Knee pain

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Knee Pain

Knee pain is quite common in people of all ages (right from children to old people) and can be caused due to a physical injury or during an exercise. While in most cases, you can treat this condition at home, in some you may require medical assistance. And knowing about its risk factors, medications and home treatment can help you to manage this condition in a better way.

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Symptoms

Symptoms of knee pain may occur due to various causes. Given below are the symptoms of knee pain caused by different ailments and conditions. It is important to diagnose the cause of one’s knee pain so that treatment can be done accordingly.


  • In case the knee pain is caused by sprains or strains, the affected person may experience pain after doing exercises due to twisting, overusing or stretching the affected joints.

  • If the cause is tendinitis, one may experience pain between the shin and kneecap due to excessive and repeated actions like jumping or running.

  • Torn ligament, tendon, or damaged cartilage can cause wobbling, inability to stand or straighten one’s leg.  At the time of the injury, a popping sound may be heard.

  • In the case of Osgood-Schlatter's disease, which mostly affects teenagers and young adults, one might experience pain and redness due to inflammation below the kneecap.

  • In case of a dislocated kneecap, the kneecap will be displaced from its normal position to the joint’s outer aspect.

  • Osteoarthritis is a condition commonly affecting older individuals. Pain on activity and joint stiffness with mild swelling are common symptoms.

  • If the knees are warm to touch and red in appearance, and pain and inflammation increases on bending or kneeling, these symptoms can be indicative of bursitis.



  • Warmth and inflammation may occur due to medications to prevent clotting of blood. This can be indicative of bleeding into the affected joint

  • Abrupt episodes of severe pain accompanied by inflamed joints can be indicative of septic arthritis or gout.

  • One might also experience knee pain due to a problem in the hips (known as referred pain), common in children. Slipped capital femoral epiphysis (SUFE) and Perthes disease are hip conditions that often present with knee pain.

Causes And Risk Factors

Causes

The common causes of knee pain include –

Injury

You may suffer from a knee injury that affects the ligaments and tendons surrounding the knee joint leading to pain and swelling. Some of the common causes of knee injury are –


  • Inflammation of the knee joint or tendons (fibrous tissues present in the knee region)

  • Sudden twisting (sprain) of the knee ligaments

  • ACL (anterior cruciate ligament) injury (this is common in people playing basketball or soccer)


Mechanical problems

  • Some the following mechanical problems may also cause knee pain.

  • Dislocation of the kneecap (knee cap slips out of place)

  • Pain in the hip region or foot

  • Iliotibial band syndrome (a condition in which the ligament that extends from the hip to the calf region and mostly affects distant runners)

  • Wearing rigid shoes used in sports like skiing and football increase your risk of knee pain. Even certain occupations recommend using protective footwear (which is tight and requires you to be on for 8 hours).

  • Also, high-heels are known to put pressure on your knee and leg.


Overuse

Certain repetitive actions can lead to knee pain.

  • Tendonitis, relating to the patella tendon or quadriceps - This usually occurs due to repetitive jumping actions performed by individuals in certain sports like basketball, volleyball etc.

  • Osgood-Schlatter disease. This condition occurs in children due to overuse of joints and muscles. It characterised by pain and swelling due to inflammation beneath the kneecap.

  • Patellofemoral pain (runner’s knee): Due to certain mechanical factors and the knee cap’s shape, pain may be experienced beneath or surrounding the kneecap.


Diseases and conditions

Even diseases affecting the knee joints and connective tissue also lead to knee pain. Some of the common ones are --

Arthritis

Gout

Lupus

Risk Factors

Here are some of the common factors that put you at risk of knee pain -

  • Being overweight or obese puts excess pressure on the knee joint that in turn makes you susceptible to knee problems or arthritis.

  • Structural abnormalities like having flat feet or one leg shorter than other

  • Lack of muscle flexibility and strength

  • In sports, rigid ski boots or basketball jumps increase stress on your knees

  • Having a history of knee injury

Prevention

Knee pain can occur suddenly due to muscle sprain or accidentally while playing sports. Hence, it is not always possible to prevent knee pain. However, you can follow these tips to prevent further worsening of the knee pain.

Shed weight: Every extra kilo you gain  adds to pressure on the knees, making them vulnerable to knee injury or pain. Hence, try to lose weight if you are overweight with simple weight loss techniques. However, it is advisable to avoid jumping and other high-impact exercises which put excess stress on the joints. Instead, opt for swimming or cycling.

Try yoga: Yoga can help strengthen your muscles and improve your body’s flexibility.

Avoid tight-fitting shoes: Make sure that the shoes you wear  are not too small or too tight but fit perfectly.  Avoid wearing high-heels or completely packed shoes for daily wear. To avoid stress while standing or walking on hard surfaces, it is advisable to wear comfortable shoes, with cushions or gel inserted into them. This can also help in such activities as gardening, which require individuals to stand for a prolonged time.

Get yourself tested: If you suffer from any diseases that might increase your risk of suffering from knee pain, it is better to get yourself diagnosed. With simple blood tests, you can detect various diseases like gout, lupus and arthritis.

