Causes of Knee Pain
Knee pain is a widespread issue that affects individuals of all ages and activity levels. It can result from injury, overuse, or underlying health conditions and varies in severity from mild discomfort to debilitating pain that limits movement. The knee joint, one of the largest and most complex joints in the body, plays a crucial role in supporting weight and facilitating movement, making it vulnerable to various problems. Below are the most common causes of knee pain that we see at the Injury Hub.
Ligament Injuries
The knee has four main ligaments that provide stability. When injured anyone of them can cause swelling, instability and pain. The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), are located deep within the knee. The medial collateral ligament (MCL), and lateral collateral ligament (LCL) are located on the inside and outside of the knee. ACL injuries are particularly common in athletes involved in sports that require quick direction changes, like football or basketball. You can get a partial tear or full thickness rupture of ACL and PCL both of which are likely to require surgical fixation. Research is ongoing in the regenerative approach meaning stems cells and patient’s blood (PRP) are being injected in to the ligaments has shown healing properties but a surgical repair is still the main choice of treatment especially in active or sport focused individuals.
The MCL or medial collateral ligament is frequently sprained giving rise to pain and swelling along the inside of the knee. With the right treatment and management, they tend to heal very well within a 6-8-week period. The LCL, lateral collateral ligament is less likely to injure but responds well to conservative management.
Meniscus Tears
There are two meniscus C-shaped pieces of cartilage that acts as a shock absorber and scaffolding that sit between the thigh bone (femur) and shin bone (tibia). A sudden twist or pivot of the knee can tear the meniscus, leading to pain, swelling and difficulty moving the knee. Often patients present with localised swelling and report an inability to straighten the knee or they hear a clicking noise when bending or straightening the knee. Occasionally, patients can feel like the knee will give way when standing. If the tear is within the perimeter of the meniscus the peripheral blood supply may heal it. If the tear is present within the deeper surfaces of the meniscus then it’s likely a surgical opinion should be obtained. A peripheral meniscal tear can be seen on ultrasound a deeper tear can only be visualised on MRI. Both of these images can be performed via the Injury Hub.
Tendon Injuries
Overuse or sudden injury to the tendons surrounding the knee can cause inflammation, pain, tenderness during the later stages on exercise or after rest. Patellar tendonitis, also called “jumper’s knee,” commonly affects athletes who participate in sports involving repetitive jumping, like basketball or volleyball and particularly in young footballers.
At the Injury Hub we commonly see and treat quadriceps and patella tendon issues with great success. A tendon will respond well to direct needling (Fenestration), shockwave and a tailored eccentric rehab program.
Fractures
A direct blow to the knee, such as in a fall or car accident, can cause fractures to the patella (kneecap) or the femur (thigh) or tibia (shin) of the knee. Fractures are usually very painful, and the knee may become swollen, bruised, and unable to bear weight. Many fractures affect the knee joint. If the fracture is deep within the knee bones then X-ray is the standard imagining modality. In some individuals especially, patients suffering with osteoporosis they may suffer an insufficiency fracture this is where the bone density has reduced leading to internal breakages, this type of fracture is better seen on MRI. Although diagnostic ultrasound is not the gold standard for looking at fractures. Ultrasound can pick up superficial, cortical breaks plus secondary findings such as swelling and quite often if we aspirate the swelling it will be blood filled indicating bone marrow has leaked in to the joint capsule, which would indicate a fracture has occurred.
Osteoarthritis
Osteoarthritis is the most common form of arthritis and a leading cause of knee pain, particularly in older adults. This degenerative condition results from the gradual wearing down of the meniscal cartilage and the underlying hyaline cartilage that cushions the bones in the knee joint. As the cartilage erodes, the bones rub against each other, leading to pain, stiffness, swelling, and decreased mobility. Osteoarthritis can develop over time due to age, but it can also be exacerbated by prior injuries, obesity, and repetitive stress on the knee. At the Injury Hub we’re experts in hands on manipulation of joints such as the knee and we can also provide injections of hyaluronic acid (lubricating and nourishing injections) and pain killers such as cortico steroid. Recent research has actually shown steroids within the knee can accelerate the degenerative process, hence why we only offer these injections to those in debilitating pain and who is awaiting a knee replacement.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation in the joints, including the knees. In RA, the immune system mistakenly attacks the joint linings, leading to pain, swelling, stiffness, and deformity over time. Unlike osteoarthritis, which typically affects people as they age, rheumatoid arthritis can occur at any age and often affects both knees simultaneously. It can cause prolonged periods of pain and disability if not treated.
Bursitis
Bursae are small, fluid-filled sacs that reduce friction and cushion the points of contact between bones, tendons, and muscles. Bursitis occurs when these sacs become inflamed, often due to repetitive movement or prolonged pressure on the knee joint. In the knee, the prepatellar bursa, located in front of the kneecap, is commonly affected. People who kneel for extended periods, such as gardeners or carpenters, are more prone to developing knee bursitis, which causes pain, swelling, and warmth around the knee.
Patella Tracking Disorder
Patella tracking disorder occurs when the kneecap (patella) moves out of its normal alignment as the knee bends or straightens. This misalignment causes pain, particularly when climbing stairs, squatting, or sitting with bent knees for long periods. Patella tracking disorder can result from muscle imbalances, such as tightness within the lateral quadricep whilst having weakness in the medial quadricep. Abnormal bone structure can be a cause, or repetitive stress on the knee joint, leading to a feeling of the kneecap slipping, catching or grinding during movement. If the tracking continues for a number of months and years it can lead to a condition called chondromelacia patellae. This is very easy to treat once a diagnosis has been made.
Iliotibial Band Syndrome
The iliotibial (IT) band is a thick band of tissue that runs along the outside of the thigh from the hip to the outside of the knee. Iliotibial band syndrome occurs when this tissue becomes tight or inflamed, leading to pain on the outer side of the knee. This condition is often seen in runners, cyclists, and athletes who engage in repetitive leg movement. Pain typically worsens during physical activity, particularly when running downhill or on uneven surfaces. At the Injury Hub we treat many runners with it within the local Victoria Park Harrier Runners Club and especially in April leading up to the London marathon.
Gout
Gout is a form of arthritis caused by the buildup of uric acid crystals that can affect both the main knee joint and more often behind the knee cap. While it most commonly affects the big toe, gout can also occur in the knee, leading to sudden and intense pain, swelling, redness, and warmth in the joint. Gout flare-ups can be triggered by dietary factors such as shell fish and red meats, dehydration, or certain medications, and it often occurs at night.
Infections
Knee infections, such as septic arthritis, occur when bacteria or other infectious agents invade the knee joint. These infections can lead to severe pain, swelling, redness, and warmth around the knee. Fever and chills may accompany the infection, and immediate medical treatment is required to prevent the infection from spreading or causing permanent joint damage.
Injury Hub is here to help.
Knee pain can arise from various causes, including acute injuries, chronic conditions, overuse, or rheumatological. A Proper diagnosis is essential to determine the underlying cause allowing a guided treatment and comprehensive management plan to be put in place. We’re able to diagnose most knee injuries by taking a thorough case history and orthopaedic examination. At the Injury Hub our sonographer will include a scan of your knee on your initial assessment and if further imaging is required we can arrange a same day MRI. Managing knee pain may involve rest, over the counter medications, physical therapy, rehab exercises, taping, injections, in some cases we may refer on for surgery. If your knee pain persists or worsens, it’s important to seek a consultation to avoid long-term complications