Knee Pain - Care Guide
Knee pain is very common. Almost one in three Americans older than age 45 reports some type of knee pain, and it's a common reason that people visit their doctors or the emergency room. It is the most common musculoskeletal complaint that brings people to their doctor. With today's increasingly active society, the number of knee problems is increasing. Knee pain has a wide variety of specific causes and treatments.
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Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Or, certain medical conditions, including arthritis, gout and infection, may be at the root of your knee pain.
Types of Knee Pain
The nerves that provide sensation to the knee come from the lower back and also provide hip, leg, and ankle sensation. Pain from a deeper injury (called referred pain) can be passed along the nerve to be felt on the surface. Knee pain, therefore, can arise from the knee itself or be referred from conditions of the hip, ankle, or lower back. All of the following sources of knee pain arise from the knee joint itself.
Patello-femoral Syndrome is the most common form of chronic knee pain and is characterized by pain occurring between the knee cap (patella) and the underlying thigh bone (femur). It causes pain and tenderness in the front of the knee. It is also known as Anterior Knee Pain. (In contrast, pain behind the knee is very rare.) Patello-femoral pain is worse when you sit for long periods and get up out of a chair or the car, or when climbing stairs. Often, people experience a grinding or crunching sensation in the knee joint.
In general, knee pain is either immediate (acute) or long-term (chronic). Acute knee pains can be caused by an acute injury or infection. Chronic knee pains are often from injuries or inflammation (such as arthritis) but can also be caused by infection.
Knee Pain Causes
There are various causes of knee pain such as sports injury or trauma, as a result of an accident. However, in most cases knee pain is simply caused by wear and tear as a result of the normal degenerative process of ageing. Over the years the cartilage behind the knee cap (patella) will soften and wear out, resulting in small areas of soft tissue breakdown and tearing. Apart from age, years of activities such as rugby, soccer, running, cycling or strenuous labour (e.g. on building sites) will affect the knees and exacerbate the erosion of knee cartilage.
Knee pain is a symptom of many different diseases and conditions. Short-term knee pain may be the result of excess stress on the knee. Possible causes of knee pain include:
- Bursitis. Inflammation of the bursae of the knee can cause knee pain. Bursitis, sometimes called house-maid's knee, can be caused by infection, gout, rheumatoid arthritis, injury, illness, or chronic irritation (crawling or kneeling).
- Muscle imbalance. The inner quadricepses are weaker than the outside quadriceps. The stronger muscles on the outside pull the knee cap toward the side. Instead of the patella running properly in its groove, the muscle imbalance leads to mal-tracking of the patella, causing cartilage erosion and pain.
- Osteonecrosis. Degeneration of the bones associated with the knee cause knee pain and deformity.
- Fracture. Breakage or crack in any of the bones associated with the knee joint can cause knee pain.
- Gout. A faulty chemical process leads to high levels of uric acid in the blood which causes inflammatory arthritis, crystal deposits in joints, joint destruction, and joint pain.
- Arthritis. Osteoarthritis (joint degeneration), rheumatoid arthritis (joint inflammation), and septic arthritis (joint infection) can cause knee pain.
- Ligament injury or instability. The ligaments supporting the knee may be injured or strained by persons who participate in sports, particularly football, rugby, lacrosse, basketball, skiing, soccer, and volleyball. Other accidents can also cause ligament damage.
- Cysts. A cyst is a fluid-filled sac. Cysts associated with the knee can cause swelling and knee pain or discomfort.
- Loose bodies. This condition refers to any loose objects that float around the knee and cause problems. They also are called "joint mice" because of their elusive nature.
- Meniscus conditions. Damage, usually in the form of a tear, to the menisci can result from degenerative changes associated with advancing age or sports-related injury. Sports that commonly cause menisci damage include football, basketball, soccer, tennis, lacrosse, and skiing.
- Patellofemoral pain. Also known as anterior knee pain syndrome, this condition is characterized by pain around the knee cap. The exact cause of patellofemoral pain is unknown but is probably related to muscle inadequacy, lack of flexibility, rapid growth, or bone positioning.
Risk factors
A number of factors can increase your risk of having knee problems, including:
- Overuse. Any repetitive activity, from cycling a few miles every morning to gardening all weekend, can fatigue the muscles around your joints and lead to excessive loading stress. This causes an inflammatory response that damages tissue. If you don't allow your body time to recover, the cycle of inflammation and microdamage continues, putting you at increased risk of injury. It's not repeated motion itself that's to blame, but rather the lack of adequate recovery time. That's why current strength training guidelines advise against working the same muscle group on consecutive days.
- Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
- Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don't absorb enough of the stress exerted on your knee joints.
- Previous injury. Having a previous knee injury makes it more likely that you'll injure your knee again.
- Lack of neuromuscular control. Studies have shown that some people who have abnormal movement patterns of the leg during activities such as squatting and stepping off a step may be predisposed to knee injury.
- Mechanical problems. Certain structural abnormalities, such as having one leg shorter than the other, misaligned knees and even flat feet, can make you more prone to knee pain and problems.
- High-risk sports and activities. Some sports and activities put greater stress on your knees than do others. Alpine skiing with its sharp twists and turns and potential for falls, basketball's jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of injury.
- Age. Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendinitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.
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