Knee Pain
Knee Pain & Causes
Knee pain is a common complaint when visiting the doctor. The pain can originate from within the knee joint or outside the knee joint. The causes of knee pain are varied: ranging from sudden injury due to a torn cartilage or a ruptured ligament, to an overuse injury or an underlying condition such as arthritis, gout or infections.
This pain can be triggered by other problems such as back conditions or a foot injury and can be aggravated by physical activity Knee pain can affect people of all ages, and home remedies can be helpful unless it becomes severe.
Knee pain can be caused by injuries, mechanical problems, and types of arthritis.
Knee Pain Caused By Common Knee Injuries
Anterior Cruciate Ligament (ACL) Injury
The anterior cruciate ligament (ACL) is one of four ligaments that connect your shinbone to your thighbone. People who frequently play basketball, soccer or other sports that require sudden acceleration-deceleration and changes in direction are at a higher risk of tearing their ACL.
The severity of the injury can range from a simple sprain to a complex tear. ACL tear symptoms include swelling of the affected knee as well as pain or instability in/of the knee whenever walking, running or climbing stairs.
Fractures
Falls and motor accidents may cause bones of the knee, including the kneecap (patella), to be broken. Osteoporosis, which weakens the bones, increases risks as one can sustain a fracture just by taking a wrong step.
For people with severe osteoarthritis, knee fractures can happen innocuously without any significant trauma. This type of pain is constant throughout, making weight-bearing very difficult on the painful knee.
Patellar Tendinitis
Sports enthusiasts who run, ski, cycle or frequently take part in jumping sports are prone to developing inflammation in the patellar tendon.
This tendon is a connection for the quadriceps muscle that lies on the front of the thigh to your shinbone. When tendinitis occurs, one or more of your tendons gets irritated and inflamed.
Knee Bursitis
The bursae contains small fluid-filled sacs that provide cushioning to the knee joint. They also allow tendons and ligaments to glide over the joint smoothly. Knee injuries can cause inflammation in the bursae, leading to pain and discomfort.
The knee becomes progressively more painful if a patient walks or stands more. Pain related to Knee Bursitis is usually on the inner or middle part of the knee.
Torn Meniscus
The meniscus is a tough, rubbery cartilage which acts as a shock absorber between your shinbone and thighbone. When carrying heavy objects, the meniscus can tear through sudden twists or movements.
Meniscus pain can present similar to fracture pain. It can present itself as locking of the knee when standing after being seated for some time. Other symptoms include finding it It is difficult to initiate standing and walking.
Knee Pain Caused By Mechanical Problems
Dislocated Kneecap
A kneecap dislocates when the triangular bone (patella) that covers the front of your knee slips out of place, frequently to the outside of your knee. Sometimes you can see the dislocation under the skin.
Hip or Foot Pain
When you have hip or foot pain, you may change the way you walk to avoid pain. However, this in turn places stress on other areas, such as your knee joint. Over time, the knee will degenerate with the increased unequal loading pressures on the knee, resulting in meniscal or cartilage injury.
Iliotibial Band (IT band) Syndrome
The Iliotibial band (IT band) is a tough band of tissue that extends from the outside of your hip to the outside of your knee. IT band syndrome occurs when the IT band becomes so tight that it rubs against the outer portion of your femur.Those who run long or cycle for long distances tend to be especially susceptible.
This type of pain can be mistaken as radicular pain from buttock to lateral part of the affected knee. It is the pulling and tightness of the left lateral thigh.
Loose Body
A piece of bone or cartilage may end up breaking off and floating in the joint space after injury or degeneration. Although this phenomenon is in itself harmless, it will cause pain when the loose body interferes with knee joint movement.
It can present as a locking knee which has jammed up the movement of the knee. Depending on where the loose body is located, it can have pain-free intervals interspersed with sudden pain.
Knee Pain Caused By Types of Arthritis
Gout
Uric acid crystals build up in the joint to form gout. Most people experience it in the big toe, but it can also occur in the knee. The excessive uric acid build-up in the body accumulates in the knee joint causing a severe inflammatory reaction.
When Gout occurs the knee is often red and swollen. It is painful even when performing non-weight bearing activities such as bending or extending the knee joint while lying in bed.
