Knee Pain

Knee pain is one of the leading causes of restricted mobility mostly seen in the elderly.1 About one-third of the elderly population (> 55 years of age) complains of knee pain due to one reason or the other. Knee pain impairs the day-to-day activities of approximately 50% of the people affected by it. It is more common in females than in males and most times, obesity is the cause in women. Finding out the underlying cause of knee pain is very important as most of the time it is treatable and ignoring the pain can lead to more damage of the joint worsening the pain. Some factors such as obesity exert extreme pressure on the knee joint leading to knee pain. Such factors are modifiable and managing these factors can prevent further pain and damage. Consulting a doctor promptly can help diagnose the underlying cause of knee pain on time. Furthermore, the doctor can advise appropriate treatment for the underlying cause without any delay ensuring a good prognosis.

What Is knee pain?

Knee pain is pain and discomfort felt in the knee joint. The pain can be either acute (lasting less than 15 days) or chronic (lasting a month or more). Usually, knee pain presents as a symptom of an underlying condition or disease, which may be a physical injury, infection, or other medical conditions like rheumatoid arthritis.

Knee pain can be divided into three types depending upon the severity of pain and length of time up to which pain can persist. These are:

• Acute
  A sudden pain can be categorized as acute pain. Generally, this type of pain is sharp and is caused due to an injury. It lasts for less than 15 days.
• Sub-acute
  This is the type of pain which lasts for over 15 days but less than one month. There is a feeling of severe knee pain and it usually happens after hip or knee ligament surgery.  
• Chronic
  This can be explained as mild to moderate pain due to an underlying medical condition such as rheumatoid arthritis or osteoarthritis. This type of pain increases with time if not diagnosed or treated on time. Such pain typically lasts more than a month.

Knee pain is usually a symptom of an underlying condition. Hence, the symptoms listed below are associated with the underlying conditions responsible for knee pain.

• Difficulty or pain while walking
  Damage of the tissues around the knee joint can cause pain while walking. Knee pain can also lead to restriction of movement while taking part in day-to-day activities.
• Redness and tenderness
  Inflammation of the knee joint can cause redness and swelling in the area around the joint. The inflammation can also result in severe pain on touch.
• Limping
  Limping is usually seen when only one knee is affected. To avoid putting pressure on the affected knee, people with knee pain tend to walk with a limp.
• Fever
  If the knee pain is due to an infection of the knee joint, fever can be an important symptom. Underlying inflammation can also cause a local increase in the temperature of the affected knee.

There are many causes and risk factors responsible for the development of knee pain. Most of the causes are modifiable and the remaining ones are treatable. Hence, a complete recovery of knee pain is possible if you follow the instructions advised by your doctor.

Causes

Causes of knee pain include:

• Physical injury
  Physical injury due to a road accident or vigorous exercise can lead to the damage of the soft tissue surrounding the knee joint or can cause injury to the bony structure. Such injuries can cause knee pain. In athletes, tear of the cushion supporting the knee joint, also known as a meniscal tear, is one of the common causes of knee pain.
• Infection
  Infection of the knee joint can also cause knee pain.
• Baker’s cyst
  A certain amount of fluid is normally present in the knee joint. This fluid is known as the synovial fluid, which helps to avoid friction and provides easy movement of the joint. Sometimes, there is an overproduction of the synovial fluid which leads to its accumulation in the backside of your knee. This fluid accumulation can lead to the formation of a cyst known as the Baker’s cyst. This leads to tightness and pain in the knee joint.
• Osteoarthritis
  In this medical condition, there is thickening of the tissues and damage of the cartilage of the knee joint leading to knee pain.
• Rheumatoid arthritis
  It is an autoimmune condition in which the immune system causes the destruction of the body’s own tissues leading to pain and damage in the joints throughout the body. Involvement of both the knee joints is seen in this condition. Mostly joints in the fingers (interphalangeal joints) are affected first and as the disease progresses, joints of knees, ankles and wrist also get affected.
• Gout
  Gout is a painful condition of the joints caused by an increase in the uric acid levels of the body.

Risk Factors

Risk factors for knee pain include:

• Overuse of the knee joint
  Overusing the knee joint without proper rest or support may cause knee pain. For example, house maids who clean the floor are prone to knee pain as there may be damage to the knee tissue due to extreme pressure on the knee joint for an extended time-period.
• Weight gain
  The knee joint is an important weight-bearing joint. When your weight increases (more than normal), it exerts pressure and strain on the knee joint leading to pain. Hence, obese individuals are prone to knee pain.
• Exercising in the wrong way
  Vigorous physical exercise without a trainer’s advice can cause damage or injury to the knee joint.
• Advancing age
  This is the most common risk factor of knee pain. Ageing leads to an increase in the weakness of the soft tissues around the knee joint. Also, the bone structure of the knee joint weakens with age. Hence, the knee joint can get easily damaged in elderly people.

