Knee pain can can be a sign of degeneration of the joints or a consequence of being overweight. It is also commonly reported by patients who have become injuried from sports or exercise.
When knee pain prevents you from being able to walk normally or if you notice that it gradually worsens over time, it may be a sign of a more serious problem, such as a ruptured ligament, osteoarthritis or Baker's cyst. These conditions can be confirmed through assessment and diagnostic imaging tests such as an x-ray or CT.
However, in most cases knee pain is not serious and can be treated at home by applying ice twice a day during the first 3 days from the onset of pain. In addition, the use of an elastic support band on the knee throughout the day can help to immobilize it and reduce pain while waiting for a medical assessment.
Main causes
The most common causes of knee pain are:
1. Injury from trauma
A knee injury can occur due to a fall, contusion, blow, sprain or fracture. In these cases, pain can be felt in the whole knee or in specific areas, depending on the type of injury.
What to do: Mild injuries can be treated with rest and cold compresses applied 2 to 3 times per day for 15 minutes. More serious injuries, like a fracture, should be assessed immediately for appropriate treatment. A physiotherapist can recommend exercises for recovery and to relieve pain.
2. Ligament rupture
The rupture of a knee ligament can occur from sprains, a direct blow, or from sudden twisting of the knee. The type of pain felt usually corresponds to the ligament affected:
- Pain on the side of the knee: This can indicate injury to the anterior collateral, posterior or the coronary ligaments.
- Pain when stretching the knee: This can indicate rupture of the patellar ligament
- Pain inside the knee: This can indicate injury to the medial collateral ligament
- Deep pain in the middle of the knee: This can indicate a rupture to the anterior collateral or posterior ligaments.
Generally, when a ligament injury is mild, it does not require any specific treatment, however it should still be assessed by a doctor.
What to do: Apply cold compresses 3 to 4 times per day for 20 minutes for 3 to 4 days. You should rest and use crutches to take load off of the knee. Elevate the affected leg to prevent swelling, and use a compressive bandage on your knee. In more serious cases, you should seek medical attention, as you will need to immobilize the knee with a brace for 4 to 6 weeks, and if necessary, perform surgery.
3. Tendinitis
Tendinitis is an inflammation of one or more of the knee tendons. The type of pain felt depend on the location of the affected tendon.
- Pain at the front of the knee: Inflammation of the patellar tendon
- Pain on the side of the knee: Inflammation of the iliotibial tendon
- Pain inside the knee: Inflammation of the goose foot tendons
Generally, one of the characteristic symptoms of tendinitis is knee pain when stretching the knee. It is most common in athletes, due to high-impact activities like running, cycling, soccer, basketball or tennis. In addition, some people may also experience a natural degeneration of the joint, which is more frequent in older adults.
What to do: You should rest and place a compressive bandage on the affected knee. Apply cold compresses for 15 minutes 2 to 3 times per day to help relieve pain and inflammation. It is important to see your doctor for assessment and for treatment with anti-inflammatories like ibuprofen or naproxen. In addition, you can participate in physiotherapy to strengthen the knee muscles and prevent further flare-ups of tendinitis.
4. Bursitis
Bursitis is an inflammation of the bursa, which is a small fluid-filled sac that acts as cushion between bones, tendons and muscles within the joints.
O+The knee contains 11 bursae, and generally activities that require repeated bending of the knee, sports (like jiu-jitsu, soccer, and volleyball) or falls or blows to the knee can cause bursa irritation or inflammation. These injuries can cause pain and swelling to the top of the knee.
In addition, obesity and arthrosis can contribute to bursitis anserine, also known as goose foot bursitis. This type of pain is felt internally, below the knee.
What to do: You should rest and apply cold compresses for 15 minutes, 2 to 3 times per day. In addition, bursitis can be treated with oral anti-inflammatories like ibuprofen or diclofenac. The doctor can also inject corticosteroids directly into the bursa. Other treatments include physiotherapy and surgery.
5. Osteoarthrosis
Osteoarthrosis, or arthrosis, in the knee is a rheumatic illness that causes degeneration of knee cartilage. It decreases the quality, quantity and thickness of cartilage, leading to chronic pain.
This illness can impact activities of daily living due to knee pain that is felt when walking, at the end of the day, with prolonged standing or when going up stairs.
What to do: It is important to see your doctor for treatment, which may involve the use of analgesics like acetaminophen, or anti-inflammatories like ibuprofen or diclofenac. In addition, you should participate in physiotherapy. In some cases, the doctor may inject the affected knee with corticosteroids or hyaluronic acid.
6. Rheumatoid arthritis
Rheumatoid arthritis is a chronic, inflammatory autoimmune disease that causes stiffness, pain and swelling in the joints. Knee pain when waking can be caused by rheumatoid arthritis. Pain is most intense in the first few minutes of the morning and improves with movement.
Knee pain and swelling without any apparent cause can be a sign of rheumatoid arthritis.
What to do: You can use analgesics and anti-inflammatories to relieve pain, but you should be monitored by a rheumatologist to guide treatment, as well as a physiotherapist to improve knee movement.
