Knee Pain

For many, knee pain is a common issue, but when it becomes severe enough to disrupt daily life or comes with swelling, tenderness, or inflammation, seeking medical help is crucial.

At Complete Orthopedics, our team specializes in treating knee discomfort caused by bursitis with personalized plans and surgical options. We prioritize understanding your symptoms, identifying the problem, and recommending the best approach to relieve pain or correct it surgically.

With locations in New York City and Long Island, and access to six hospitals, we offer state-of-the-art facilities for advanced knee surgeries and orthopedic care. Scheduling an appointment with an orthopedic surgeon is easy—either online or by phone.

Learn about the various causes and treatments for knee pain, and determine when surgery might be the best solution.

Overview

Knee pain has numerous different potential causes that include both pathology within the knee joint and pathology that presents with pain referred into the knee and felt in and around the knee joint. Examples of this include hip pain, lower back pain, and less commonly, pelvic pain.

Causes from within the knee joint include arthritis, meniscal tears, osteochondral defects, osteonecrosis, patella maltracking, patellofemoral syndrome, cruciate ligament damage, collateral ligament damage, and other more rare causes such as pigmented villonodular synovitis (PVNS).

Causes 

Ligament Injuries and Tears: One common cause of knee pain is ligament injuries, such as an ACL (anterior cruciate ligament) tear. Research studies have explored different surgical techniques and rehabilitation protocols to optimize outcomes for individuals with such injuries. By understanding the latest advancements in ligament repair, you can make informed decisions about your treatment options.

Osteoarthritis: Osteoarthritis, often referred to as “wear-and-tear” arthritis, is another prevalent cause of knee pain, particularly among older adults. Recent research has focused on innovative treatments like knee arthroplasty, a surgical procedure that replaces damaged knee joints with artificial implants. Learning about the benefits and potential risks associated with these procedures can empower you to make decisions aligned with your health goals.

Rheumatoid Arthritis: For individuals dealing with rheumatoid arthritis, inflammation of the knee joint can lead to persistent pain and stiffness. PubMed studies have explored the efficacy of various medications and surgical interventions in managing rheumatoid arthritis symptoms. By staying informed about the latest research findings, you can collaborate effectively with your healthcare provider to develop a personalized treatment plan.

 

Symptoms

Knee pain can manifest in various ways, depending on the underlying cause. Here are some common symptoms associated with knee pain:

Pain: The most obvious symptom of knee pain is discomfort or pain in and around the knee joint. This pain can range from mild to severe and may be constant or intermittent. It might worsen with certain activities, such as walking, running, or bending the knee.

Swelling: Swelling, also known as edema, is another common symptom of knee pain. The knee may appear swollen or feel puffy or full. Swelling can result from inflammation, injury, or fluid buildup within the joint.

Stiffness: Knee stiffness refers to a sensation of reduced mobility or difficulty moving the knee joint. It may feel like the knee is “locked” or has limited range of motion. Stiffness can make it challenging to bend or straighten the knee fully.

Instability: Knee instability occurs when the knee feels wobbly or gives way during movement. This sensation of instability can be unsettling and may increase the risk of falls or further injury. Instability often accompanies ligament injuries or conditions affecting the knee’s supporting structures.

Clicking or popping: Some individuals with knee pain may experience audible or palpable sensations of clicking, popping, or grinding within the knee joint. These noises or sensations can occur during movement and may be indicative of cartilage damage or misalignment.

Difficulty bearing weight: Knee pain can make it challenging to bear weight on the affected leg. Individuals may limp or favor one leg to alleviate discomfort. Difficulty bearing weight may indicate a significant injury or condition affecting the knee joint.

Redness and warmth: In cases of inflammation or infection, the skin around the knee may appear red and feel warm to the touch. These signs, along with pain and swelling, may suggest an underlying inflammatory condition that requires medical attention.

 

Diagnosis

Any persistent knee pain that has proven unresponsive to over-the-counter analgesia, exercise, rest or sustained physical activity should be referred to a specialist physician or orthopaedic surgeon.

They will be begin by discussing your medical history with you and performing a physical examination. The discussion will include questions about the knee pain and its duration, nature, characteristics and exacerbating or alleviating factors.

