Overview of knee pain
Knee pain may be noticed in children, adolescents, adults and the elderly for various reasons. The pain may be associated with a history of trauma to the knee, certain atraumatic causes, overuse or infections. Knee pain is commonly noticed in individuals such as athletes who are physically more active. In case of adults or the elderly it may indicate some underlying pathologic process. The pain may be self-limiting at times, while it may be severe enough to restrict the movement in some cases. Proper care and timely medical intervention can prevent worsening of the condition.1
Causes of knee pain
In case of children knee pain may be a result of certain physical changes in the bones that occur with growth. Patellar subluxation is a common cause of knee pain in adolescent girls that occurs due a physical variation in the muscle and joint structure in them. In case of adolescent boys or girls a condition called tibial apophysitis or Osgood-Schlatter lesion is a frequent cause of knee pain that typically persists for a few months. This condition usually occurs after a growth spurt while another condition known as jumper’s knee is noted in adolescent boys during a growth spurt. These are usually self-limiting conditions that resolve over a period of time without any specific treatment, while a doctor’s consultation is necessary to rule out other causes.1, 2
Adults suffer from knee pain that may be attributed to overuse, trauma, certain infectious conditions or joint disorders. Overuse may be noticed in general individuals with repeated overuse of the knees as in walking, running or squatting. Overuse of the knees is more common in case of athletes such as runners or cyclists. Trauma to the joint ligaments while running, jumping or sudden twisting also results in significant pain in the knees both in adults and children. Abrupt appearance of knee pain that is associated with swelling of the knee is a familiar feature of the infection of the knee. Elderly individuals tend to suffer from knee pain due to various disorders that are common during the old age. These conditions include osteoarthritis, ankylosing spondylitis, rheumatoid arthritis and other joint disorders.1, 2
Signs and Symptoms of knee pain
The knee pain may either occur while at rest or when the knee is in use. The pain may be constant or may wax and wane at frequent intervals. Activities such as walking, running, climbing or descending the stairs may aggravate the pain. Swelling or redness over the knees that may at times be painful to touch may also be noticed. Another sign that requires prompt examination by a doctor is the ‘popping’ or ‘clicking’ sound heard when the leg is bent or extended. The ability to bend or extend the leg at the knee joint may be reduced. 1, 2
Diagnosis of knee pain
Knee pain is a symptom which is caused due to some underlying causes that may either be a normal physical change as in case of children or due to some underlying causes. The diagnosis of the cause of knee pain is based on the history of the condition, age of the individuals, their profession and other related features.
The doctor may perform certain physical tests such as bending or extending the legs, applying pressure on the joints, moving or rotating the ankles in order to check for any underlying injuries and the extent of possible movements.
Some of the laboratory investigations advised may include examination of the fluid within the knee joint and general blood tests. Radiographs of the knee alongwith MRI and CT scan may be advised when required to confirm the diagnosis or rule out the presence of other abnormalities.1–3
Treatment of knee pain
Knee pain related to overuse at home or due to physical activities generally respond to certain simple steps such as rest. Weight-bearing exercises or lifting heavy objects must be avoided till the pain is reduced. Applying ice packs for about 15 min once in an hour initially and 3–4 times in a day after that also helps in reducing the pain and swelling. The knee must be rested at an elevated position while sitting or lying down. Crepe bandages or elastic sleeves available as over-the-counter products may be applied on the knees to reduce the swelling. Common painkillers such as acetaminophen or ibuprofen that are also available over-the-counter are helpful in reducing the pain. However, a doctor should always be consulted when:
- The pain is severe
- Fever associated with significant swelling and redness of the knee joint is noticed
- Symptoms do not improve after 2–3 days of home treatment
- Visible deformation of the joint is present
- There is a clicking or popping sound heard when the knee is bent or flexed
The treatment of knee pain due to other causes depends on the cause and the severity of the condition. Individuals with mild-to-moderate type of pain with no underlying pathology may be advised to take certain stronger painkillers or other drugs that belong to the group of corticosteroids or other specific groups. Knee pain due to specific underlying disorders such as rheumatoid arthritis is treated with disease specific therapeutic modalities.2, 4
Alternative Therapy for knee pain
Alternative therapies such as ice packs, physiotherapy and acupuncture may be advised as an adjunct to the medical management protocols.
Prevention of knee pain
Although the occurrence of underlying disorders cannot be prevented effectively, knee pain arising from trauma or overuse can be prevented to a major extent. Performing physical activities and exercise within one’s capability will decrease the strain on the joints and the associated structures. Warming up exercises and stretching before sports is always advised. Wearing proper footwear prevents injuries that occur due to slipping or twisting.
Complications of knee pain
In the absence of any underlying conditions, there are no complications associated with knee pain other than temporary restriction of movements.
Living with Knee Pain
Although the pain may persist for many months in certain cases, proper care and appropriate therapy helps in reducing the severity of the pain and preventing further complications.
- Hutchens M, Calmbach WL. Evaluation of patients presenting with knee pain: Part II. Differential diagnosis. Am Fam Physician. 2003; 68(5): 917–922.
- Hamer AJ. Pain in the hip and knee. BMJ. 2004; 328(7447): 1067–1069.
- Hutchens M, Calmbach WL. Evaluation of patients presenting with knee pain: Part I. History, physical examination, radiographs, and laboratory tests. Am Fam Physician. 2003; 68(5): 907–912.
- Miller MD (ed.). Review of orthopaedics. Philadelphia: WB Saunders, 2000.