What Causes Knee Pain?
There are many ways knees can be injured such as damaging the cartilage, ligaments, bones, tendons and/or muscles. All these structures work together so any pain you feel in your knees should be identified and addressed to prevent additional injuries.
Common Mechanical Issues
- Dislocated Kneecap: When the patella, a protective knee bone, slips out of place.
- Iliotibial Band Syndrome: When the iliotibial band rubs against your thigh bone it can become tight and cause pain.
- Loose Body: The result of an injury or natural break where bone or cartilage falls into the joint space and can impede normal joint motion.
- Patellofemoral Pain Syndrome: Pain arising between the kneecap and the underlying thigh bone due to abnormal biomechanics or joint alignment.
- Hip and Foot Pain: When injured, you may compensate and change the way you walk to avoid pain. However, this change may put more stress on your knee.
Common Knee Injuries
- ACL Injury: A tear of the ACL, or anterior cruciate ligament. It is a common injury for athletes with more aggressive sports requiring plenty of running or movement. The ligament is one of four that connect the femur to your tibia.
- Knee Bursitis: Bursae are small fluid-filled sacs found around the knee joint that can become inflamed and painful.
- Torn Meniscus: Your meniscus is knee padding/cushioning between the two knee bones (shinbone and the thigh bone). Injuries typically occur due to twisting your knee when putting too much weight on it.
- Patellar Tendinitis: Irritation and inflammation of the patellar tendon due to strain or injury.
- Fractures: There are two types of fractures. Stress fractures can occur due to sudden increase in one’s activity
- Tendonitis: General term for excessive loading or overuse of the tendons resulting in inflammation and pain.
Arthritis that Affects the Knee
- Gout: A type of arthritis that occurs when uric acid crystals build up in the knee.
- Pseudogout: Like gout, but caused by calcium containing crystals instead.
- Rheumatoid Arthritis: A chronic autoimmune disease that progressively destroys joints and can lead to deformity and disability. Common joints include hands, wrists, feet, elbows, knees.
- Osteoarthritis: The most common type of arthritis that occurs due to wear-and-tear of the knee’s cartilage.
- Septic Arthritis: An infection of the knee joint caused by bacteria or viruses. Septic arthritis is often associated with redness, warmth/heat, swelling, fatigue and fevers. Urgent treatment is necessary to prevent spread to the bloodstream.
Potential Risk Factors for Knee Problems
- Previous Injury: A previous knee injury means your knee is more susceptible to another injury.
- Lack of Exercise and Physical Activity: Without exercise, your body loses strength and flexibility. Joints become stiff and more likely to get injured. You need strong, flexible muscles to keep your knee protected and moving as they should.
- Being Overweight: Excess weight causes stress on your knees throughout your day and increases the risk of osteoarthritis. Losing 1lb is the equivalent of losing 5lb for your knee.
- Playing Sports or Certain Jobs: Sports or jobs that involve repetitive movement and use of the legs place a large amount of stress on the knee joints.
Preventing Knee Injuries
- Exercise: Make sure to condition your muscles for any labor or sports you will be participating in. Practice your movements in order to keep the stress on your knees to a minimum. The stronger your body, the more balance and stability you will have and you will be less likely to overstress your knee.
- Keep Yourself at a Healthy Weight: You should aim to maintain a healthy weight to ease the pressure off your knees. Your knees are at greater risk of arthritis or injury with every pound of pressure on them. Aim for a body mass index (BMI) of less than 25. Calculate your BMI here.
- Stretch: Tight muscles can impede normal joint motion and lead to injuries. Prevention is the way to go, keep your muscles limber and stretch regularly.
- Know Your Limits: Be sure to consider any past injuries or problems with your knees before putting extra pressure on them. Osteoarthritis and chronic knee pain may worsen if you continue participating in high-impact exercise. Listen to the signals from your body and talk to your doctor if you are unsure or not improving as expected.
Knee Self Care
If you are feeling pain in your knee or knees, try not to aggravate them and manage any symptoms to prevent them from worsening.
- Rest: If you are having an acute (sudden worsening) of knee pain, allow yourself to rest. Avoid strenuous activity, keep your weight off the affected knee. Once pain begins to subside, gentle range of motion is encouraged to maintain normal joint motion.
