Knee pain facts
- Knee pain is a common problem with many causes, from acute injuries to complications of medical conditions.
- Knee pain can be localized to a specific area of the knee or be diffuse throughout the knee.
- Knee pain is often accompanied by physical restriction.
- A thorough physical examination will usually establish the diagnosis of knee pain.
- The treatment of knee pain depends on the underlying cause.
- The prognosis of knee pain is usually good although it might require surgery or other interventions.
What is knee pain?
Knee pain is a common problem that can originate in any of the bony structures compromising the knee joint (femur, tibia, fibula), the kneecap (patella), or the ligaments and cartilage (meniscus) of the knee. Knee pain can be aggravated by exercise, affected by the surrounding muscles and their movements, and be triggered by other problems (such as a foot injury). Knee pain can affect people of all ages, and home remedies can be helpful unless it becomes severe.
Quick GuideExercises for Knee Osteoarthritis and Joint Pain
Your Knee Pain: Is It Chondromalacia?
Chondromalacia, technically termed chondromalacia patellae, is the most common cause of chronic knee pain. The condition is also called the patellofemoral syndrome.
What are knee pain symptoms and signs?
The location of the knee pain can vary depending on which structure is involved. With infection or an inflammatory process, the whole knee might be swollen and painful, while a torn meniscus or fracture of a bone gives symptoms only in one specific location. A Baker cyst will usually cause pain in the back of the knee.
The severity of the joint pain can vary, from a minor ache to a severe and disabling pain.
Some of the other signs and symptoms that accompany knee pain are
Knee pain can be divided into three major categories:
- Acute injury: such as a broken bone, torn ligament, or meniscal tear
- Medical conditions: arthritis, infections
- Chronic use/overuse conditions: osteoarthritis, patellar syndromes, tendinitis, and bursitis
Below is a list of some of the more common causes of knee pain. This is not an all-inclusive list but rather highlights a few common causes of knee pain in each of the above categories.
Acute knee injuries
Fractures: Direct trauma to the bony structure can cause one of the bones in the knee to break. This is usually a very obvious and painful knee injury. Most knee fractures are not only painful but will also interfere with the proper functioning of the knee (such as kneecap fracture) or make it very painful to bear weight (such as tibial plateau fracture). All fractures need immediate medical attention. Many fractures require significant force, and a thorough examination is performed to detect other injuries.
Ligament injuries: The most common injury is the ACL (anterior cruciate ligament) injury. This is often a sports-related injury due to a sudden stop and change in directions. The remaining ligaments (posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament) are injured less frequently.
Meniscus injuries: The menisci (medial and lateral) are made of cartilage and act as shock absorbers between bones in the knee. Twisting the knee can injure the meniscus.
Dislocation: The knee joint can be dislocated, which is a medical emergency that requires immediate attention. Knee dislocation can compromise blood flow to the leg and have other related problems. This injury often occurs during a motor-vehicle accident when the knee hits the dashboard.
What causes knee pain? (Continued)
Rheumatoid arthritis is an autoimmune condition that can affect any joint in the body. It can cause severe pain and disability, as well as swelling.
Gout is a form of arthritis that is most commonly found in the big toe, though it can also affect the knee. Gouttends to flare up and is extremely painful during the acute episodes. When there is no flare-up, the knee can be pain free.
With septic arthritis (infectious arthritis), the knee joint can become infected; this leads to pain, swelling, and fever. This condition requires antibiotics and drainage treatments as soon as possible.
Chronic use/overuse conditions
Patellar tendinitis is an inflammation of the tendons connecting the kneecap (patella) to the bone of the lower leg. Patellar tendinitis is a chronic condition often found in individuals repeating the same motion during exercise (such as runners and cyclists).
Patellofemoral pain syndrome is caused by degeneration or stress under the kneecap (patella) where it meets the thighbone (femur). Patellofemoral pain syndrome occurs in runners and cyclists.Osteoarthritis: A wearing down of cartilage of the joint due to use and age
What are risk factors for knee pain?
Biomechanics: The knee joint is complicated in its operation and is used frequently throughout the day. Any change in the movement of the joint (leg-length difference, change in walking style due to back problems) can cause subtle changes and cause pain and injuries.
