Knee

 

Do you have knee pain?

The knee plays a large role in your everyday life. It helps you walk, stand, run, jump, navigate stairs, and sit down and stand up from a chair. The knee joint must take the primary load of your body weight, so it is no wonder why it is commonly injured!

The knee can be painful in all different age groups, and there are multiple causes of knee pain. There can be a specific injury that caused the knee to become painful, or the pain can come on suddenly without any known cause.

What Causes Knee Pain?

There are various causes of knee pain, but to simplify things, we can divide the causes into three main types: sudden/traumatic injuries, overuse injuries, or underlying conditions.

Traumatic Injuries

• Typically occur in younger population (ages 15-40)
• Acute injury (pain begins immediately)
• Commonly see increased swelling and inflammation
• Pain is linked to a specific event:
  • Fall
  • Sudden twisting motion or a sharp turn
  • Blow to the knee
  • Car accident
  • Sports injury (foot is planted and knee twists)

Examples of Traumatic Injuries:

• Ligament Injuries (tear or sprain)
  • ACL Injury
• Tendon Injuries
  • Patellar Tendonitis, Quadriceps Tendon Tear
• Meniscus Tears
• Muscle Strain
  • Hamstring Strain, Calf Strain, Quadriceps Strain
• Fracture
  • Patellar (kneecap) fracture, Tibial Plateau fracture (top of shin bone)

Overuse Injuries

• Can occur in any age group, but most common in ages 25-50
• Typically there is no specific injury that causes knee pain
• Pain can either start out gradually and then get worse over time or can become extremely painful all of a sudden
• Due to repetitive stress due to poor body mechanics, muscle imbalances, and/or tight muscles

Examples of Overuse Injuries:

• Patellar Tendinitis (Jumper’s Knee)
• Runner’s Knee (Patellofemoral pain)
• IT Band Syndrome

Poor body mechanics:

The knee also can become painful due to issues at the hip or ankle joints. If there is hip weakness, this can change the alignment of the hip which can then cause excess stress at the knee joint. The same thing can occur at the ankle joint, especially when someone over-pronates. We often see that the ankle or hip is the culprit of the dysfunction, but the knee is the victim of the pain!

Underlying Conditions

• Common in older population (age 55 and up)
• General wear and tear
• Pain can occur suddenly or gradually over time

Examples of Underlying Conditions:

• Osteoarthritis
• Rheumatoid Arthritis
• Pseudogout

Signs and Symptoms of Knee Pain

Symptoms for knee pain can depend on the underlying cause of the pain. Some common symptoms that patients often report are:

• Stiffness
• Swelling
• Clicking or popping
• Catching sensation
• Knee giving out or buckling

The location of your pain can also give clues to what is causing your pain.

ACL Tear

ACL stands for Anterior Cruciate Ligament, and this ligament connects the thigh bone (femur) to the shinbone (tibia). This ligament helps stabilize the knee by preventing the shinbone from sliding forward. Damage to this ligament can occur when someone plants their foot and pivots, quickly changes directions while running, or landing from a jump with a hyper-extended knee.

Injuries to the ACL often occur in the athletic population, specifically in sports such as soccer, tennis, basketball, and skiing. Common symptoms of an ACL tear include hearing a pop in the knee followed by intense pain and swelling. Patients also report a feeling of instability in the knee.

Meniscus Tear

The meniscus is a rubbery piece of cartilage that cushions the knee joint and acts as a shock absorber. You have a medial meniscus in the inside of your knee and a lateral meniscus in the outside of your knee.

The meniscus can frequently become injured and tear due to twisting movements. This can occur in the younger population during sports injuries, and often one of the cruciate ligaments is also torn. Meniscus tears can also occur in the middle aged population. As you age, your cartilage begins to thin down, making it easier to tear the meniscus with less intense activity.

Common symptoms include hearing a pop, catching, locking, swelling in the knee, stiffness, and decreased ability to straighten your knee.