The physical examination of the knee joint will involve feeling your knee joint and moving it around, as well as performing certain special tests designed to detect abnormalities in certain structures within the knee.

You may be asked to undergo plain film radiographs – x-ray studies that will give us more information about the anatomy of your knee and potentially give us a diagnosis.

If at this point the diagnosis is still unclear, then further imaging studies such as a CT or MRI scan may be ordered in order to achieve a definitive diagnosis.

Treatment

The first line treatment for any joint pain should be rest of the affected joint for a short period of time. Over-the-counter analgesics such as Tylenol or nonsteroidal anti-inflammatory medications are also appropriate.

If neither of these prove effective at relieving your pain then you may require a full course of dedicated physical therapy. If this also proves ineffective then consultation with a healthcare professional in regards to your knee pain is warranted.

Definitive and effective treatment of persistent knee pain requires a firm diagnosis, and depending on what your diagnosis is, the treatment may be simple and involve a prolonged period of activity modification, or it may be more serious and require a surgical procedure to correct.

It is also important to recognize when consultation with a specialist physician is necessary – avoiding seeing a doctor with a diagnosis such as an ACL rupture, for example, can lead to more serious problems developing earlier on in life.

Untreated ACL-deficient knees will lead to a phenomenon known as repeated tibiofemoral subluxation (abnormal movement of the two bones within the knee relative to one another) and this will lead to rapid wear of the joint cartilage and development of potentially debilitating arthritis much earlier on in life than if the problem had been treated with an ACL Reconstruction, or even an ACL-specific brace.

Summary

Knee pain has a potentially wide range of causes – some are less serious and self-limiting, others will require medical or surgical intervention to treat effectively.

It is important to identify persistent troublesome knee pain early on and seek out medical attention for it as early as possible to avoid a potentially very easily treatable condition being left untreated and developing into a more serious problem which requires more invasive treatment.

Do you have more questions? 

How can I manage knee pain during activities like gardening or sports?

Using proper body mechanics, wearing supportive footwear, and taking frequent breaks can help reduce strain on your knees during activities like gardening or sports. Using knee braces or supportive devices may also provide added stability and protection.

Is there a difference between acute and chronic knee pain?

Acute knee pain typically occurs suddenly due to an injury or trauma and may resolve on its own or with treatment within a few weeks. Chronic knee pain, on the other hand, persists for an extended period, often due to underlying conditions like arthritis or repetitive stress on the knees.

Can weather changes affect knee pain?

Some individuals report that changes in weather, particularly cold and damp conditions, can exacerbate knee pain, especially for those with arthritis. While the exact reason for this is not fully understood, staying warm and maintaining mobility can help alleviate discomfort during weather fluctuations.

Can losing weight help with knee pain?

Yes, losing weight can reduce the load on your knees and alleviate pressure on the joints, which may help decrease pain and improve mobility. Even modest weight loss can have significant benefits for individuals with knee osteoarthritis.

Is knee pain common in older adults?

Yes, knee pain is a common complaint among older adults, particularly those with osteoarthritis or other age-related joint changes. However, it’s essential to seek medical evaluation to determine the underlying cause of knee pain and develop an appropriate treatment plan.

Can knee pain be hereditary?

While genetics may play a role in certain knee conditions like osteoarthritis, knee pain itself is not typically hereditary. However, family history can increase your risk of developing certain joint-related issues, so it’s essential to be proactive about maintaining joint health.

How can I make my home more knee-friendly?

Simple modifications like installing handrails, using a shower chair, or adding cushioned mats can make your home more knee-friendly and reduce the risk of falls or injury. Your orthopedic surgeon or physical therapist can provide recommendations based on your specific needs.

Are there any long-term consequences of untreated knee pain?

Untreated knee pain can lead to decreased mobility, muscle weakness, and joint damage over time, potentially resulting in chronic disability and reduced quality of life. It’s essential to address knee pain promptly and follow a comprehensive treatment plan to prevent long-term complications.

What can cause knee pain?

