Knee Pain: What Causes It, How to Treat It and When to See a Doctor
Knee pain is a common problem that many people experience. According to a report, knee pain affects approximately 25 percent of adults, and accounts for nearly four million primary care visits annually. Knee pain can be inside or around the knee. The joint is made up of four bones—femur, tibia, fibula, and patella—and four compartments—medial and lateral tibiofemoral, patellofemoral, and the superior tibiofibular joint. Knee pain limits the ability to move and function and ultimately can impair one's quality of life.
What are the common causes of knee pain?
Knee pain can be caused by repetitive injury, traumatic injury, or as part of the normal aging process.
Osteoarthritis of the knee is the most common type of osteoarthritis, affecting more than 12 million people over 65 years of age. It occurs when the cartilage in the joints breaks down and causes pain and stiffness that limit movement and function. This happens gradually over time as a result of repetitive load on our joints with insufficient self-repair, or may be as a result of a previous injury to a joint.
Patellofemoral Pain (PFP)
The most common cause of knee pain seen by doctors is a Patellofemoral Pain (PFP), which is estimated to affect one in four adults every year. This condition occurs when there is too much pressure on the patella, the small bone at the front of the knee joint (also called the kneecap). This can happen due to repetitive motions, such as running or jumping, improper shoe support, muscle imbalances, or excessive changes in one's exercise routine. Abnormal tracking or alignment of the kneecap can also occur as a result of bone structure or muscle imbalances. Evidence suggests that early physical therapy intervention (within 30 days of diagnosis) can decrease the need for unnecessary imaging and medication management.
Iliotibial Band Syndrome (ITBS)
IT band syndrome is a condition that occurs when the iliotibial band, a ligament that runs from the pelvis over the lateral hip and knee, inserting below the knee joint, becomes tight or inflamed. This can happen due to repetitive motions, such as running or cycling, along with weakness in the stabilizing gluteal muscles. The iliotibial band helps to stabilize the knee, so when it becomes tight or inflamed, it can cause lateral knee pain above and below the joint.
A meniscus tear is a common knee injury. The meniscus is a C-shaped piece of cartilage that sits between the femur and tibia and acts as a shock absorber for the knee joint. An acute tear can occur due to trauma, such as a direct knee blow, while a chronic tear can occur due to repetitive motions, causing wear and tear of the joint over time. Common symptoms of a meniscus tear may include clicking, locking, or catching of the knee joint. The joint is often swollen and sometimes may experience knee buckling, the sensation of the knee giving out.
Bursitis occurs when the fluid-filled sacs that cushion the joints become inflamed. Bursitis in the knee can be caused by overuse, injury or infection. Bursitis in the knee joint can cause pain and limitations in motion, making it difficult to bend and straighten your knee.
How is knee pain treated?
There are several different treatment options available for knee pain. The type of treatment that is right for you will depend on the cause of your knee pain.
Knee pain relief
Traditional knee pain relief for acute pain includes home care such as rest, ice, compression, elevation, and over-the-counter pain medication per your physician's recommendation.
Physical therapists are movement specialists that can help restore your motion and strength for quick return to the activities that matter most to you. They can help educate on pain management techniques to reduce the need for medications, especially opioids and other invasive procedures, such as steroid injections.
Protecting the joint can be achieved with a few different methods. You can decrease the load on an inflamed joint by using an assistive device, such as a cane, walker, or crutches, or brace or kinesio tape to stabilize the joint, as recommended by your healthcare provider. Improving your posture, movement techniques and joint alignment will help reduce knee pain. Using modifications to activities (such as sliding a heavy box rather than lifting it) can also help.
Knee strengthening exercises
Muscle imbalances and weaknesses put increased load and pressure on the knee joint. Often, strengthening the hip muscles, specifically the glute muscles, will restore normal balance and function. Exercises for knee pain also include targeting muscles in the thigh (quadriceps and hamstrings), lower leg (gastrocnemius, soleus, posterior and anterior tibialis) and core (midsection). A physical therapist can help identify which areas need to be addressed and help guide you through progressive exercises while demonstrating how to move correctly and safely.
Stretching the muscles and ligaments from the pelvis down to the foot are essential for maintaining flexibility and preventing pain around the knee joint. Some of the best stretches for knee pain relief include:
- hip flexor stretch
- gluteal stretch
- hamstring stretch
- quadriceps stretch
- calf stretch
- iliotibial band stretch
- gastrocnemius/soleus muscle stretch
Take care when beginning an exercise routine and don’t ignore or push through pain. Instead, build up the exercises slowly and steadily, and seek out a physical therapist to assist you in the process.
When to see the doctor about knee pain
Knee pain that is severe or does not improve with prescribed exercise interventions requires medical attention. Additionally, if you notice any of the following symptoms, make note of their frequency and severity so you can discuss with your health care provider.
- redness or warmth around the joint
- swelling around the joint
- inability to put weight on the affected leg
- knee pain that wakes you up at night
- joint instability
- locking or catching sensation in the knee
- popping or grinding noise when the knee is moved
These could be signs of a more serious condition and should be discussed with your primary care provider.
Evidence suggests that physical therapy is effective in managing osteoarthritis of the knee over steroid injections. In severe cases of osteoarthritis, surgery cannot be avoided and a knee joint replacement may be recommended. Working with a physical therapist before and after your surgery can help with quicker recovery from surgery.
How to prevent knee pain
While strenuous or repetitive exercise can lead to knee pain, a combination of moderate cardiovascular exercise and strength training can help prevent not only knee pain but other joint injuries as well. Incorporating strength training that targets the muscles around the knee will help protect joints from repetitive injury, improve balance, increase endurance, and help improve your metabolism.
How can physical therapy help with your knee pain?
Physical therapists are movement experts who diagnose and develop treatment plans to restore movement, reduce pain, improve function, and prevent injury and disability. Among the services a physical therapist can offer:
- patient education on developing a proper individualized exercise program
- pain-management techniques
- mobility exercises to restore lost motion
- manual therapy to restore normal joint motion
- progressive strength training of the core, hip, knee, and ankle muscles
- functional training to return to your unique goals, safely, slowly and with controlled movements in a monitored environment
- recommendations for braces and assistive devices for stability, to reduce pain, unload joint, and reduce and control swelling
At Lifespan Rehabilitation Services, we can help you make lifestyle changes to manage your knee pain or improve your overall health and well-being. Exercise can reduce pain and improve function. Choose exercise, choose to move, choose physical therapy.
Visit us online to begin your comprehensive patient-focused rehabilitative journey.
About the Author:
Julie Valois, MPT, DPT, C-PS
Julie Valois, MPT, DPT, C-PS, is a physical therapist with Lifespan's Adult Outpatient Rehabilitation. Valois is functional movement screen certified and has completed the National Academy of Sports Medicine Optimum Performance Training for performance enhancement. Her special interests include orthopedics, running, and the female athlete.