thighbone (femur).

This condition is common in:

  • Athletes
  • Young adults, especially those with a mal tracking of the kneecap
  • Older adults, especially those with underlying arthritis of the kneecap

Muscle imbalance, tightness, and misalignment of the legs usually cause this condition.

Common symptoms include:

  • Deep knee pain and stiffness
  • Occasional “buckling,” meaning your knee is suddenly unable to bear the weight

As the condition worsens, the softening and breaking down of the kneecap (patella) cartilage occurs, leading to chondromalacia patella. It may cause dull pain behind your kneecap when bending or straightening the knee.

Activities that might trigger pain include:

  • Climbing up or down hills/stairs
  • Straightening the knee while it is bearing weight

Iliotibial band syndrome (ITBS)

Pain on the SIDE of the knee

Iliotibial band syndrome (ITBS) happens when the iliotibial band (a fibrous ligament that extends from the outside of the pelvic bone to the tibia) becomes so tight that it rubs against the bottom outer portion of the femur (the lateral femoral condyle).

Cyclists and distance runners are especially susceptible to ITBS. They usually complain of outside knee pain that typically comes on 15 minutes into an activity. Symptoms will improve with rest.

Osgood-Schlatter Disease

Knee pain in adolescent athletes

Osgood-Schlatter disease occurs in teenage athletes where repetitive extension of the knee causes inflammation and injury of the tibial tubercle (the bony protrusion at the top of the shin, just below the kneecap). It happens when you are young when the knee structures are still changing. It is a self-limiting condition that usually resolves as the tibial tubercle stops growing with the adolescence (at about age 17 in males and age 15 in females).

Children suffering from this syndrome typically experience pain at the tibial tubercle. The pain is usually worse when the leg is extended. The tibial tubercle may be tender to touch and gradually begins to protrude more because the chronic inflammation triggers the bone to grow. It can result in a painful spur below the knee, where a kneecap tendon connects to the skin. The knee pain may come and go.

Baker’s cyst

Pressure in the back of the knee

Baker’s cyst is a fluid-filled sac behind the knee as a result of arthritis or an injury. It may not be noticeable initially, as small cysts do not typically cause pain. However, as the cyst grows, it may shift the surrounding muscles or exert pressure on tendons and nerves, causing pain.

Symptoms include:

  • Pressure in the back of the knee
  • Tingling sensation
  • Swelling behind your knee
  • Stiffness and trouble flexing your knee

These symptoms get worse when you’re physically active. If the cyst bursts, you’ll feel a sharp pain in your knee.

Underlying conditions that cause knee pain

Underlying medical conditions – including arthritis, gout, pseudogout, and infections – can cause knee pain.  

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a condition that occurs when your immune system attacks and damages the synovial membrane that lines the joints. The membrane becomes inflamed, causing pain and restricted movement of the affected joint.

It usually affects the joints in the feet and hands, but can also affect the knees and other joints. Symptoms may not show up in the knees until much later, even years after diagnosis. The symptoms are often symmetrical – this means both knees could be affected. Common symptoms include:

  • Pain, tenderness, or discomfort that gets worse when you stand, walk, or exercise
  • Stiffness or locking of the knee joint, especially in the morning or during cold weather
  • Warmth around the joint
  • Weakness or instability of the knee joint when you exert weight on it
  • Difficulty moving or straightening your knee joint
  • Cracking, clicking or popping noises when the joint moves

Untreated RA can cause chronic inflammation that can ultimately damage the cartilage and ligaments of the knee joint. As the cartilage wears away, the bones start to grind against each other. This may result in the wearing down of bones, making it difficult to walk or stand without pain or weakness.

Gout in knee

Gout is a type of arthritis that occurs when uric acid crystals buildup in the joint. While gout is most common in the big toe, it can develop in any joint, including the knee. The uric acid crystals can cause sudden bouts of pain, tenderness, and swelling.

When gout affects the knee, everyday movements such as standing or walking can be painful or uncomfortable. While there’s no cure for gout, several treatments can help prevent flare-ups and mitigate painful symptoms.