Overuse during repetitive motions as are found during certain exercises (jogging, skiing) or work conditions (long periods of kneeling) can cause breakdown of cartilage and lead to pain.
When should people with knee pain call a health care professional?
Any pain that does not respond to rest or disappears within a few days should be evaluated by a doctor. In addition, the following are symptoms and signs in the knee that a doctor should evaluate:
- Inability to bend
- Unable to walk or discomfort while walking
- Significant pain
What are some of the complications of knee pain?
Frequently, knee pain will disappear without ever finding a specific cause. Depending on the underlying cause of the pain, the condition can progress and lead to more serious injuries or complications. Usually, these complications are long term and result in worsening pain or an increasing difficulty to walk.
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.
Sometimes the doctor might want to do further studies such as the following tests.
Plain X-ray can establish fractures and degenerative changes of the knee.
MRI is used to evaluate the soft tissues of the knee for ligament tears or cartilage and muscle injuries.
If gout, arthritis, or other medical conditions are suspected, a health care professional might order blood tests.
Removal of joint fluid (arthrocentesis)
Some conditions are best diagnosed by removal of a small amount of fluid from the knee joint. During arthrocentesis, a small needle is placed into your joint and fluid is withdrawn. This is done in a sterile method. The fluid is then sent to the laboratory for evaluation. This procedure is especially helpful if an infected knee joint is suspected or to distinguish gout and different forms of arthritis. If there is a collection of blood in the joint due to a traumatic injury, removing the fluid can help relieve the pain.
What kind of doctors treat knee pain?
Often knee pain can be evaluated and treated by your primary-care doctor. If the knee pain requires surgery or the cause of the pain needs further evaluation, an orthopedic surgeon will usually be consulted. With arthritis, gout, or inflammatory joint problems a rheumatologist may be consulted.
What is the treatment for knee pain?
Treatments for knee pain are as varied as the conditions that can cause the pain.
Medications might be prescribed to treat an underlying medical condition or for pain relief.
If you are taking over-the-counter pain medications regularly for your knee pain, you should see your doctor to be evaluated.
Sometimes strengthening the muscles around the knee will make it more stable and help guarantee the best mechanical movements. This can help avoid injuries or further worsening of an injury.
Injecting medications directly into your knee might help in certain situations. The two most common injections are corticosteroids and lubricants. Corticosteroid injections can help arthritis and other inflammations of the knee. They usually need to be repeated every few months. Lubricants that are similar to the fluid already in your knee joint can help with movement and pain.
What is the treatment for knee pain? (Continued)
Knee operations range from arthroscopic knee surgery to total knee replacement. Arthroscopic knee surgery is a very common surgical procedure that allows the physician look inside your knee through a few small holes and a fiberoptic camera. The surgeon can repair many of the injuries and remove small pieces of loose bones or cartilage. This is a common outpatient procedure.
Partial knee replacement: The surgeon replaces the damaged portions of the knee with plastic and metal parts. Because only part of the knee joint is replaced, this procedure has a shorter recovery then a total knee replacement.
Total knee replacement: In this procedure, the knee is replaced with an artificial joint.
Are there any home remedies for relief of knee pain?
Over-the-counter pain medications can frequently alleviate the pain. If someone is taking these medications on a regular basis, he or she should see a health-care professional to evaluate the knee pain for proper diagnosis and to avoid the potential side effects of chronic medication use.
The RICE mnemonic is often helpful, especially for minor injuries:
Rest: Rest the joint, and take a break from your usual activities involving the knee joint.
Ice: Applying ice can help with pain and inflammation.
Compress: A compression bandage can help prevent swelling and help knee alignment. It should not be tight and should be removed at night.
Elevate: Elevation can help with swelling and resting of the knee.
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Is it possible to prevent knee pain?
There can be many reasons for knee pain. Therefore, there are different strategies to prevent the pain depending on the underlying cause. Running on soft surfaces or decreasing the amount of running can help if the pain is due to overuse. Avoiding any direct injuries to the knee including wearing a seatbelt can prevent traumatic injuries. Weight loss can be helpful for many different forms of knee pain.
What is the prognosis of knee pain?