Knee pain has a wide array of different potential causes that include both pathology within the knee joint itself as well as pathology that presents with pain referred into the knee and felt in and around the knee joint. Example of this includes hip pain, lower back pain, and less commonly, pelvic pain.

Causes from within the knee joint include arthritis, meniscal tears, osteochondral defects, osteonecrosis, patella maltracking, patellofemoral syndrome, cruciate ligament damage, collateral ligament damage, and other rare causes such as pigmented villonodular synovitis (PVNS).

How to diagnose knee pain?

Any knee pain that is persistent and refractory to over-the-counter analgesia, exercise, rest or sustained physical activity should be brought to the attention of a healthcare professional. Our specialist orthopedic surgeons would be happy to see you in consultation for any knee pain that you may be having.

The process begins with a formal history and physical examination, which will include discussion of the knee pain and its duration, nature, characteristics and exacerbating or alleviating factors. We will then perform a physical examination of the knee joint and arrange for you to undergo plain film radiographs, x-ray studies that will give us more information about the anatomy of your knee and potentially give us the diagnosis at that point.

If at this point the diagnosis is still unclear, then further imaging studies such as a CT or MRI scan may be ordered in order to ascertain exactly what is causing the underlying knee pain based on the clinical suspicion from the history and physical examination.Depending on the cause, in some cases your knee pain may be able to be diagnosed in the office during your first visit, but for other causes that are less clear-cut it may require you to undergo a further scan of some kind and return to the office when the scan has been completed for us to discuss the results with you.

What can I do for knee pain?

The first line treatment for any type of joint pain should be rest of the affected joint for a short period of time. Over-the-counter analgesics such as Tylenol or nonsteroidal anti-inflammatory medications are also the first protocol for analgesia.

If neither of these strategies are effective then you may require a full course of dedicated physical therapy and if this does not work either then, at this point, consultation with a healthcare professional in regards to your knee pain is essential to investigate the underlying diagnosis so that appropriate treatment can be initiated.

Do knee braces help with knee pain?

Bracing of the knee is indicated in a number of conditions that include both osteoarthritis and patellofemoral causes. If your healthcare provider feels that you would benefit from a course of bracing, they will inform you as such as give you recommendations as to the best type of brace for you to purchase.

It is worth mentioning, however, that braces will only provide relief from knee pain for the duration that they are worn. Many patients find that with some of the bulkier braces, they are uncomfortable and find they are unable to tolerate them for significant periods of the day. This leads some patients to not wear their brace and if this is the case then clearly bracing is not the appropriate intervention for these patients, as not wearing the brace defeats the purpose of the bracing strategy for treating the patient’s complaint.

Can knee pain cause hip pain?

Although it is possible for alteration in a patient’s gait pattern as a result of knee pain to adversely effect other joints as part of the gait cycle (these do include both the hip, lower back and even in some cases the ankle) it is actually more common that pathology in the hip can present with knee pain.

This is well known to be the case in younger patients who sustain injuries known as a slipped capital femoral epiphysis (SCFE). These patients will often present with knee pain and have their knee extensively investigated only to reveal no major clinical abnormality responsible for the ongoing pain and these critical injuries can often go missed causing long-term problems with the hip and leading to surgical intervention much earlier on in life than it would have been necessary had the hip pain been investigated at an earlier stage.

Therefore it is important to bear in mind that while you may be feeling the pain in and around the knee joint it is the responsibility of your treating healthcare practitioner to investigate both the joint above and below and, if done properly, this will reveal pathology within the hip that is presenting as referred pain in the knee. This can also happen in certain cases with osteoarthritis.

What kind of doctor should I see for my knee pain?

Although many patients choose to begin with their regular family physician to investigate their knee pain, and this is entirely appropriate, our specialist orthopedic surgeons who have years of experience treating common and complex knee complaints will be more than happy to see you in consultation for any knee pain that you may be having.

They will utilize their specialist expertise to achieve a definitive diagnosis for your knee pain and will be happy to explain all of your potential treatment options including any surgical procedure or if nonsurgical procedures are more appropriate, we will offer those or offer a referral to practitioners who provide them for you.

What can cause knee pain without injury?