Pain and discomfort are the main symptoms of gout in the knee. The gout flare-ups are unpredictable. You might go weeks or months without any symptoms, only to wake up with burning pain in your knee. Over time, these flare-ups may persist longer than previous episodes. Other symptoms include tenderness, redness, swelling, warmth, and stiffness.

Pseudogout

Pseudogout is a type of arthritis characterized by sudden, painful swelling in the joints. The knee is the most commonly affected joint.

“Pseudogout” was coined for its similarity to gout. Both conditions are caused by crystal deposits, although the type of crystal differs — pseudogout results from the accumulation of calcium pyrophosphate (CPP) crystals within the cartilage. When the CPP crystals are later released into the joint fluid, it triggers the acute symptoms of pseudogout.

During a pseudogout flare-up in the knee, the joint is usually swollen, warm, tender, and severely painful. The skin around the joint may also turn red or purple.

Infection

There are many types of knee infections. The most common examples include cellulitis and septic arthritis.

Cellulitis

Cellulitis is a severe bacterial skin infection that can affect the knee joint. Symptoms include redness in the infected area and skin that feels hot and tender to the touch.

It can be life-threatening if you do not receive immediate treatment. Pay close attention to any scrapes or bruises, especially if they do not seem to be healing.  

Septic arthritis (infectious arthritis)

Septic arthritis is an infection in the joints. With septic arthritis in the knee, the knee joint can become swollen, painful, red, and tender. You may also have a fever.

Septic arthritis can rapidly cause extensive damage to the knee cartilage. See your doctor immediately to treat it as soon as possible.

Risk factors

Several underlying factors can increase your risk of knee pain.

Biomechanics

The knee joint is used frequently throughout the day. It also has complex biomechanics. Any subtle changes in the movement of the knee joint (leg-length difference, change in walking style due to back problems) can cause pain and injuries.

Excess weight

Being obese or overweight exerts stress on your knee joints, even during mundane activities such as walking or climbing stairs. It also increases the risk of knee osteoarthritis by accelerating the breakdown of knee joint cartilage.

Lack of muscle flexibility or strength

A lack of muscle flexibility and strength can increase the risk of knee injuries. Strengthen your muscles to help stabilize and protect your joints. Flexibility exercises can also help you achieve a full range of motion.

Certain sports or occupations

Certain sports such as alpine skiing exert extreme stress on the knees. The rigid ski boots and the pivots and repeated pounding on your knees can increase your risk of a knee injury. Other sports that are susceptible to knee injury include basketball, running, and soccer.

Jobs that exert repetitive stress on the knees, such as farming or carpet laying, also can increase your risk of knee pain.

Previous injury

Having a prior knee injury makes it more prone to re-injury.

Overuse

Overuse during sports that require repetitive motions (e.g., skiing, jogging) or work conditions (prolonged periods of kneeling) can cause the breakdown of knee cartilage.

When to see a doctor

Call your doctor if you:

  • Have significant knee swelling
  • Are unable to bear weight on your knee or feel as if your knee is unstable (giving out)
  • Experience unbearable pain that wakes you or does not improve with rest
  • Are unable to flex, bend, or extend your knee fully
  • Have visible deformity in your knee or leg
  • Have large puncture wounds or drainage
  • Have severe knee pain associated with injury

An apparent knee injury caused by sudden trauma, such as from a road accident or a fall, may warrant immediate medical attention.

Diagnosis

Medical history

A healthcare professional will begin by asking questions related to your 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.).  

Physical exam

Next, a physical examination of the knee may be performed.

During the physical exam, your doctor may:

  • Inspect your knee for any pain, tenderness, swelling, warmth, and visible bruising
  • Push or pull the knee joint to evaluate the stability and integrity of the knee structures
  • Bend the lower leg through the full range of motion

Compare the examination of the painful knee with the other knee.

Imaging tests

Your doctor may order imaging tests such as:

X-ray

X-ray of the knee can help detect bone fractures and degenerative changes in the knee.

Computerized tomography (CT) scan

Rarely, the doctor may request a CT scan of the knee to precisely define a deformity or fracture. CT scans can be used to diagnose bone problems and minor fractures. A special kind of CT scan can also accurately identify gout even when the joint is not inflamed.