Frequently, knee pain will occur for a short period of time and then resolve. Sometimes it can return a few weeks or months later. If your knee pain becomes chronic, it is important to get it evaluated to avoid further damage to cartilage, bones, or ligaments. Prognosis depends on the underlying causes of the pain.
With modern surgical techniques, it’s possible to relieve many of the knee pain syndromes and return to an active lifestyle.
Knee injury facts
- The knee is one of the most common body parts to be injured.
- Types of knee injuries include sprains, strains, bursitis, dislocations, fractures, meniscus tears, and overuse injuries.
- Knee injuries are generally caused by twisting or bending force applied to the knee, or a direct blow, such as from sports, falls, or accidents.
- Risk factors for knee injury include overuse, improper training, having osteoporosis, and playing high-impact sports that involve sudden changes in direction.
- The main signs and symptoms of knee injury are pain and swelling.
- Knee injuries are diagnosed by a history and physical examination. Sometimes an X-ray or MRI may be done.
- Treatment of knee injuries depends on the type and severity of the injury and can involve RICE therapy (rest, ice, compression, elevation), physical therapy, immobilization, or surgery.
- Prognosis for knee injury depends on the type and severity of the injury and the need for physical therapy or surgery.
- Prevention of knee injuries involves proper training, proper equipment, and maintaining a safe playing field or home environment to avoid falls.
What are the different types of knee injuries?
The knee is one of the most commonly injured parts of the body. Sports, falls, and motor-vehicle accidents account for the vast majority of injuries to the knee.
The different types of injuries to the knee are defined by the affected anatomy of the knee and the mechanism by which it’s injured.
Knee sprains are injuries to the ligaments that hold the knee together. There are multiple ligaments that stabilize the knee and keep it in alignment. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) stabilize the knee in movement from front to back and cross each other in the middle of the knee joint. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) stabilize the knee so that the bones do not slide from side to side.
Ligament sprains are graded by the amount of stretching or tearing of the ligament fibers and how much instability it causes as follows:
- Grade 1 knee sprain: The ligament is stretched and painful, but fibers are not torn and no instability is present.
- Grade 2 knee sprain: The ligament fibers are torn partially, mild instability may be evident.
- Grade 3 knee sprain: The ligament fibers are completely torn and the knee is unstable.
Knee strains occur when tendons or muscles surrounding the knee are stretched, usually due to hyperflexion or hyperextension of the knee. These strains can lead to pain outside of the knee joint but can cause dysfunction of the normal range of motion of the knee. The patellar tendon stretches from the lower kneecap to the front of the tibia bone at the front of the leg.
Knee bursitis occurs when a fluid-filled pouch (called a bursa) in the knee is irritated, inflamed, or infected. Bursas are fluid-filled sacs located around joints that act as shock absorbers that minimize the friction between various tissues, such as the muscles and tendons around the joints. In the knee, there are two main bursas, one above the kneecap (patella), and one below the knee joint near the front of the tibia bone.
Tears of the meniscus can occur from damage to the inside of the knee. The medial and lateral menisci (plural of meniscus) are semi-round, articular cartilage that act as shock absorbers and smooth cushions for the thighbone (femur). These menisci can be injured acutely or can become dysfunctional gradually due to overuse and/or aging.
Knee joint dislocation can occur due to high-impact, large-force injuries to the knee (sports, motor vehicle accidents). This is a rare injury but causes severe damage to all the anatomical components of the knee and can include damage to the blood vessels and nerves about the knee. This requires emergency treatment or surgery.
The kneecap (patella) can dislocate to the side of the knee. Patella dislocation can be very painful but is generally not life-threatening and can be treated by popping it back into place (reduction of the patella), splinting, and physical therapy.
Knee fractures occur from direct blows to the bones. Patella, or kneecap, fractures occur when a person falls directly down onto the knees and the kneecap cracks due to the force. Collapse of the top of the tibia bone in the knee (tibia plateau fracture) can occur from sudden compression injury to the knee, especially in people with osteoporosis. Other fractures of the long bones (fibula, tibia, and femur) are rare with isolated injures to the knee.
Other overuse injuries of the knee include patellofemoral pain syndrome (often referred to as “runner’s knee”) and weakness and degeneration of the cartilage under the kneecap (chondromalacia patella). These injuries are due to an accumulation of repetitive damage to the knee structures. This may be cause by either congenital problems or improper mechanics of the knee movement.