There are multiple reasons that can cause knee pain without injury. This may include inflammation of the tendon, gradual long-standing injury to the articular cartilage or the meniscal cartilage, inflammation of the plica inside the knee joint, inflammation of the capsule, inflammation of the surrounding muscles and tendons etc.

What can cause pain in the back of the knee?

Pain in the back of the knee can be caused by tendonitis, strain of the muscles of the back. It can also be caused by degenerative changes in the knee causing a formation of cysts in the back of the knee. Occasionally, meniscal tears can present with pain in the back of the knee. Unusual cause of pain there may be a clot in the vein or injury to the ligament.

Where is the knee VMO muscle?

VMO means vastus medialis Obliquus. It’s the lower part of the inner side of the quadriceps muscle. This muscle helps in the last stages of straightening of the knee joint and is very important in the function of the knee joint. This is the first muscle to weaken and the last muscle to strengthen in patients of injury of the knee joint.

Is walking good a bad knee?

Walking is a good exercise for knee pain. It should be done as much as possible, without aggravating the knee pain. It helps not only in general body exercise, but also strengthening muscles of the knee joint, which help in decrease in pain throughout the knee.

Is running bad for your knees?

Running, especially on hard surfaces, can be bad for the knee. Especially if they are already injured or have degenerative changes. Person should have proper shoe and should try not to run on hard surfaces. They should also do dedicated knee muscle strengthening exercises as well as warm up before the running.

What is patellar tendonitis of the knee?

Patellar tendonitis means inflammation of the patellar tendon which is found between the kneecap and the leg bone called tibia. It does usually involve the upper part of the tendon where it attaches to the kneecap. It is usually treated with rest, ice, compression, and elevation along with anti-inflammatory medication. Patient is advised not to involve in contact sports and avoid activities that will worsen the pain. Bracing may help also.

What is Plica Syndrome?

There are soft tissue reflections inside the knee joint called plica. The knee joint has multiple plica bands in the knee, the most remarkable being on the inside, and on the upper part of the kneecap. They are usually present and do not cause any problems. Sometimes, a plica may be thickened or inflamed and may start rubbing on the articular surface and cause pain. In these patients, they are initially treated with anti-inflammatory medications, ice, elevation, and rest followed by physical therapy. If they are not improved with conservative management, then surgical treatment may be required.

How do you treat tendonitis in the knee?

Tendonitis in the knee is usually treated in the same way as it is in any other part of the body, by using the RICE protocol (rest, ice, compression and elevation). The patient can also be sent for physical therapy as well as use anti-inflammatory medications. Bracing may also help.

What is the IT band?

The IT band, or the iliotibial band is a thickening of soft tissue, which extends from the hip to the knee joint. It functions in stabilizing the hip as well as the knee joint and also functions in the movement of the knee joint.

What is IT band Syndrome?

IT band syndrome is caused due to rubbing of the IT band over the outer part of lower thigh bone leading to inflammation and causing pain. It usually occurs in runners and cyclists. It is usually relieved with rest and anti-inflammatory medications. Occasionally a steroid shot may help.

How do you reduce fluid in the knee?

Fluid in the knee is usually reactionary to some other pathology in the knee like injury to the ligament, the meniscus or the cartilage. To decrease the fluid these pathologies are to be taken care of accordingly. In an acute setting, if the fluid is causing pain and discomfort, the fluid can be aspirated by needle from the knee joint. Cortisone injection may also be given at the same time if appropriate which may help in decreasing the swelling and pain.

Dr. Sebastian Heaven
Orthopedic surgeon at London Health Sciences Centre (LHSC)

I provide Orthopaedic patient care at several different locations, including a Regional Joint Assessment Centre, a Level 1 Trauma Centre and a District General Hospital. My scope of practice is broad and includes Trauma, Arthroplasty and Sports Orthopaedics.

My areas of special interest include Primary and Revision Arthroplasty, Periprosthetic Fracture Management and general orthopaedic trauma management in isolation and in the context of complex polytrauma patients. I also have clinical research interests in these areas, as well the development of interprofessional relationships between trauma team members and fellow healthcare professionals.

I have personally written all or most of what's on this page for Complete Orthopedics, and approve the use of my content.