Runner’s Knee (Patellofemoral Pain Syndrome)

Pain in the front of the knee and around the kneecap is extremely common. The patellofemoral joint is the joint where your kneecap (patella) meets your thigh bone (femur). There are various causes to pain on and around the patella including:

• Structural issue in the joints
• Having knock-knees or bow-legged
• Tightness in the thigh and calf muscles
• Weakness in the hip and/or ankle muscles
• Muscle imbalances causing the kneecap to become stiff
• Overuse or excessive training

Symptoms may include pain in the kneecap while you are walking, running, jumping, going up or down stairs, squatting, or kneeling. Pain can also occur if you sit for a while and then stand up. Patients can also report clicking, grinding, or instability in the knee joint.

Muscle Strain or Injury

Muscles surrounding the knee such as the quadriceps, calf, and hamstrings muscle can become injured and cause pain in the knee. Injuries to the muscles can occur suddenly due to a specific injury or gradually over time. 

An acute injury to a muscle can occur if you suddenly trip, fall, or twist your knee. You can also injure your muscles if you are fatigued and overstretch your muscle, often during a sporting event. Often you have heard someone say they pulled a muscle, and this refers to a muscle strain. Muscle strains often result in localized swelling, pain when attempting to stretch the muscle, and muscle spasms.

Muscle injuries can also occur over time and are not linked to a specific injury. If you recently started a new type of exercise or workout routine, the muscles in your thigh and lower leg can become overworked and develop trigger points (knots). Trigger points cause a muscle to become weakened and can refer pain to the knee.

Osteoarthritis

You have cartilage at the end of your thigh bone (femur) and at the end of your shin bone (tibia). Cartilage acts as a cushion for your joints, but as you age, cartilage begins to break down and thin out. As it wears away, the joint space narrows and becomes more bone on bone which causes your knee to feel stiff and very painful.

There are various stages of osteoarthritis (OA) in the knee, and most people often do not realize that they have OA in the early stages. But as the condition progresses, the inflammation increases and bone spurs (osteophytes) can also occur. 

The most common symptoms of osteoarthritis are:

• Gradual onset of knee pain which becomes worse over time
• Knee stiffness, especially first thing in the morning or after prolonged sitting
• Loss of knee range of motion
• Increased swelling or enlargement of the joint
• Pain standing up from a chair

Tips for Managing Your Knee Pain

Physical Therapy for Knee Pain

In the majority of cases, knee pain can be successfully treated through Physical Therapy. Even if you were told by your doctor that you were a candidate for knee surgery, give PT a try first! Meniscal tears, ligament tears, and osteoarthritis can be treated through PT to help reduce your pain and improve your range of motion and strength.

During your first session, your PT will ask you multiple questions so he/she can figure out what is the underlying issue of your pain. These questions could include:

• What leg movements cause your pain?
• How did your knee symptoms begin?
• Did you injure your knee or did the symptoms begin gradually?
• Did you start any new workout routines such as running or weight lifting?
• What activities are you unable to perform due to your knee pain?

The initial goal of PT is figuring out what is the source of your knee pain, whether it be a muscle strain, ligament damage, meniscus tear, osteoarthritis or another type of knee injury. This will help create a treatment plan that was designed specifically for you. Typical PT sessions will include:

• Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms.
• Range of Motion and Stretching Exercises: Often your knee motion becomes limited due to pain. Your PT will prescribe you stretches for the muscles around your knee to help regain your mobility and allow you to move your knee with less pain.
• Strengthening Exercises: The quadriceps and hamstring muscles are typically weakened which makes it challenging to perform your daily activities such as walking, navigating stairs, and standing up from a chair. Your PT will give you strengthening exercises for your weakened muscles in the thigh and hip to reduce the strain in your knee. 
• Manual Therapy: Hands-on treatment also assists in loosening your tight knee muscles and improving the stiffness in your knee joint. Dry needling is also an effective approach for relieving knee pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of knee pain.

Conclusion

Knee pain is very common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had knee pain for years or just started experiencing knee pain recently, we can assist in alleviating your pain! Click here or fill out the form below to schedule an appointment!