Osteoarthritis
Also known as degenerative arthritis, this is the most common type of arthritis. Especially common with old age, this happens after the cartilage in your knee deteriorates with use and wear-and-tear.
As one ages, the synovial fluid (lubricant) dries up. This increases friction between the articulating cartilage surfaces of the knee joint. The friction will cause accelerated wearing off of the cartilage, resulting in cartilage thinning and loss. Once the protective layer of cartilage is breached, the underlying bone will swell and inflame with any seemingly harmless weight bearing activities on the knee.
If untreated, the ongoing degeneration of the knee will result in destruction of the knee joint, resulting in pain, swelling and deformity of the knee. This will restrict the normal function of the knee, making it difficult to stand, walk or climb stairs.
Pseudogout
Pseudogout is often mistaken for gout but it is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout. It has similar inflammatory signs to gout but the uric acid levels are not elevated.
Rheumatoid Arthritis
This is an autoimmune condition that can affect almost any joint in your body, including your knees.
Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go. This is part of the systemic condition affecting many body organs/joints.
Similar to osteoarthritis, the inflammation and end-result of joint destruction is the same. The major difference is that this is immune-mediated and not due to age degeneration.
Septic Arthritis
Septic Arthritis is the infection of the knee joint, leading to symptoms like swelling, pain and redness. It often occurs with a fever, and there’s usually no trauma before the onset of pain.
Septic arthritis can quickly cause extensive damage to the knee cartilage. If you have knee pain with any of these symptoms, see your doctor right away.
This infective cause of painful knee is potentially dangerous and it can progress to systemic sepsis (generalised infection of the body), causing harm to other body organs. Severe localized septic arthritis can even result in loss of limb such as amputation of the leg to save the patient.
Symptoms of Knee Pain
Due to the varied causes of knee pain, the location and severity of the pain may vary. However, you can watch out for accompanying signs and symptoms that include:
- Swelling and stiffness
- Popping or crunching noises
- Inability to fully straighten the knee
- Redness and warmth to the touch
- Weakness or instability
- Pain when putting weight on the knee
- Pain when walking, standing, or squatting
When Should You Seek Medical Care?
You should seek medical help when:
- You can’t bear weight on your knee or feel as if your knee is unstable (gives out)
- Have marked knee swelling
- Are not able to fully extend or flex your knee
- Have affected sleep due to painful knee
- Notice an obvious deformity in your leg or knee
- Experience a fever, in addition to redness, pain and swelling in your knee
- Experience severe knee pain that is associated with an injury
A Message About Knee Pain
Knee pain may or may not be serious. However some conditions such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. Knee injuries, even minor ones, will predispose you to similar injuries in the future.
Diagnosing Knee Pain
Your doctor will diagnose knee pain with a series of preliminary tests before moving on to further evaluation if needed.
Preliminary Tests
Your doctor will:
Inspect
- Check for swelling, pain, tenderness, warmth or visible bruising
Evaluate Movement
- Move your lower leg in different directions to see how far you can move
Check Integrity
- Push on or pull the joint to check the integrity of the structures in your knee
Further Evaluation
Depending on the results of your preliminary tests, your doctor may further evaluate through these tests:
CT scans can help diagnose bone problems and subtle fractures. A special kind of CT scan can accurately identify gout even when the joint is not inflamed. Infection or inflammation can be detected through blood tests and/or sometimes a procedure called arthrocentesis. A needle is inserted into the swollen knee, a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis. This test, uses radio waves and a powerful magnet to create 3D images of the inside of your knee, is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles. Sound waves are used to produce real-time images of the soft tissue structures within and around your knee. During the ultrasound, your doctor may move your knee into different positions to check for specific problems. An X-ray can help detect bone fractures and degenerative joint disease.Computerised Tomography (CT) Scan
Joint Aspiration/blood tests
Magnetic Resonance Imaging (MRI)
Ultrasound
X-ray
What Treatments Are Available for Knee Pain?
After proper diagnosis, the doctor will prepare the appropriate treatment for your knee pain. Common methods of knee pain treatment can be categorised as non-surgical, surgical and home remedies.
Non-surgical Treatments for Knee Pain
Non-surgical treatments include physical therapy to aid in rehabilitation, the use of supports and braces to relieve pressure or injections to provide pain relief.
