Knee pain is a common reason that people visit their doctors' offices or the emergency room. Often, knee pain is the result of an injury, such as a ruptured ligament or torn cartilage. But some medical conditions can also cause knee pain, including arthritis, gout and infections.
Depending on the type and severity of damage, knee pain can be a minor annoyance, causing an occasional twinge when you kneel down or exercise strenuously. Or knee pain can lead to severe discomfort and disability.
Many relatively minor instances of knee pain respond well to self-care measures. More serious injuries, such as a ruptured ligament or tendon, may require surgical repair.
Severe knee pain that comes on suddenly (acute pain) is often the result of injury. Some of the more common knee injuries include the following:
Chronic knee pain can often be the result of arthritis, either rheumatoid, or osteoarthritis. An underlying injury can also be at the root of chronic knee pain. Of course, Gout can also be a cause of arthritis and knee pain as well.
Pain involving one or both knees is common in both the young and advanced aged population. Often, it is self limiting, and goes away over time, however if it persists, may be an indication to search for a possible cause.
Pain is usually over the inside, front, or outside aspect of the knee, and can be worsened with activity. If the knee itself feels unstable, a physician should be consulted as soon as possible.
Your knee joint is essentially four bones held together by ligaments. Your thighbone (femur) makes up the top part of the joint, and two lower leg bones, the tibia and the fibula, comprise the lower part. The fourth bone, the patella, slides in a groove on the end of the femur.
Ligaments are large bands of tissue that connect bones to one another. In the knee joint, four main ligaments link the femur to the tibia and help stabilize your knee as it moves through its arc of motion. These include the collateral ligaments along the inner (medial) and outer (lateral) sides of your knee and the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which cross each other as they stretch diagonally from the bottom of your thighbone to the top of your shinbone.
Other structures in your knee include:
Many knee injuries are due to overuse, problems with alignment, sports or physical activities, and failure to warm up and stretch before exercise. But they can also result from trauma, a fall, or a direct blow to your knee.
Common knee injuries and their causes include:
If you have new knee pain that isn't severe or disabling, a good rule of thumb is to try treating it yourself first. This includes resting, icing and elevating the affected knee, and sometimes using Nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. If you don't notice any improvement in three to seven days, see your doctor or a specialist in sports medicine or orthopedics.
Some types of knee pain require more immediate medical care. Call your doctor if you:
A comprehensive medical history and thorough physical exam play a larger role in diagnosis than any single test.
A magnetic resonance imaging (MRI) test may aid in the diagnosis.
Unlike an X-ray, which isn't useful for viewing ligaments, tendons and muscles, an MRI can help identify injuries and damage to soft tissue. Depending on the type of injury, other imaging tests include:
The key to treating many types of knee pain is to break the cycle of inflammation that begins right after an injury. The inflammation itself causes further damage, which in turn triggers more inflammation, and so on. For best results, start treating your injury right away and continue for at least 48 hours.
Commonly referred to by the acronym P.R.I.C.E., self-care measures for an injured knee include:
NSAIDs also have a ceiling effect, which means there's a limit to how much pain they can control. If you have moderate to severe pain, exceeding the dosage limit probably won't relieve your symptoms.
When self-care measures aren't enough to control pain and swelling and promote healing in an injured knee, other options include:
Normally, the goal of physical therapy is to strengthen the muscles around your knee and help you regain knee stability. Training is likely to focus on the muscles in the back of your thigh (hamstrings), the muscles on the front of your thigh (quadriceps), and your calf, hip and ankle. In the early stages of rehabilitation, you work on re-establishing full range of motion in your knee. Finally, you work on training specific to your sport or work activities, including exercises to help you prevent further injury.
There's no single best way to treat most knee injuries. Whether surgical treatment is right for you depends on many factors, including:
If you have an injury that may require surgery, it's usually not necessary to have the operation immediately. In most cases, you'll do better if you wait until the swelling goes down and you regain strength and full range of motion in your knee.
Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what's most important to you. Nonsurgical treatment isn't an option if you have cartilage damage that interferes with your range of motion (locked knee) or if the blood supply to your knee is severely compromised.
If you choose to have surgery, your options may include:
In this procedure (unicompartmental arthroplasty), your surgeon replaces only the most damaged portion of your knee. The surgery can usually be performed with a small incision, and your hospital stay is typically just one night. You're also likely to heal more quickly than you are with surgery to replace your entire knee. Unfortunately, many people who opt for knee replacement surgery have damage too extensive for unicompartmental arthroplasty. In addition, long-term results may not be as good as they are with a total knee replacement.
In recent years, a number of nonsurgical treatments for knee pain that results from arthritis have been investigated or become available.
Although it's not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration: