Knee Pain

This article was written, reviewed and contributed to by some of Australia’s leading experts in the field of knee pain and injuries. Our goal is to empower you with the knowledge to understand what’s causing your pain and alleviate any concerns or anxiety you may have.

Our goal is to enlighten you with some new information if knee pain is something you’ve been dealing with over a long period.

Included is a practical and actionable plan, backed by the latest medical research to treat your knee pain (including things you can do from home) and help you get back feeling your best.

Continue to read the information below as we guide you to understand the different types and causes of knee pain and discover what type you may have.

What is Knee Pain?

Knee pain is a term used to describe conditions or issues that lead to discomfort around the knee joint. Numerous injuries to structures can lead to knee pain, including the joint, muscle, cartilage and ligaments.

Examples of knee pain conditions include arthritis, anterior cruciate ligament tears (ACL tears), bursitis and ITB syndrome.

Knee pain is one of the leading physical health problems in Australia. According to the Royal Australasian College of Physicians, up to 35% of Australian adults will experience knee pain [1]. Trends from this study also point out that knee pain increases with age. Especially after the age of 70, people are 39-69% more likely to live with knee arthritis [2].

Pain is categorised as either acute, subacute or chronic knee pain

Acute knee pain: (0 days - 6 weeks)

Acute knee pain is pain that lasts anywhere from a few days, up to six weeks. The cause of acute knee pain is usually a minor injury, like a muscle strain or ligament sprain. Of course, not all pain is associated with damage, sometimes just sleeping awkwardly or doing something else may flare it up without any structural damage. This type of pain usually resolves itself with movement and appropriate rest.

Subacute knee pain: (6 weeks - 3 months)

Sub-acute knee pain usually results from acute pain that doesn’t quite resolve. This can be due to more serious injury or sometimes a poor recovery. If you are still aggravating your knee pain with painful movements then it may take longer to heal and recover.

Chronic knee pain: (3 months +)

Chronic knee pain is defined as pain that lasts longer than three months. Chronic pain is usually more complex and can be difficult to treat. There are usually multiple factors leading to the development of chronic knee pain, such as other injuries or health issues. Stress, lack of sleep and other lifestyle factors like obesity can increase the likelihood of chronic pain.

What are the symptoms of knee pain?

Knee pain is the primary symptom that may indicate a condition affecting the knee joint or surrounding tissues. These symptoms can vary from a mild and dull ache right through to sharp and stabbing pain. Knee pain is most commonly felt at the front of the knee or can be felt "in the knee".

Common complaints of pain in the knee

• Knee pain when bending

• Medial knee pain

• Lateral knee pain

• Knee pain when squatting

• Pain above the knee

• Pain in the back of the knee

• Swelling around the knee joint

• Difficulty bending and straightening the knee

• Feeling of instability or “giving away” of the knee

• Knee cap tenderness

• Popping or clicking sound during knee movements

People may experience

Pain areas: in the knee, calf, or thigh, muscles and bones

Sensory: calf numbness or pins and needles

Also common: instability or weakness

What causes knee pain?

Knee pain is commonly caused by injury to either the muscles, ligaments or bones that form the knee joint. Muscle and ligament injuries are usually caused from accidents and sporting injuries, whereas bone related problems usually occur over time and with age, such as osteoarthritis.

According to MedicineNet [3], knee pain is defined as “pain that originates in any of the bony structures compromising the knee joint (femur, tibia, fibula), the kneecap (patella), or the ligaments, tendons, and cartilage (meniscus) of the knee.”

Knee pain can result from an issue in one or several parts of the knee, including:

• Muscles (strain)

• Ligaments (sprain)

• Nerves

• Bone injuries - in the knee, the bones are the femur (top of knee), tibia (bottom of knee) and patella (knee-cap).

Common reasons why people experience pain in the knee

• Sitting for a prolonged time

• Sporting injuries

• Arthritis or inflammation of the joints

• Obesity or general poor health.

This list of causes is only a fraction of the possibilities, with many factors contributing to the possibility of knee pain.

Common injuries that cause knee pain

Patella tendonitis

Patella tendonitis is also known as jumper’s knee. It is the inflammation of your patella tendon which connects the kneecap to your shin bone. This occurs particularly with overuse and in sports like running.

Sprained ligament

Tears and damages to the knee’s ligaments are usually caused by direct impact to the knee or a sudden twisting motion of the knee during acceleration. An ACL injury is one of the most common injuries in contact sports.

Runner's Knee

A specific injury in relation to running, runner's knee describes knee pain around the kneecap (patella) due to structural defects or repeated stress on the knee from running.

Torn meniscus

Similar to a sprained ligament, this can happen with high pressure and a rotational force on the knee joint. Meniscus tears usually occur along with ligament injuries.

Osteoarthritis

Osteoarthritis happens when the cartilage that serves as a cushion in the joints wears down over time. As we get older, stress and microdamage accumulates in the cartilage of the knee joints.

Kneecap dislocation

It is often caused by a sudden change in direction while the leg is planted on the ground. Kneecap dislocation can also be caused by a direct blow to the knee cap.

Fractures

Fractures are rare, but they do happen, usually in the case of extreme force directed to the knee like a large fall. Some conditions which result in brittleness or a decrease in bone density can also increase the risk for bone fracture (e.g., osteoarthritis).

Common conditions that cause knee pain

Some conditions may cause knee pain. If you have any of these conditions, knee pain could be one of the symptoms:

• Osteoarthritis

• Rheumatoid Arthritis

• Lupus

• Psoriasis

• Gout

Sports that increase the risk of knee pain

Previously, we listed some of the more common causes of knee pain, like prolonged sitting or osteoarthritis. However, knee pain may also occur when playing sports.

Sporting events that rely heavily on agility put a tremendous amount of stress on the knee joint and the structures around it, resulting in potential injury or pain over time. Here is a list of the most common sports that result in knee pain:

• Basketball

• Football

• Gymnastics

• Competitive cheerleading

• Running

• Soccer

• Tennis

Other risk factors include

Knee pain can occur at any stage of life, even in teenagers and children. However, these risk factors might increase your likelihood of getting knee pain:

• Excess weight - Being overweight or obese increases the mechanical load on your knees, even during basic activities like walking or taking the stairs. It also increases your risk of osteoarthritis by accelerating the breakdown of joint cartilage.

• Lack of muscle flexibility or strength - Having poor flexibility or weakness of the knee muscles can be a risk factor for knee pain. Strong muscles help maintain good control and protect your joints from injury, and muscle flexibility can help you achieve full range of motion.

• Certain sports or occupations: - There are obvious sports that put more stress on your knees than others. Skiing is a likely problem, with stiff boots and fast turning actions. Basketballers are at risk with jumps and pivots, combined with the fast-paced running up and down the court. Working in construction or other highly physical jobs can also increase the risk of knee pain.

• Previous injury - Recurrences of knee pain are unfortunately more likely once you have injured your knee. Good rehabilitation is the key to preventing that!

How is knee pain diagnosed?

There are several options available to you when it comes to diagnosing the underlying cause of your knee pain. One of the most common, and one that is most recommended by Australian GP’s, is an assessment from a physiotherapist.

Knee pain is very common and is a problem that physiotherapists see on a regular basis. The process of diagnosis is straightforward.

Like visiting a GP, your assessment will start with your physiotherapist asking you vital questions about your problem – this is referred to as a consultation. Your consultation will last for about 30 to 60 minutes. Take this time to discuss relevant issues relating to your knee injury.

After establishing the background of your condition, your physiotherapist will perform specific physical tests to determine the most likely cause of your pain and rule out other conditions.

Following your initial assessment, your physiotherapist will provide you with a tailored treatment plan based on your condition.

From here, your physiotherapist will give you the details of your treatment program.

This will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and prevent worsening of the condition

• Timeline for complete recovery.

How is knee pain treated?

Having knee pain can be quite distressing and certainly limit your daily activities, getting worse if left untreated.

There are several options when it comes to treating knee pain. One of the more common, and the treatment option that is referred to by Australian GP’s the most, is physiotherapy.

Knee pain is something that physiotherapists come across regularly, and the process of treatment is straightforward. Following an initial consultation, the physiotherapist will be in the best position to determine your specific treatment plan.

A combination of manual therapy, stretching, and specific movement exercises will be given to you by your physiotherapist. Depending on the severity and root cause of your knee pain, a physiotherapist may provide you with a combination of the following types of treatments:

• Education and professional advice - Speaking to a physiotherapist is vital in gaining the correct information regarding knee pain

• Manual therapy - Hand-on physiotherapy, used to help reduce pain and increase range of motion

• Soft tissue and joint mobilisation - Specific joint mobilisations are used to reduce stiffness in particular areas

• Therapeutic exercises - Specific exercises tailored to improve your knee pain

• Stretching - Stretching will help lengthen muscles and increase range of motion

• Dry needling - A technique used to help alleviate pain and reduce muscle tension

• Therapeutic massage - Another hands-on-technique, primarily used to reduce muscle tension

• Heat and electrotherapy - Used to reduce tension and pain in acute situations.

A typical physiotherapy session with a local physiotherapist will last anywhere between 30-60 minutes, and it is not uncommon for patients to feel the benefits in just one session.

Next step: Creating a treatment plan made for you.

Following your initial appointment, your physiotherapist will craft a tailored treatment plan that will highlight the course of action required, including what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.

Self-care strategies

If you are experiencing knee pain, here are the best things you can do:

1. Cold compress

If there’s a significant inflammation around the knee, consider applying a cold compress for about 10 to 15 minutes. This will reduce the amount of swelling and pain in your knee joint.

