Melissa Messer is the physician assistant in our orthopedic clinic. She has seen patients at Upland Hills Health since 2010 and assisted with more nearly 2,000 orthopedic surgeries in that time.
Knee pain is a common complaint and can affect people of all ages and activity levels. Knee injuries and conditions can greatly affect a person’s life and ability to stay independent.
What is the knee?
The knee is a joint made up of the femur (thigh) bone, tibia (shin) bone, and patella (kneecap). There is a smooth protective layer of cartilage on our bones called articular cartilage. This type of cartilage makes knee movement smooth and pain free.
There are two C-shaped cartilages called meniscus cartilage that act as “shock absorbers.” There are also 4 main supporting ligaments (ACL, PCL, MCL, and LCL). Their main function is to provide stability. Finally, there are two main tendons (quadriceps and patellar) that connect the leg muscles to the knee cap. These connections are what helps us bend and straighten our knee.
Causes of Knee Pain
Many knee problems have symptoms in common. Patients can experience pain, swelling, stiffness, instability (giving out), decreased motion, and weakness. While there are several causes of knee pain, they can generally be broken down into 2 categories: injury and medical conditions.
Knee injuries can occur in a variety of settings. Patients young and old can experience torn ligaments as well as a torn meniscus. A meniscus is commonly torn with a twisting or hyper-flexion (knee bent) injury.
For example the foot stays planted and the body twists. Many patients report feeling a pop, followed by pain. Any one of the knee ligaments can be torn with an injury as well. Fast changes in direction (cutting in sports), landing wrong from a jump, or a direct hit may be the cause of a ligament tear. Initially, pain and swelling are the biggest complaints, followed by popping and giving out (instability).
To treat torn cartilage or ligaments, physical therapy often helps strengthen and stabilize the knee. There are also special braces that can be worn, during activities where the patient feels pain or instability.
Over-the-counter medications and cortisone injections may also be used for pain and swelling. If the knee doesn’t improve, a specialized test called an MRI may be performed. An MRI can identify a tear or other soft tissue injuries. If no other treatment works, a surgery called a knee arthroscopy, or “scope” may help. With this surgery, three to four small incisions are made in the knee. A camera system is used to look inside and allows the surgeon to use the small incisions to repair or clean up a meniscus tear. The small incisions can also be used for some ligaments surgeries. Depending on which ligament was torn, it may be repaired or replaced with new tissue called a graft.
Osteoarthritis is the slow wear and tear of the protective cartilage on the bones. It usually take several years for the wear to happen. This can cause pain, stiffness, swelling, catching, and giving out. Sometimes patients look “knock-kneed” or “bow-legged.” Osteoarthritis can be caused by aging, previous injury, being overweight, and family history. While osteoarthritis can affect any joint, it is most commonly found in the larger weight-bearing joints like the hip and knee.
Osteoarthritis may be treated with physical therapy, anti-inflammatory medications, prescription knee brace, and knee injections. These treatments can help a person live with osteoarthritis for many years. Unfortunately, the cartilage will not grow back and for some, the treatments become less effective over time. Many patients will eventually move on to a knee replacement surgery. Physical therapy after this surgery is extremely important to get the most benefit out of the new knee joint.
Patellofemoral syndrome is a term used to describe pain in and around the kneecap and in the front of the knee. It may be caused by overuse, muscle imbalance, and trauma. This type of pain is usually made worse with kneeling, squatting, going up and down stairs, and sitting for long periods of time. Symptoms can include pain in the front of the knee, mild swelling, and sometimes a grinding sensation with knee movement.
Overuse can happen with running and jumping activities that put a repetitive strain on the knee joint. Muscle imbalance may occur when certain muscles between the hip and knee are weak. This weakness may cause the kneecap to be misaligned, causing pain. Trauma can include injuries to the cartilage and bone of the kneecap which cause pain. Physical therapy is the main treatment for kneecap pain.
Less common causes of knee pain can be gout and infection. Both of these conditions can cause a red, hot, and painful knee. It is best to have these symptoms evaluated urgently. Knee joint infections may require urgent surgery.
What you can do on your own?
- STOP the activity if it is causing you extreme pain or if there is an obvious injury.
- RICE which stands for Rest, Ice, Compression, and Elevation. Wrapping your knee with an ACE wrap as well as getting your leg up on a pillow may help with pain and swelling.
- Consider over-the-counter medications such as ibuprofen or Aleve, which decrease inflammation and pain, or Tylenol, which decreases pain. There are also many creams and ointments that can be rubbed into the skin over the knee including Capsaicin-P and menthol type rubs such as Flexall and BENGAY.
- Wear a brace. There are a variety of knee sleeves and braces on the market as well as custom made braces. A sleeve or brace may decrease swelling as well as give a sense of stability. Some people wear them all day long, others wear them during certain activities.
- Keep active. Staying physically fit will keep your muscles strong, which can help knee instability symptoms. Smooth activities such as walking, elliptical, biking, and swimming are also beneficial with knee arthritis.
When to seek help
Some knee pain may be short-lived and calm down with time and rest. However, continuing trouble can begin to affect your social life as well as your work ability.
It may be time to seek help when you experience pain that you can no longer control with ice, over-the-counter medicines, or other home remedies. For obvious injury where there is concern of a broken bone, seek help at urgent care or an emergency room. For less urgent knee pain, call your primary care provider.
It will be helpful to know when it started, what makes it worse, what makes it better, and what treatments you have already tried. They will examine your knee to look for anything out of the ordinary. X-rays are normally the first test done, to show the bones that make up the knee as well as the thickness of your protective articular cartilage. Based on what your provider finds, they may recommend physical therapy, further testing, or referral to an orthopedic surgeon. Orthopedic surgeons specialize in the treatment of bone, joint, ligament, tendon, and muscles problems.