Understand the Four Types of Knee Pain June 5, 2023 Knee pain that shows up after an extra-long run on a sunny day or a vigorous round of tennis may feel like a small price to pay for a little fun, but when that nagging pain persists for a few days, what should you do about it? “Knee pain is your body telling you something, so don’t ignore it,” said Josh Lenhof, DO who specializes in sports medicine at Samaritan Athletic Medicine Center. “The type of pain you feel, the location and what you were doing when the pain started can tell us a lot about your injury and how serious it is.” Knee Anatomy To understand your knee pain, it helps to learn a little about the different aspects of this joint. The knee is made up of the following four key parts: Bones. The thighbone (femur) and the shinbone (tibia) meet to form the knee joint. The kneecap (patella) rests on top of the joint. Cartilage. The ends of the thighbone and shinbone are covered in cartilage, which is slick and helps the bones move smoothly against each other. The meniscus is a type of cartilage, although it is thick and acts as a shock absorber in the joint. Ligaments are tough and fibrous. There are many ligaments that hold the bones together and keep the knee joint stable. The posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) are located inside the knee joint, while the medial collateral ligament (MCL) and lateral collateral ligament (LCL)are located on the sides of the knee. Another important set of ligaments are the patellofemoral ligaments (PFL) which help the kneecap glide smoothly with the femur. Tendons connect muscle to bone. The quadricep tendon runs from your thighbone to your kneecap, and the patellar tendon holds the kneecap in place and runs from your kneecap to your shinbone. The iliotibial band is a tendon that runs from your pelvis to your kneecap and tibia. Common Types of Knee Pain 1. Dull, Achy Pain at the Front or Sides of the Knee Having a dull and achy pain noted superficially around your knee is usually due to overuse that causes tendonitis, which is a common complaint in active adults, reported Dr. Lenhof. Your knee may also feel tight or throbbing. Tendonitis is when the tendons become irritated and inflamed, usually after a rapid increase in activity like a week of heavy training, or sudden stress on the knee like landing a jump wrong. The pain may get worse when you bend your knees, like going up and down stairs. You may feel pain at the kneecap along the patellar tendon, or on the outer knee at the iliotibial band. This type of overuse injury is common with runners and cyclists, but anyone can develop tendonitis if they put too much stress on their knees. Treatment – The pain from an overuse injury will usually go away on its own within a week or two if you stop the offending activity and allow the body to heal naturally, reported Dr. Lenhof. Be careful with anti-inflammatories unless there is significant swelling. They can help improve pain on the short term but are not intended to be taken chronically for tendonitis. Rest. Avoid doing any activity that causes pain in the knee. Ice. Apply an ice pack throughout the day for 30 minutes at a time. Avoid heat. Compression. Wrap your knee in a bandage or compression sleeve. Elevation. Keep a pillow under your knee when sitting or lying down. Keep your foot and leg elevated above your heart if you notice swelling. 2. Sudden Pain Accompanied by a Pop or Snap Sudden, sharp pain accompanied by a popping or snapping sound and swelling that starts soon after the injury – often within two hours – are usually signs of a ligament injury or meniscus tear. Your knee joint may feel weak or unstable, or unable to support your weight. Spraining the ACL or MCL are common ligament injuries, said Dr. Lenhof. Damage typically occurs if you slow down or stop suddenly while running, are changing direction quickly or land a jump wrong. Treatment – A physical exam and imaging may be necessary to determine the extent of a ligament injury. Sometimes, rest and physical therapy are enough for healing, but some injuries may need surgery to repair. 3. Popping Sound While Turning or Twisting – Minimal Pain The meniscus is sturdy but can tear in certain circumstances. When the injury occurs, you may hear a pop, but might not feel pain or notice swelling right away. Over the course of two or three days the knee may start to swell and feel more tender. If you have torn the meniscus, you may feel your knee catching or locking at the joint when you bend your knee, when turning a corner or getting out of a vehicle. Tearing the meniscus usually happens when twisting or pivoting while putting weight on your leg, often during sports. However, the meniscus can weaken with age, so it is possible to damage it while moving around your home, especially if you suffer from osteoarthritis. Treatment – “A popping sound is always a concern with knee injuries,” said Dr. Lenhof. “Even if you can walk on the injured leg, you should have the knee examined soon.” Your health care provider may order imaging to determine the extent of the injury. Rest and physical therapy may be all that are needed for some injuries, while others may need surgery. 4. Achy Pain Throughout the Joint With No Clear Cause For people over the age of 50, osteoarthritis (OA) in the knees becomes more common. OA is a degenerative disease that slowly erodes the cartilage between the bones, so the pain often starts gradually and gets worse as the months and years go by. OA usually affects both knees. The joints may feel stiffer in the morning but loosen up with some activity. The pain is frequently worse at the end of the day but gets better with rest. Treatment – Keep moving! It may feel counterintuitive, but the Arthritis Foundation promotes exercise as the most effective non-drug solution to improve mobility and decrease pain. If pain from OA becomes more than a minor annoyance, talk to your health care provider. There are ways to manage the pain and stay active. For people with advanced osteoarthritis who experience daily pain, it may be helpful to talk with your provider about joint replacement surgery. Keep Your Knees Pain Free Whether you currently struggle with knee pain or want to stay pain-free as you age, Dr. Lenhof recommended these steps for trouble-free knee maintenance: Cross training helps to build strength and flexibility throughout your whole body, including the muscles that support your knee. Instead of running or walking every day, try lifting weights or doing yoga a few times a week. Increase your training by no more than 10 percent a week, by measure of distance, time or weight. This is enough to challenge your body to improve while giving it time to adjust to the new demands on it and reduce the chance of an overuse injury. Invest in shoes that fit well and are supportive. Runners and walkers should replace shoes every 300 to 500 miles, even if they don’t look worn out. “The midsole layer in shoes becomes compressed over time and doesn’t provide as much shock absorbency. This puts more stress on your body and can contribute to knee pain,” said Dr. Lenhof. Manage your weight. Carrying extra weight puts more force on your joints and makes them work harder. Any amount of weight loss helps. One study published in the journal Arthritis & Rheumatology found that each pound of weight lost resulted in a four-pound reduction in the load exerted on the knee joint with every step. Knee braces can help in the short term with overuse injuries; however, the injury is likely to happen again if you don’t modify your body mechanics. Instruction from a physical therapist can help with strengthening and adjusting your technique to prevent future problems. For athletes or anyone living an active lifestyle, knee pain shouldn’t be common. “Don’t accept knee pain as a consequence of being active,” said Dr. Lenhof. “Your joints were made to move, and movement keeps them strong and limber. If you’re struggling with recurring pain, talk to your health care provider about resources to support you.” Join a Matrix class at The SAM (Samaritan Athletic Medicine). Matrix is a group training class for community members who have had a lower body injury, like ACL repair, and is focused on functional strengthening and sport-specific training. Analyze your body movements to highlight where you may have mobility or stability limitations with a functional movement assessment. You’ll walk away with an action plan to strengthen and correct your form and prevent future injury.