2. Take a break

Listen to your body and rest. Watch out for the signs of inflammation and symptoms of a knee injury. Give your body time to heal by decreasing your activity for the day.

3. RICE (Rest, Ice, Compression, Elevation)

If you just had an injury or trauma to the knee, use the RICE protocol to control the inflammation. RICE is crucial in the first 24 hours after the injury. This will help you reduce the pain and reduce swelling.

4. Worst case scenario, use crutches

Crutches may seem extreme, but they are great at allowing you to decrease the load on your knee and assist you in walking, minimising any potential damage to your knee during the initial stage of the injury.

Things to avoid:

• Avoid high-impact activities

Take rest and consult a physiotherapist as soon as possible. Avoid high-impact activities and sports that can further damage your knee if you are having persistent knee pain. Pain is usually a sign of underlying issues in your body. Listen to your body and seek professional advice for proper assessment and treatment.

Do I need a specialist or surgery?

In severe cases, surgical intervention is required to get the optimal result. An arthroscopy may also be done as a diagnostic tool, assessing the severity of the injury.

Diagnostic imaging is usually required, such as a CT scan or MRI to assess the knee joint structure. In some cases, surgery is required to repair the damage within the knee joint.

If your doctor determines that the cause of your pain could be treated without surgery, they may coordinate with your physiotherapist to provide you with proper treatment and further assessment.

What is the recovery time / prognosis for knee pain?

Ultimately, recovery time is dependent on your proactiveness to seek professional treatment and the severity of your knee pain.

In some cases, patients begin to feel the benefits of manual therapy in just one session. Typically, full recovery for mild knee pain can be three weeks, while the more severe cases can take 6 to 8 months or more.

Important factors in your recovery post treatment:

• Sticking to your rehabilitation program and regularly exercising

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

Recovery is also influenced by a number of other factors, such as:

• Age

• Severity of the condition

• General health

• Lifestyle

• Excess weight

• Lack of flexibility or muscle weakness

• Previous injury of the knee.

Physiotherapy can improve the outcome and provide faster recovery from injury while preventing secondary complications.

You may immediately feel signs of relief during your first physiotherapy session. Generally, you will be asked to continue with your program to strengthen your muscles and improve joint stability to prevent future injuries.

Can pain in the knee be prevented?

Guaranteeing prevention can be impossible; however, you can decrease the risk of knee pain through some of these techniques.

• Strengthen your muscles: Keeping your lower body muscles strong through regular exercise will prevent soft tissue injuries and allow your joints’ greater stability. Your physiotherapist will provide you with optimised training exercises to keep your lower body strong and prevent injuries.

• Warm up your muscles before intense activity: Proper warm-up and activation of your lower body muscles, particularly the quadriceps, hamstrings, and glutes, can help you maximise your performance and prevent injuries to your knee.

• Maintain a healthy weight: Keeping your body weight in check is one of the most effective prevention strategies for any joint pain and injury. Extra weight puts increased stress on your knee joint, especially when engaging in high-intensity activities. This can result in accelerated wear and tear of your knee.

• Maintain flexibility: Maintaining the flexibility of your muscles through stretching exercises will help you keep the natural range of motion of your knee joint and prevent tightness of the muscles.

• Wear properly fitting shoes: Use shoes that properly fit you and protect you from injury. Each person has different footwear needs depending on their anatomy. Consult your physiotherapist for assessment and recommendation.

• Optimising your workouts and training routine: Over fatigued muscles provide less protection on your joints and increase the chance of injury. Make sure that you are adequately rested in between your activities.

Outlook and the main takeaways

If there is one main takeaway from this article, it’s that there are many types, causes and severities of knee pain. The most important thing you can do is listen to these pain signals (you’re getting them for a reason). Book a time, and have your knee pain diagnosed by a physiotherapist today.

Anatomy of the knee

Three bones form your knee joint: the thigh bone (femur), shinbone (tibia) and kneecap (patella).

Inside your knee, there are two wedge-shaped pieces of cartilage called the meniscus. They are located between the thigh bone and shinbone. The meniscus acts as a cushion, or shock absorber, which protects the vital bone structures of the knee joint.

You also have ligaments that maintain the stability of the knee joint

• Anterior Cruciate Ligament (ACL)

• Posterior Cruciate Ligament (PCL)

• Medial Collateral Ligament (MCL)

• Lateral Collateral Ligament (LCL

Strong muscles around the knee joint allow controlled movement and promote stability of the knee:

• Quadricep muscle group (rectus femoris, vastus lateralis, vastus medius, and vastus intermedius)

• Hamstring muscle groups (semitendinosus, semimembranosus, and biceps femoris)

• Sartorius

• Iliotibial Tract

• Gracilis

• Adductor