- Place a Pillow Under the Knee: Sleeping with a pillow either under (face up sleeping) or between your knees (side sleeping) can help with nighttime pain or discomfort.
- Wear an Elastic Sleeve or Brace: These help by providing support and reducing swelling. Avoid long term use, as this could lead to weakening of your muscles.
- Apply Cold Packs/Ice: Reduce inflammation and swelling by applying ice or a cold pack. Always place a protective layer between your knee and the ice (pillow case, plastic bag, etc) and remove ice every 20 minutes to avoid skin injury.
When to Seek Medical Help
You should contact a medical professional for treatment if:
- Knee pain persists after several days.
- You cannot bear weight.
- Pain is severe at rest (while sitting).
- If you cannot bend or straighten your knee all the way.
- You have associated leg symptoms of swelling, tingling, discoloration or numbness.
How Your Knee Injury is Diagnosed
Medical professionals will take your medical history and perform a physical examination. They may also test the knee for problems using the following:
- Musculoskeletal Examination: Examines the structural integrity of the ligaments, muscles, meniscus, tendons and joints, and assesses the strength and stability of the joints.
- X-Rays: A quick, effective and painless way to evaluate your joints and bones. Radiation is passed through the affected area and images are then evaluated by your physician and/or a radiologist.
- Computed Tomography Scan (CT Scan): Similar to x-ray, but many more images are taken to produce a more detailed 3D visual of the affected body part. Typically takes 20-30 minutes.
- Magnetic Resonance Imaging (MRI): Large magnets are used to create detailed images of soft tissue (structures other than bones). They give detailed 3D images of structures such as the knee cartilage, tendons, and ligaments.
- Radionuclide Bone Scan: A small amount of radioactive material is injected and tracked to look for areas of increased and abnormal activity.
- Arthroscopy: An invasive way to visualize the joint space directly through cameras inserted into the knee. This is done in an operating room setting and requires sedation and/or anesthesia.
Is Post-Surgery Knee Pain Common?
Patients who suffer from chronic knee pain due to severe osteoarthritis often view surgery as their only remaining option. For most of these patients, arthroplasty (joint replacement) is a highly effective procedure that helps reduce or completely eliminate their pain. A total knee arthroplasty has, on average, a 93% success rate for pain relief, approximately 2% complication rate, 90-95% 10 year success rate and 80% 20 year success rate.
Arthroscopy is another type of knee surgery that can be used to clean up the inside of the knee or repair torn ligaments if severe osteoarthritis has not already occurred.
Surgery is still an invasive procedure that comes with inherent risks. Some of those include complications and incomplete pain relief. Not all causes of knee pain can or will improve with surgery.
How is Post-Surgery Knee Pain Addressed?
The experienced team of interventional pain physicians at Garden State Pain & Orthopedics specialize in treating patients who suffer from knee problems after having knee surgery. They provide a full scope of treatment options, including:
Viscosupplementation treatment is a therapeutic solution that contains hyaluronate, a substance that occurs naturally in human joint fluid that lubricates and cushions your knee joint. The pain management specialists at Garden State Pain Control use Synvisc-One injections to relieve knee pain and improve function.
Genicular Nerve Blocks
Genicular nerve block injections are commonly used to address knee pain both before and after surgery. In the case of chronic knee pain, your pain management physician can treat the nerves with anesthetic medications, and a longer lasting procedure, radiofrequency ablation (RFA) to help alleviate pain and improve function.
Corticosteroid (“Steroid”) Injections
Steroid injections use an anti inflammatory medication to relieve pain flare ups. Relief typically lasts about 3 months. The number of injections that can be given in a year is limited due to risk of side effects.
Dorsal Root Ganglion (DRG) Spinal Cord Stimulation
Dorsal root ganglion (DRG) spinal cord stimulation involves surgically placing a small catheter directly over the dorsal root ganglion in the spine. The stimulation provided helps block and disrupt pain signals in your legs from reaching the brain.
Platelet Rich Plasma (PRP) Injections
Platelet-rich plasma (PRP) injections help alleviate knee pain while restoring function. The therapy, which uses a small amount of your own blood plasma injected directly at the source of pain, harnesses the power of highly-concentrated growth factors to promote healing and rapid soft tissue, cartilage, and bone regeneration.