Strengthening exercises will help build up the muscles around your knee to make it more stable. A physiotherapist will be able to advise on the specific types of exercise that will be based on the condition causing your pain. If you are physically active or practice a sport, the therapist will guide you to use exercises to correct movement patterns that may be affecting your knees and to establish good technique during your sport or activity. They may sometimes include exercises to improve your flexibility and balance. The therapist will recruit and strengthen weakened muscles to compensate for the specific painful area of the knee, offloading the pressure on the injured area. It is recommended to use supports and braces to shift pressure away from the knees, which is most affected by osteoarthritis. Sometimes, different types of braces may be used to help protect and support the knee joint. Knee injections in Singapore are becoming more common. Corticosteroids Hyaluronic acid Depending on the severity of the arthritis of knee, the outcome of the visco supplement injections may be as follows: 1. Early arthritis: 5 years sustained outcomes Platelet-Rich Plasma (PRP)Physical Therapy
Knee Supports and Braces
Knee Injections
Medications or other substances may be injected directly into your joint for different types of treatment. Such instances include:
2. Moderate arthritis: 2 – 5 years
3. Late arthritis: 6 months or less
Surgical Treatments for Knee Pain
It is important to consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction before deciding to go under the knife.
If you choose to have surgery, your options may include:
A fiber-optic camera and long, narrow tools are inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage (especially if it is causing your knee to lock) and reconstruct torn ligaments. It also cleans up the inflamed area and hence alleviates the pain. However, this does not reverse the degeneration. Here, only the most damaged portions of your knee are replaced with parts made of metal and plastic. The surgery can usually be performed through small incisions, so you’re likely to heal more quickly than surgeries that replace your entire knee. Damaged bone and cartilage from your thighbone, shinbone and kneecap are replaced with an artificial joint made of metal alloys, high-grade plastics and polymers. These implants last from 8 years to 12 years. Post-surgery, degeneration will cause implant fatigue and wear. Another new implant may be needed to replace the old one in selected patients.Arthroscopic Surgery
Partial Knee Replacement Surgery
Total Knee Replacement
Home Remedies for Knee Pain
You can get over-the-counter anti-inflammatory medications such as paracetamol and ibuprofen to help relieve knee pain. Many OTC pain relief creams contain methanol to cool the skin and surrounding tissue, giving limited relief. Other specific prescription pain creams contain a numbing agent or analgesic, such as lidocaine, salicylate or capsaicin might be more effective and more targeted at reducing pain and swelling. Rest Ice Compression Elevation A heat pack or hot water bottle can give you temporary pain relief when applied to the painful area on your knee.Over-the-counter Medication
Rest, Ice, Compression and Elevation (RICE)
Heat
Alternative Medicine for Knee Pain
These supplements are usually taken to relieve osteoarthritis pain. The clinical data has been non-conclusive regarding its use. Different papers have shown differing outcomes. This traditional Chinese method involves the placement of hair-thin needles into your skin at specific places on your body. Research suggests that acupuncture may help relieve knee pain caused by osteoarthritis.Glucosamine and Chondroitin
Acupuncture
How Can I Prevent Knee Pain?
It may be difficult to prevent knee pain but some careful measures can be taken to forestall injuries and joint deterioration.
Making sure that your knees don’t experience a strain in supporting your weight is the best thing you can do to keep them healthy. Weight reduction has been shown to be the single more important variable in the outcome of knee arthritis management. Every kilogramme above the target BMI for the individual increases 4% loading stress on the degenerated knee. One should aim to work towards the target BMI for each individual. Work with a coach or trainer to prepare your muscles for the demands of sports participation, thus ensuring that your technique and movement are the best they can be. Before you develop arthritis of the knee, knee-strengthening exercises such as climbing steps, stairs and jumps are helpful in building strength and integrity of the knee. These sports would not be applicable for those who have developed arthritis and degeneration of the knee. Weak muscles are a leading cause of knee injuries. That said, build up your quadriceps and hamstrings which support your knees. Work on your balance and stability to help the muscles around your knees work together more effectively. Include flexibility exercises and stretching in your workouts because tight muscles also can contribute to injury. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you work out. Consider swimming, water aerobics or other low-impact activities. Simply limiting high-impact activities will sometimes provide relief.Maintain a healthy weight
Condition yourself for your sport
Get strong, stay flexible
Choose your exercises