Ultrasound

Ultrasound technology utilizes sound waves to produce real-time images of the soft tissue structures in and around your knee.

Magnetic resonance imaging (MRI)

MRI uses magnets and radio waves to construct 3D images of the inside of the soft tissues, revealing injuries to structures such as ligaments, cartilage, tendons, and muscles.

Arthrocentesis (removal of joint fluid)

Arthrocentesis is a procedure in which a small amount of fluid is aspirated from the knee joint with a needle and sent to a laboratory for evaluation. This diagnostic procedure is ordered if knee infection is suspected. It can also distinguish gout from other forms of arthritis. Furthermore, if there is a collection of blood trapped in the joint, removing the fluid can help relieve pain.

Prevention

Although knee pain is not always preventable, the following suggestions may help forestall knee injuries and overuse.

Stay physically fit

Maintaining a healthy weight can reduce strain on your knee joints and protect it from injury. It can also help prevent unnecessary wear-and-tear damage.

Weight loss can ease the pressure on your knee joints. Furthermore, fat loss can reduce inflammation. Keep the weight at bay, and you’re much less likely to get knee arthritis later in life.

Be in shape to play your sport

Warm-up before any workout to get the blood flowing and to loosen tense knee muscles. It generally involves low-impact light activity that would not overtax the body. Specific knee warmups should be combined with a full-body warmup to make sure that unready muscles do not exert others to overcompensate during the warmup, a situation that can trigger injury. Once your warm-up is complete, move on to stretching.

Stretch before and after working out. Numerous simple knee stretches don’t require special equipment. Remember to stretch all other areas of the body to make sure there are no imbalances as you begin your sport.

Exercise wisely

Selecting the proper exercises can protect the knees from potential issues. Exercises can keep the knee joints healthy, as long as you don’t overdo the same motion, or overstress the knee joint.

High-impact activities that involve lots of jumping, bending, kneeling, and running should be avoided, as should step exercises. Switch to low-impact exercises instead.

Some of the best full-body workouts involve minimal pressure on the knees. Swimming and cycling are both excellent sources of cardio exercise, and many gyms have low-impact devices such as the rowing machines.

Avoid drastic changes in intensity during or between workouts. Abruptly going from low intensity to high intensity can exert undue pressure on the knees, and high intensity to low intensity can cause muscle weakening. Gradual increases and decreases in intensity level should be the rule-of-thumb.

Respect and listen to your body. If your knee hurts, change what you’re doing. 

Get active, stay flexible

Because weak knee muscles are prone to injuries, you’ll benefit from building up your hamstrings and quadriceps, which support your knees. Flexibility and strength training can help the muscles around your knees to work together seamlessly.

Protect the knee

You can wear a knee brace during exercises to stabilize the knee if you have chronic knee issues. These braces confer additional cushioning against potential falls, and their support can allow you to get your share of physical activity without aggravating existing knee problems. Speak to your doctor before purchasing a knee brace.

Proper posture

Address your posture to minimize knee strain:

  • Sit on a pillow to raise your seating level, if necessary
  • Avoid low chairs and couches that you “sink” into
  • Adopt a good sitting posture, without slouching or leaning

Use proper shoes

Proper footwear goes a long way in protecting your knees. You should also consider arch supports and shoe inserts for additional knee protection.

Treatment

Treatment will vary, depending on the exact cause of your knee pain.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation. Over-the-counter options include ibuprofen (Motrin IB, Advil, etc.) and naproxen sodium (Naprosyn, Aleve, etc.).

Some people may also find relief by rubbing the affected knee with creams containing a numbing agent, such as lidocaine or capsaicin.

Physical therapy

Once the injury has healed slightly, your doctor or physical therapist may recommend strengthening and stretching exercises based on the specific condition that is causing your pain. The exercises may help strengthen and stabilize the muscles around the knees.

If you actively participate in sports, you may need conditioning exercises to correct movement patterns that may be affecting your knees and to establish proper technique during your sport. Physical therapists and coaches can keep you moving in the right direction.

Injections

Injecting medications directly into your knee joint might help in certain situations.

