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Knee Pain

(By BruceBlaus (Own work) [<a href="http://creativecommons.org/licenses/by/3.0">CC-BY-3.0</a>], <a href="http://commons.wikimedia.org/wiki/File%3ABlausen_0596_KneeAnatomy_Front.png">via Wikimedia Commons</a>Common causes of knee pain)

Simple strain

If you think your pain is the result of having done more activity than you're used to, you've probably just strained the knee. This means that the knee tissues have stretched, but are not permanently damaged. Read more about sprains and strains.

You should care for your knee at home and the pain should eventually go away.

We can help you prevent future knee pain by:

  • advising on warm up and cool down exercises 
  • advising on good work posture and practice
  • biomechanical assessment of you leg and foot function

Anterior knee pain syndrome

Knee pain felt at the front of the knee, around the kneecap, is called anterior knee pain syndrome. The cause is not understood, but it is usually made worse by sitting for prolonged periods or by climbing stairs.

You can treat this yourself with anti-inflammatories, an ice pack and rest, and you should also do strengthening exercises for the muscles in front of your thigh.

Damage to the menisci

Sitting between the upper and lower leg bones at the knee joint are rubbery pads of tissue called menisci. These cushion the bones, acting as shock absorbers.

The menisci can become worn as you get older, and are commonly the reason for knee pain in middle-aged people.

A meniscus can also be torn after suddenly twisting the knee joint, resulting in pain, swelling and, occasionally, locking of the knee. These symptoms may settle down without treatment, although an operation is sometimes needed to repair the torn pad of tissue.

Osteoarthritis

In older people, repeated attacks of knee pain are likely to be a sudden worsening of osteoarthritis, the most common type of arthritis in the UK. Osteoarthritis causes damage to the articular cartilage (protective surface of the knee bone) and mild swelling of the tissues in and around the joints.

A painful fluid-filled swelling may develop at the back of the knee as a result of osteoarthritis – this is known as a Baker’s cyst, or popliteal cyst.

Osteoarthritis can sometimes affect younger people, especially those who are overweight or have had serious injuries to the knee in the past.

You should see your GP if you think the cause of your knee pain is osteoarthritis. 

Less common causes of knee pain

Tendonitis

Overusing or injuring the tendon that connects the kneecap to the shin bone can cause patellar tendonitis (inflammation of the tendon). This condition is sometimes called "jumper's knee", as it can be brought on by jumping activities such as basketball or volleyball. The area may be swollen, red and warm.

Learn more about tendonitis.

You can care for your knee at home as you would with a simple sprain.

Housemaid's knee

Repetitive movement of the knee or kneeling for long periods can cause a build-up of fluid over the knee joint, known as bursitis or "housemaid's knee".

Housemaid's knee tends to affect people with certain jobs that involve kneeling (such as carpet layers), or sports players (such as footballers). Find out more about bursitis.

Torn ligament or tendon

Knee pain may be caused by torn ligaments or tendons. Ligaments are tough bands of tissue that connect the bones at the knee joint; tendons connect the muscles to the bone. You can tear these tissues during running sports such as rugby or football.

Injured tendons or knee ligaments at the side of the knee may cause pain even when the knee is at rest, which may get worse when you bend the knee or put weight on it. There may also be warmth and swelling around the knee.

If you feel that your knee is also unstable or keeps "giving way", you may have torn the anterior cruciate ligament (one of the main knee ligaments). This probably resulted from a sudden change in direction or a twisting movement, and you may have heard a pop when it happened. You should see your GP if this happens, and you may be referred to an orthopaedic specialist for advice and treatment.

Read about surgery to repair a damaged knee ligament.

Bleeding into the joint

An injury that causes significant damage to the knee joint may cause bleeding into the joint spaces, known as haemarthrosis. This can happen if a cruciate ligament is torn or if there is a fracture to one of the bones of the knee.

Signs of haemarthrosis are swelling of the knee, warmth, stiffness and bruising. You should go to hospital immediately to have your knee treated if you have a very swollen knee.

Osgood-Schlatter's disease

Swelling and tenderness over the bony bump just below the kneecap is known as Osgood-Schlatter's disease. 

This is a common cause of knee pain and swelling in teenagers, particularly teenage boys who sprain or overuse their thigh muscles when playing football or other sports.

Mild cases usually settle with rest and taking anti-inflammatory medication. Severe cases may need referral to a specialist.

Gout and pseudo gout

If the knee joint is also hot and red, the cause is likely to be gout or pseudo gout, which are types of arthritis.

Gout is caused by a build-up of uric acid in the body. Uric acid is a waste product that is produced during the process of metabolism (when the body breaks down food to use as energy). Usually, uric acid is excreted by the kidneys.

People whose kidneys do not excrete uric acid properly, or those who produce too much, can have high levels of uric acid in their blood. If the level becomes very high, crystals form in the joints. The crystals cause the joints to become inflamed and painful.

Gout will cause severe pain in the knee, limit movement of the joint and may cause a slight fever.

Usually, gout affects the joint of the big toe first, before it affects the knee joint or any other joint.

Pseudo gout is a similar condition to gout in that crystals of calcium are deposited in and around the joint. But unlike gout, pseudo gout can affect the knee joint first.

You should see your GP if you think the cause of your knee pain is gout or pseudo gout.

Septic arthritis (infected knee)

Septic arthritis is a serious condition that causes a very painful, hot, swollen knee. You may also have a fever and any movement of the knee will be very painful.

It can be mistaken for gout or pseudo gout (see above). You should see your GP urgently, or go to accident and emergency (A&E) if you suspect you have septic arthritis.

Septic arthritis is treated with antibiotics and surgery is often needed to clean out the infection.

Sciatica means pain that goes down the leg. One common reason for this is some pressure on the nerves that run down the leg as they pass out of the spine. The pressure can be caused by a damaged disc in the back.

It was once thought that the discs "slipped" but in fact they behave more like a car tyre with a bulge in the wall. The bulge can press on the nerve giving sharp pain in the leg.

There is a myth that osteopaths can correct "slipped discs" using manipulation. Unfortunately this is not true. The management of disc injuries relies greatly on appropriate advice and progressive exercise. Osteopathic treatment may be useful in helping with the associated mechanical (muscle and joint) back problems that accompany the disc injury.

Another cause of sciatic pain is called referred pain. In this case there need not be any pressure on the nerve root. The pain felt in the leg is really coming from somewhere else. If the origin of the pain is found (for example a ligament in the back) and treated then the leg pain will go away.

This is the most common type of sciatica that we see and it responds well to our non surgical osteopathic treatment.

Special tests.
In some cases it my be necessary to see a special MRI scan of your back to show whether or not there is a specific disc injury pressing on a nerve. Your osteopath or practitioner will discuss this with you.

X-Rays are no help in this condition because they only show the bones not the softer tissues that cause this sort of trouble.

by John Chaffey last review March 2013

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