7. Iliotibial band syndrome
Iliotibial band syndrome causes pain to the side of the knee and is most common in runners, cyclists and other athletes that require repetitive bending of the knee. Generally, this syndrome is related to weakness and poor muscular flexibiltiy, or inappropriate training at high intensity or heavy lighting. Other training factors that can contribute to IBS include the type of floor used, shoes or inadequate form. This type of pain should not be ignored, as it can worsen over time.
What to do: You can apply topical anti-inflammatories to the knee 2 to 3 times per day or apply cold compresses for 15 minutes at a time. If performing physical activity regularly, it is important to also invest time in movements that strengthen and stretch the knee muscles. These can be guided by a personal trainer.
Nonetheless, if the pain on the side of the knee is felt when exercising, you should see your doctor for diagnosis and treatment with anti-inflammatories like diclofenac or ibuprofen. You should also see a physiotherapist to strengthen the knee muscles.
8. Meniscus injury
Injuries to the meniscus can cause symptoms like knee pain when bending the leg, pain in the internal knee, pain when going up stairs, or pain with squatting. Generally meniscus injuries are caused by physical activities like jiu jitsu or with normal aging of the knee, which can happen around 40 years of age.
What to do: You should rest and avoid activities that require too much knee movement. You can also participate in physiotherapy to strengthen the knee muscles. The doctor may opt to inject the affected knee with steroids or hyaluronic acid. Serious cases require surgical repair.
9. Patella problems
Other common causes of knee pain are problems in the patella, like patellar chondropathy, which is characterized by degeneration of the joint around the patella, or patellar chondromalacia, which is a softening of the patellar cartilage. Generally, patella problems are related to aging, obesity, flat feet or sports involving running.
Patellar injuries can cause pain in the knee with squatting or pain when going down stairs. You may also feel like your knee is displacing.
What to do: Runners are advised to temporarily try other sports, like swimming or water aerobics until the knee muscles are stronger. A physiotherapist can help to strengthen the knee. Once pain is relieved, you should participate in strength training as guided by a personal trainer. The doctor may opt to inject the affected knee with steroids or hyaluronic acid. Serious cases require surgical repair.
10. Baker’s cyst
A Baker’s cyst, also known as a popliteal cyst, is a lump that forms behind the knee joint due to accumulation of fluid. It causes pain behind the knee, as well as swelling, stiffness and pain with bending that worsens with physical activity. These cysts care caused by osteoarthritis or rheumatoid arthritis.
What to do: You should rest and see your doctor for assessment. Treatment may involve aspiration of the cyst fluid, or injections with corticosteroids directly to the cyst. Cysts that rupture require surgery.
11. Osgood-Schlatter Disease
Osgood-Schlatter disease is an inflammation of the patellar tendon. It is related to fast growth and can occur in children between the ages of 10 to 15 years old. Generally, pain is felt after physical activities like soccer, basketball, volleyball or gymnastics. The pain is usually noted in the lower knee and resolves with rest.
What to do: You should rest and limit the physical activities that cause pain. In addition, you should be monitored by your doctor.
Natural and medical treatment options
Oral anti-inflammatories like ibuprofen or diclofenac can be used as advised by your doctor, however topical ointments can also provide significant pain relief. Both forms can be accessed at the pharmacy without a prescription.
There are also foods you can incorporate into your diet that contain anti-inflammatory properties. Some exampels include salmon, chia seeds, crab, saffron, macerated garlic and ginger teas, for example.
Pain caused by severely damaged knee tissues may require surgery for repair or replacement. Mild to moderate pain can be treated more conservatively with alternative treatments. Other options to consider include:
- Homeopathy: Use of homeopathic remedies containing Ruta Graveolens, Rhus tox or Bryonia, prescribed by your orthopedist, can help to treat knee inflammation caused by arthritis or tendonitis;
- Compresses: Apply a hot compresses with 3 drops of sage or rosemary essential oil twice a day, from the 3rd day after symptom onset;
- Acupuncture: This technique can help to relieve knee pain related to arthritis, osteoarthrosis, or trauma;
- Knee rest: consists of bandaging the knee to immobilize and support it, especially when you anticipate you will be standing for a long time.
There are also foods you can incorporate into your diet that contain anti-inflammatory properties. Some examples include salmon, chia seeds, crab, saffron, macerated garlic and ginger teas, for example. You should also avoid sugary foods because they can aggravate inflammation in any part of the body. Read more about an inflammatory diet and which foods are most recommended.
Other natural ways to relieve knee pain
When experiencing knee pain, you should avoid activity like running or walking, picking up heavy weights and sitting on high chairs.
Keep in mind that any alternative treatment for knee pain should not replace the treatment indicated by the doctor as it may worsen the problem that caused the knee pain originally.
When to see a doctor
You should seek medical attention if you experience any of the following:
- The pain lasts for more than 3 days, even after resting and applying cold compresses;
- The pain is very intense when doing daily activities such as ironing while standing, carrying your child, walking or climbing stairs;
- The knee won’t bend, or it makes a noise when moving;
- The knee appears visibly deformed;
- Other symptoms appear like fever or tingling;
In these cases, the doctor may opt to order imaging tests, like an x-ray or MRI, to diagnose the problem and recommend appropriate treatment.