Corticosteroids

Corticosteroid injection directly into the knee joint can help ease inflammation in the knee and limit an arthritis flare. Their effectiveness may last up to a few months.

Lubricants (e.g., hyaluronic acid)

Lubricants are viscous fluid, similar to that in the knee joint. It can be injected into your knee, improve mobility, and ease the pain. Relief from lubrication shots may last up to six months.

Platelet-rich plasma (PRP)

PRP is made up of a concentration of various growth factors that reduce inflammation and facilitate healing. These types of injections work more effectively in people whose knee pain is caused by tendon tears, injury, or sprains.

Surgery

You may need surgical intervention if your knee pain is severe or chronic.

Arthroscopic surgery

Depending on your injury, your doctor may examine the joint damage using arthroscopic surgery. The surgeon inserts a narrow tube with a tiny fiber-optic camera through small incisions around the knee to view the internal structures. Arthroscopy may also be used to remove loose bone or cartilage pieces and reconstruct torn ligaments.

Partial knee replacement surgery

In partial knee replacement surgery, your surgeon replaces only the most damaged portion of your knee. Its replaced with a plastic or metal parts. The surgery can usually be performed with a small incision, so you’re likely to recover more quickly than you are with total knee replacement surgery.

Total knee replacement surgery

In a total knee replacement, your surgeon cuts away damaged bone and cartilage from your knee area. It’s then replaced with an artificial joint made of metal alloys, high-grade plastics, and polymers.

Self-care measures: PRICE

Most types of minor knee pain respond well to self-care measures. Standard self-care techniques for knee pain include protection, rest, ice, compression, and elevation – the mnemonic PRICE summarizes this regimen.

Protect

Wear proper protection for the activity at hand to avoid knee injuries, or at least keep the damage to a minimum. When driving, wear a seat belt to prevent knee-versus-dashboard injuries. When laying carpet or playing volleyball, you can protect your knees with kneepads.

Rest

Take a break from your daily activities to reduce repetitive strain on your knee, give the injury time to heal, and help prevent further injury. Avoid things that aggravate the pain, like squatting, lunging, or running for long periods.

Resting for a day or two may be all you need for a minor knee injury. More severe damage may require a longer recovery time.

However, do not stop all movement. Too much rest can lead to stiffness and, in time, muscle weakness, which can worsen knee pain. Instead, you should gently flex and straighten the knee several times a day to maintain a range of motion.

Ice and Heat

Ice can reduce pain, inflammation, and swelling. Apply a cold compress to the knee for 15 to 20 minutes two to three times a day following the onset of knee pain. Although ice therapy is generally safe, don’t use ice for longer than 20 minutes at a time because it may potentially damage your nerves and skin. Keep using it for 2 to 3 days or until the pain dissipated.

On the other hand, heat relaxes muscles and improves lubrication, leading to a reduction in stiffness. Use a heating pad to temporarily enhance mobility in the morning and reduce swelling later in the day.

For the first 72 hours after a knee injury, use a cold pack to ease swelling and numb pain. After that, you can incorporate heat for maximum pain relief.

Compression

Compression helps prevent swelling in damaged tissue and stabilize the knee alignment. Look for a compression bandage, straps, or brace that’s lightweight, breathable, and self-adhesive.

Wrap it around your knee snugly to ease swelling. It should be tight enough to support your knee without restricting circulation.

Elevation

To help reduce swelling and facilitate blood circulation, try elevating your injured leg on pillows or by sitting in a recliner. Ideally, you should keep the knee elevated above the heart level.

Alternative medicine

Arch supports or orthotics

Arch supports or orthotics can help to divert pressure away from the side of the painful knee. They may also help with the position of your feet.

Massage

Massage may help relieve knee pain. For a hassle-free relief, invest in an electric knee massager. It can provide powerful vibration massage, help reduce knee joint pain, swelling, and muscle stiffness.

Acupuncture

Acupuncture may help relieve knee pain caused by osteoarthritis and joint dysfunction. Electro-acupuncture is especially helpful in the treatment of knee osteoarthritis. It works by warming the meridians, remove wind and dampness, circulate blood, and qi to relieve swelling and pain.

One Response

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