What’s Causing Your Knee Pain?
We get asked all the time, why does my knee hurt? Sometimes the stairs are the enemy, other times the pain slowly increases as you walk it all depends on which structures are involved. Most people can only think of 1 or 2 structures in their knee, so diagnosing them self is impossible. It’s rare if ever someone arrives to clinic having accurately diagnosed the source of their knee pain. Here’s some common knee structures that can hurt in your knee and the kinds of symptoms you would expect to have with each.
ITBFS (Runner’s Knee)
The iliotibial band is a tight tendon structure at the outside of the leg. It is often visible as an indentation in the side of a bulky rugby leg. When this band gets to tight or stretched too much it can cause rubbing as it flicks over the bone. This rubbing can then cause inflammation and pain especially while the band snaps back and forth while running.
Patella Tendon Tear
The patella tendon attaches the quads (via the knee cap) to the top of the shin bone. With overload this tendon can degenerate and finally rupture. The rupture is sudden and debilitating and requires surgical repair and long-term rehabilitation for a good recovery.
Meniscus Tear (Cartilage Tear)
This is the grizzly/spongy cartilage in your knee, It looks like a couple of orange segments and helps absorb shock. If you’ve eaten chicken and found yourself gnawing on spongy grizzly bit near the end of the bone you’ve probably chewed on the chicken’s cartilage.
Sudden tears can be caused by a twist and swell up after a couple of hours. Tears can cause locking and clicking in the knee. Pain is usually consistent as these tears don’t tend to heel quickly and can benefit from activity modification and appropriate exercises.
Ligament Tear (Spain or Rupture)
Ligaments are the tough rope like structures that connect bone to bone. They don’t contract like a muscle they act more like tough cable rope stopping joints from over stretching and keeping the joint surfaces in close contact.
A ligament tear is usually caused by a big impact or twist, it’s usually followed by sudden swelling and immediate intense sharp pain. A pop can usually be felt and sometimes heard. An example of this type of injury is Owen rupturing his ACL at the World Cup.
Anterior Knee Pain (Chondromalacia Patellae)
This is usually caused by your knee cap rubbing unevenly on the joint surface behind it. Your kneecap is “V” shaped at the back and this “V” slides up and down in a groove on your femur. A muscle imbalance or control issue can lead your knee cap not gliding in the groove correctly. This causes grating that can become very painful. Sometimes you can even hear the grinding, it sounds a little like paper ripping as the patient squats.
Sitting for periods is usually increasingly uncomfortable and using the stairs can be very painful.
Inflammation
You can overload a knee much like any other joint, by suddenly increasing the demands. Your body takes time to adapt to new demands and if you’re increasing your training to quickly your knee can become irritated as it struggles to keep up with the new higher demands.
Osteoarthritis (Wear and Tear)
Everyone that’s been around as long as me 30 years will have some wear and tear, that is normal. When that wear and tear builds up its called Osteoarthritis. All that means is the joint is wearing out. Typical findings are stiffness in the morning lasting more than 5 minutes. Pain after activity and regular swelling. Limited range of motion with both flexion and extension limited at the end. Thickening of the bone around the joint is common and often easily visible. This is treatable, a full recovery is unrealistic but frequently substantial improvements in pain and function are possible. Surgery may or may not be indicated.
Patella Dislocation
Your kneecap can pop out of the groove laterally at the front of the knee, this is very traumatic and usually only happens with a twisting motion. In most cases it pops back in itself when the leg is straightened. Swelling is immediate, pain is intense, the pop can usually be heard. The medial aspect of the knee cap can become very tender and contracting the quads is very painful. X-rays are required to rule out an associated fracture.
Fat Pad Syndrome
Everyone has a pad of fat on the lower front part of their knee. And that pad of fat can become inflamed and ache. This is common in people that are very flexible (hyper extending knees/ donkey knees). Standing for long periods usually in work brings on a moderate dull pain.
Patella Tendinopathy (Jumper’s Knee)
This is the bit of tissue that connects the knee cap to the top of the shin. Pain in this tendon is very common, particularly in jumping sports like basketball. The tendon is breaking down quicker than is healing correctly. It becomes tender to touch and may feel thickened. In the early stages pain usually settles during activity/exercises and comes back after. Unlike knee cap pain that gets worse as activity continues.
Osgood-Schlatter Disease
This is often brushed off as grown pains as teenagers are the sufferers. Their bones are still soft and growing. The load going through the attachment of the quads on the shin can stress this soft bone and cause inflammation and pain. It’s usually possible to see a bump with the extra bone where the quad attaches and the bone feels very tender at that attachment.
Housemaids Knee (Prepartella Bursitis)
There is a small fluid filled shock absorber at the front of the knee called the Prepartella Bursa. Kneeling for long periods of time or one sudden impact can make your bursa inflamed. This causes pain and swelling at the front of the knee. Bending your knee may also be painful. If you have a fever with this condition you should speak to your GP to rule out an infection.
Conclusion
Not every knee pain is from the same source and different structures are aggravated by different activities. There’s lots structures to consider and possibly more than one source of pain. It’s important to get knee pain properly diagnosed by a professional who will carry out an array of hands-on tests to the structures likely to be involved. In some cases, X-rays or MRI’s along with hands-on tests may be necessary for an accurate diagnosis.
Tip: Acute knee injuries accompanied by immediate swelling merit further investigation by a MD or skilled clinician as soon as possible.