Torn ACL Symptoms and Signs
With an acute injury, the patient often describes that they heard a loud pop and then developed intense pain in the knee. The pain makes walking or weight-bearing very difficult. The knee joint will begin to swell within a few hours because of bleeding within the joint, making it difficult to straighten the knee.
If left untreated, the knee will feel unstable and the patient may complain of recurrent pain and swelling and giving way, especially when walking on uneven ground or climbing up or down steps.
Most knee injuries are caused by an external force bending or twisting the knee in a manner that it was not anatomically designed for. The vast majority of knee injuries are from a twisting mechanism from falls, sports, or accidents. A twisted knee can cause damage to the ligaments and cartilage.
High-force injuries such as sports injuries and motor vehicle accidents can disrupt multiple parts of the knee anatomy, causing multiple types of knee injuries.
What are risk factors for a knee injury?
High-impact sports, including running, basketball, football, hockey, soccer, cycling, and others, can increase the risk of knee injury. Sports where shoes with cleats are worn and sharp, sudden changes in direction are made are common risks for knee injury. Exercise, such as high-impact cardiovascular activity or yoga, can also cause knee injury.
The elderly may be at higher risk for knee injury due to falls and osteoporosis.
Women may be at higher risk for particular knee injuries to the anterior cruciate ligament (ACL) and patella. This is due to the anatomy of a woman’s hips and femur and the angle at which the knee is tilted. This can lead to chondromalacia patella (CMP), an inflammation or irritation of the underside of the patella.
Being overweight can be a risk factor for knee injury, as excess weight puts more stress on the lower extremity joints.
What are knee injury symptoms and signs?
The symptoms and signs of knee injury are related to the type of injury and the part of the knee that was injured.
The main symptoms of knee injury are as follows:
- Difficulty bending the knee
- Problems weight bearing
- Clicking or popping sounds
- Locking of the knee
- Feeling of instability
If the injury is acute, the main symptoms will most likely be pain and swelling. If the injury is chronic or from overuse, the symptoms of clicking, popping, and intermittent pain will be more prominent.
What specialists treat knee injuries?
A knee injury may first be examined and treated by a primary care provider (PCP), such as a family practitioner, an internist, or a child’s pediatrician. If you go to the emergency room for your knee injury, you will be seen by an emergency-medicine specialist.
If the knee injury is severe, you may be referred to an orthopedist (a specialist in injuries of the musculoskeletal system) or an orthopedic surgeon. If your knee injury is related to sports, you may see a sports-medicine specialist.
Other medical professionals who may be involved in treating your injured knee include physical therapists, occupational therapists, or other rehabilitation specialists.
How do health care professionals diagnose a knee injury?
The diagnosis of a knee injury is made by a physician on the basis of history, physical examination, and sometimes the use of X-rays or MRIs.
Depending on the how the knee was injured and whether or not there are accompanying medical issues, the doctor will perform specific tests involving bending or twisting the knee to test the stability of the ligaments and check for damage to the cartilage. Knee-bending tests done by your doctor are designed to isolate specifically which ligament or part of the cartilage has been damaged.
Further testing with X-rays, CT scans, or MRIs may be necessary to evaluate the extent of the injury and help determine treatment and prognosis. X-rays and CT scans are used to asses for bony injuries (fractures), and MRIs are used to evaluate soft-tissue damage (ligaments and cartilage).
Treatment for a knee injury depends on the part of the knee that is damaged and the extent of the damage.
Some injuries such as simple strains or sprains are treated with home remedies such as RICE therapy (rest, ice, compression, and elevation). Taking time off from sports and exercise may be enough for minor injuries to heal. Over-the-counter nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) may help treat the pain and inflammation from these minor injuries. Chronic knee injuries may respond to heat therapy.
What is the medical treatment for a knee injury?
More serious knee injuries require medical care.
Knee immobilization or splinting keeps the knee from moving and decreases the chance of further injury. Immobilizing the knee can help stabilize an injured knee that may not be stable due to torn ligaments. It also keeps the knee from moving to assist in resting the knee.
Chronic knee injuries involving inflammation and bursitis may be treated with anti-inflammatories. Injections of cortisone (a steroid with powerful anti-inflammatory effects) may be helpful in these situations.
