Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions such as arthritis, gout and infections also can cause knee pain. Knee pain becomes more common as we get older and there is a higher risk of getting knee pain if you are overweight.
The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:
- Swelling and stiffness
- Redness and warmth to the touch
- Weakness or instability
- Popping or crunching noises
- Inability to fully straighten the knee.
Knee pain can be caused by injuries, 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 your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:
- Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
- ACL injury. Tear of the anterior cruciate ligament (ACL) — one of the four ligaments that connect your shinbone to your thighbone is one of the more common causes.
- Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
- Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone is the commonest type.
- Fractures. The bones of the knee, including the kneecap (patella), can be broken during motor vehicle collisions or falls. People whose bones have been weakened by osteoporosis can sometimes sustain a knee fracture simply by stepping wrong.
Some examples of mechanical problems that can cause knee pain include:
- Loose body. Sometimes 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, in which case, one can have pain and giving way sensation.
- Iliotibial band syndrome. This occurs when the tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners and cyclists are especially susceptible to iliotibial band syndrome.
- 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. In some cases, the kneecap may stay displaced and you will be able to see the dislocation.
Patellofemoral pain syndrome is a general term that refers to pain arising between the kneecap (patella) and the underlying thighbone (femur). It is more common in young adults due to maltracking of the kneecap, but in adults it is due to arthritis of the join
Knee pain can develop gradually over time, may come on suddenly or may repeatedly come and go. Whatever the pattern of pain, it is most often not due to arthritis, but could be in some people.
Most common type of Arthritis include:
- Osteoarthritis. Sometimes called degenerative or wear & tear arthritis, osteoarthritis is the most common type of arthritis. It may affect anyone at any age but is most common in people over the age of 50.
If you have osteoarthritis, you may feel that the knee is painful and stiff at times and may affect one or both knees. The pain may feel worse at the end of the day, or when moving the knee. It may improve with rest. You also may have stiffness in the morning which may last for no more than an hour. The pain may be felt all around the knee, or just in front or the side. It may get worse after moving your knee in a certain way like going up or downstairs.
- The other causes of arthritis include Rheumatoid arthritis (an autoimmune condition), Gout or Pseudo Gout (due to crystal deposits in the knee) or rarely due to infection (Septic Arthritis). Septic Arthritis is associated with swelling, pain and redness, sometimes with redness. If you have knee pain with any of these symptoms, see your doctor right away.
Balancing Rest and Exercise:
- Important to balance rest and movement especially during the initial part of the rehabilitation.
- Try to use your knee more after the initial 24-48 hours, as exercise can help with long-term pain.
- When using the stairs, use the handrail if there is one. When going upstairs lead with the good leg and with the sore leg when going downstairs
- Try and stick to your normal routine like staying at or returning to work if possible.
- Avoid lifting heavy weights.
- Low impact exercises like cycling and swimming can be useful.
Carrying extra body weight makes it more likely that you will get joint pain. If you have joint pain already, being overweight can make it worse. Losing even small amount of weight can make a huge difference towards alleviating the pain.
- Gentle warmth is an effective and safe treatment for most aches and pains. You could use a wheat bag, heat pads, deep heat cream, hot water bottle or a heat lamp.
- Do not use heat in a new injury as it may make the problem worse by increasing the bleeding under the skin.
- Try not to have the heat on the skin for longer than 20 minutes.
- Ice can be useful in managing acute knee pain. You could use a bag of frozen peas or use a pharmacy bought ice pack.
- Ice can be left on for 20-30 minutes and can be repeated every 2-3 hours.
Sensible well-padded shoes and arch supports if you have flat feet can be helpful in reducing the pain by taking the stress off the knee.
- Paracetamol: As a first step, you may take Paracetamol regularly for a few days.
- Non-Steroidal Anti-inflammatory drugs (NSAIDs) -Tablets: These can reduce the pain, inflammation and swelling. There are many types and brands. Some like Ibuprofen are available over the counter in Pharmacies or Supermarkets, but other types which are stronger, need a prescription. NSAIDs carry a number of potential serious side effects, so you should ask your doctor or pharmacist if they are suitable for you before taking them.
- Non-Steroidal Anti-inflammatory drugs (NSAIDs)- Rub-on: These are topical painkillers. Some can be bought over the counter, while others need a prescription. The amount of medication that gets into your bloodstream is much less with rub-on painkillers, thus they are safer due to less side effects.
Call your doctor if you:
- Cannot bear weight on your knee or feel as if your knee is unstable (gives out) or clicks painfully.
- Have marked knee swelling.
- Are unable to fully extend or flex your knee.
- See an obvious deformity in your leg or knee.
- Have a fever, in addition to redness, pain and swelling in your knee.
- Have severe knee pain that is associated with an injury.
- If the knee pain does not get better after a few weeks.
Your doctor will be able to diagnose your knee problem from your symptoms along with a physical examination of your knee. It may be aided by doing some tests and also X-rays and occasionally a scan, especially if more specialised treatment is needed.
If your pain does not settle within a few weeks, the doctor may suggest treatments to deal with the underlying cause of knee pain. These may be:
Stronger painkillers/NSAIDs: If the pain is severe, you may be prescribed stronger painkillers like codeine or NSAIDs like Naproxen will be prescribed. Since these have more side effects, they can only be prescribed for a short time and your doctor will probably suggest other treatments.
Physiotherapy: Individualised Physiotherapy tailored to specific causes of knee pain may help. This would include an exercise programme, taping of the kneecap to make it track better or knee braces to ease the pressure on the knee.
Surgery or Injections: These are not recommended in most cases as people recover well or get better with non-invasive treatments. Different types of Knee Injections, while not curative can help to alleviate the pain or postpone the need for surgery. Your doctor may refer you to a surgeon if you have Arthritic pain that is not controlled with non-invasive methods, to consider for Partial or Total Knee Replacement Surgery.