Wear safety gears: The most important thing to keep in mind is to use protective gear while at work. And even children playing sports should take precautionary measures to avoid injury.

Diagnosis

Your doctor might do a physical examination followed by imaging tests and blood tests (in some cases).

Physical examination: Your doctor will inspect your knee for tenderness, warmth, and visible bruising or swelling. He will also make you move your lower leg in different directions and check the integrity of the knee.

Imaging tests: These include –


  • X-ray to detect bone fractures or degenerative disease of the knee joint

  • CT-scan to diagnose bone problems

  • Ultrasound to check for inflammation in and around the knee region

  • MRI to reveal injuries of the tendons, ligaments and muscles

  • A radionuclide bone scan is a test that identifies the blood circulation and cellular activity of the bone. This test utilises a minute amount of a radioactive substance into the affected individual’s bloodstream, which is then detected by a scanner.


Arthroscopy:  It involves insertion of a tiny, lighted tube (arthroscope) via a small surgical incision made at the joint. It helps in evaluating changes in the joint due to degeneration or arthritis, detection of diseases of the bone or tumour. It also helps identify the causative factors for the pain and inflammation of the joint.

Blood tests: If your doctor suspects that the knee pain is due to gout or any infection in the knee region, he may recommend blood tests for confirmatory results.

Treatment

Depending upon the exact cause of the knee pain, your doctor will decide the treatment. These are –

Medications: Your doctor might prescribe painkillers to relieve the pain if it is caused due to an injury or sudden sprain. However, if the knee pain is due to an underlying disease like gout or arthritis, medications are recommended.

Injections: In case of knee pain due to arthritis, corticosteroid injections to reduce inflammation are recommended. Although they are known to provide relief for a long time, these injections are not effective for all knee injuries.

Surgery: Your doctor will decide the surgical intervention to treat knee pain based on the infection’s severity and extent.


  1. Arthroscopic surgery– It involves the use of the fibre-optic camera.

  2. Partial or total knee replacement surgery– This surgery is done to treat severe joint arthritis. This surgery replaces the joint surface with metal alloy and polymer. If the damage to the joint is limited to a single compartment, then partial joint replacement might be recommended. Total joint replacement is done for severe joint arthritis involving both knee compartments.


Physiotherapy: In some cases, undergoing a physiotherapy session is what helps in providing relief from knee pain (caused due to various conditions). It focuses on strengthening the muscles of the knee and improves your balance.

Home Remedies

While OTC drugs and creams or ointments are the commonly preferred options to get rid of knee pain caused due to injury, here are some home care measures that can help you. But if the knee pain persists for more than two days or does not provide any relief with home care techniques, visit a doctor immediately.

Get some rest: In case of a minor knee injury, resting for a day or two is sufficient to get rid of the pain. If you feel that the stress to the knee increases due to exercising or climbing the stairs, take some rest as it may further worsen the condition.

Ice-packs: One of the quick and effective home-care measures to relieve pain is the use of ice packs to soothe the affected area. All you need to do is take a few ice cubes in a cotton cloth, wrap them and apply this pack on the knee.

Use compression: This technique helps to prevent fluid build-up in the tissues and thus, alleviates pain. However, choose the correct bandage compression as a tight one might interfere with blood circulation.

Lifestyle Management

An active lifestyle involving strengthening of muscles, such as exercises and activities that enhance an individual’s range of motion, can help. Some of the lifestyle changes which can be adopted are as follows.

Exercise: Aerobic exercises,  swimming, riding a stationary bike etc., can help in maintaining joint flexibility. Muscle stretching and strengthening exercise programs can help reduce the knee pain. Exercises can also help in weight loss which will prevent undue stress on the joints.

Diet: Consuming a nutritious, well-balanced diet can help in weight reduction and maintenance of optimal body weight to prevent excess stress and strain on the joints.

Prognosis And Complications

Prognosis

The prognosis for knee pain depends on the cause. Individuals often recover fully if the required treatment is done. Preventive measures can help individuals reduce the intensity of the pain. Recovery in teenagers may take time because their bone growth is still in process. Once they reach adulthood, the symptoms will disappear.

Complications

Knee pain does not usually indicate any serious illness. Resting adequately or performing physiotherapy can help alleviate knee pain. However, if knee pain is caused due to chronic ailments like osteoarthritis, then disability or damage to the joint may occur over the years.

Alternative Treatments


  • Glucosamine and chondroitin: Research has shown that chondroitin, which is one of the components of the cartilage of the knee, has properties of shock absorption and prevents collagen breakdown. Glucosamine, which is produced naturally in the body, helps in the building of collagen. Glucosamine also helps in the retention of water and the prevention of the breakdown of collagen. These have shown to reduce knee pain.

  • Acupuncture: It is a process of inserting fine needles into the part of inflammation of the knee. It has been shown to help reduce knee pain to some extent, especially if the pain is osteoarthritic in nature.

References

https://my.clevelandclinic.org/health/symptoms/21207-knee-pain

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