More extensive injuries involving torn ligaments, instability of the knee joint, swelling, decreased range of motion, or fractures will require an orthopedic surgeon consultation. In the initial stages of these more extensive injuries, RICE therapy can still be used. Staying off the leg by using crutches or a wheelchair may be advised.
Surgery may be indicated for tears of the ligaments or extensive damage to the menisci. Surgery may also be needed for fractures or dislocations of the knee. Some acute injuries such as those with high-force impact, or multiple parts of the knee damaged, may require emergency surgery.
Most knee surgery can be done by arthroscopy, a procedure in which a camera is used and small punctures are made in the knee to insert instruments. Repairs can be done inside the knee without having the open the knee with a large incision. Most arthroscopic surgeries do not need to be done immediately after an acute injury. Some are delayed to allow for decreased inflammation.
After surgery, or if surgery is not an option, physical therapy can be used to strengthen and stretch the muscles surrounding the knee. Physical therapy can also allow for better movement mechanics of the leg and the knee to help prevent future injury.
What exercises are recommended, and what exercises should be avoided during rehabilitation for a knee injury?
During physical therapy for rehabilitation of a knee injury, the patient will be given specific exercises by the physical therapist in order to strengthen and stabilize the knee joint. These exercises include strengthening the front of the thigh (quadriceps), back of the thigh (hamstrings), calf, and hip. Consult your doctor and your physical therapist before starting any exercise program. Your physical therapist should insure you perform the exercises properly before doing them on your own.
If you have any pain or discomfort while doing prescribed exercises, see your doctor or physical therapist.
Some exercises your physical therapist may recommend include the following:
- Quad sets
- Straight leg raises
- Straight-leg raise to the front
- Straight-leg raise to the back
- Hamstring curls
- Heel raises
- Heel dig bridging
- Shallow standing knee bends
The American Academy of Orthopedic Surgeons (AAOS) has an exercise guide that includes directions and pictures. Consult your doctor or physical therapist before trying any of these exercises on your own.
Some exercises to avoid following knee injury include the following:
- Full-arc knee extensions
- Deep squats
- Hurdler’s stretches
These exercises can further stress already damaged knee joints.
What is the recovery time for a knee injury?
The recovery time for a knee injury depends on the type and severity of the injury. If the injury is significant enough to require surgery and/or physical therapy, the recovery time will be longer.
Simple strains or sprains can last for one to two weeks. More extensive injuries requiring arthroscopic surgery may take one to three months to heal.
Major traumatic injuries to the knee may take up to a year to heal.
Following the doctor’s instructions for rest, immobilization, staying off your feet, and avoiding exercise that aggravates the injuries will help speed recovery.
Physical therapy can also speed recovery time. It is important to follow directions of your physical therapist to insure you are doing the exercises correctly and attaining the best results.
Chronic knee injuries that do not require surgery may flare up from time to time. Physical therapy, anti-inflammatory medications, and cortisone injections are used to provide temporary relief.
What is the prognosis of a knee injury?
The prognosis of a knee injury depends on the type and severity of the injury.
Most minor knee injuries (strains, minor sprains) heal on their own with conservative treatment. The prognosis for these types of injures is good.
Ligament or cartilage injuries that lead to dysfunction or instability of the knee may require surgery. These injuries generally respond well to surgery and patients can ultimately gain full or nearly full range of knee motion.
What are complications of knee injuries?
Knee injuries are rarely life-threatening, though severe injuries may be disabling. Some knee injuries lead to chronic, irreversible damage to the knee and may result in complications such as long-term dysfunction. Knee-joint dislocations can cause blood vessel injuries and can lead to severe disability.
Is it possible to prevent knee injuries?
Knee injuries can be prevented by taking steps to reduce the risks:
- Maintain fitness and lower-body strength
- Stay at a healthy weight
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- Train properly for your sport and do not over train
- Maintain the playing surface for sports in optimum condition
- Avoid slippery or uneven surfaces
- Avoid loose turf or gravel
- Wear knee braces and pads if required by your sport or suggested by your doctor
- Do all rehab exercises if you have had a previous knee injury
- Treat osteoporosis if you have it
- Make sure your home is safe to avoid falls
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