Most times, knee pain is preventable. The following measures can be undertaken to prevent damage to the knee joint:

• Wearing proper shoes
  Wearing proper fitting shoes can help avoid putting a strain on the knees and ankles while walking or running. This can help avoid knee pain.
• Warming-up before exercise
  Warming-up before exercise can prevent sudden stress or strains on the joints. Your doctor or fitness trainer can advise you about warm-up techniques to follow before exercising.
• Weight control
  Obesity can put extra load on your knees while walking. Hence, weight control via opting regular exercise and a healthy diet is essential to prevent knee pain.
• Walking or running on a smooth surface
  Always prefer walking or running on a walking track or plain ground as undulations on the ground surface can put more stress on your knees.
• Avoiding exercises that involve heavy weights
  Light exercises such as brisk walking, cycling and swimming do not put excessive pressure on your knees. If you want to try exercises such as weight lifting or running, you should get help from your fitness trainer. He/she will help you plan your exercise regimen in such a way that will not compromise the health of your knee joint.

To find out the exact cause of knee pain, careful medical history and investigations are required. Your doctor may ask you to do some blood tests and radiological tests.

• Complete medical history
  Medical history includes recording the details of the nature, onset, and intensity of the pain (mild, moderate or severe), past history of any injury or joint overuse, and occupational history to rule out any occupation-related cause of knee pain.
• Physical examination of the knee
  Your physician will perform a physical examination in which you will be asked to sit and keep the affected leg in a relaxed position. Then he/she will try to move the leg in all possible directions to check for pain in the knee joint. Pain on touch, redness over the knee joint, and any break in the ligaments can be identified by examining the knee joint.
• Blood examination
  In case the knee pain is not related to an injury, your doctor may suspect some underlying medical cause for which, he/she may advise you some blood tests to diagnose the cause of your pain. Blood tests may include testing for rheumatoid arthritis and gout.
• Radiological tests
  An X-Ray and MRI of the bone are the most promising tests to diagnose the cause of knee pain. Abnormalities detected on an X-Ray can help to understand the pathophysiology of bone, which can assist in starting treatment promptly and lead to early recovery. Ultrasonography can be performed to diagnose Baker’s cyst.
• Joint fluid test
  Sometimes, your doctor may recommend a joint fluid test in which he/she will examine the fluid (synovial fluid) present in the knee joint. The pathological and microscopic examination of the synovial fluid can help to diagnose the reason for your knee pain. Abnormalities in the synovial fluid can be caused by infection or other diseases.

Knee pain can worsen if not treated on time, hence, consult your doctor immediately to diagnose the exact cause of your knee pain and to start treatment promptly. Before visiting the doctor you can try some home remedies for pain relief, but, it will not cure your pain.

• Home remedies
  Some temporary home remedies can be used to get relief from mild to moderate type of pain. These include the RICE therapy which comprises of Rest, Ice, Compression and Elevation.
  • Rest
    Rest is the most important part of treatment for relieving knee pain. If you feel knee pain while performing any activity, you should stop doing that activity immediately and should rest the knee to avoid further pain and damage to the knee joint.
  • Ice packs
    Pain and redness around the knee joint can be reduced by using ice packs intermittently throughout the day and before bed-time.
  • Compression bandage
    A bandage can be rolled around the knee joint (neither too tight nor too loose) to keep the ligament in position and relieve pain. It can be used for the entire day, but, should be removed at night.
  • Elevation
    Elevation of the knee by putting pillows under the knee joint can relieve pain and relax the joint.

If home remedies fail to relieve pain, your doctor may advise you the following:

• Rest
  Your doctor will also advise you to take some rest along with some medications. Resting the knee joint can provide relaxation and early recovery in case of any damage or infection.
• Painkillers
  Over-the-counter medicines like Non-steroidal anti-inflammatory (NSAIDs) drugs which include Paracetamol and Ibuprofen can help in case of mild to moderate pain, but in case of severe pain, your doctor may advise injections or admission to hospital.
• Physiotherapy
  Physical therapy as guided by a physiotherapist doctor can reduce the knee pain. Also, regular therapy can completely cure the pain in most cases.
• Acupuncture
  Acupuncture is a type of sensory stimulation of the nerves which helps relieve pain. It is one of the famous non-pharmacological treatments mostly tried for a chronic type of pain.
• Surgery
  When physical therapy or medications fail to relieve the knee pain, your doctor may advise you surgery depending upon the underlying cause. Some known surgical procedures for the management of knee pain are:
  • Repair of ligaments
    The knee joint is supported by thick band-like structures called ligaments. Due to an injury, these structures can be damaged leading to pain in the knee joint. These ligaments are repaired by surgery using an artificial support to these ligaments.
  • Total knee replacement
    If the damage to the knee joint is not treatable by medication or if ligament repair is not possible, the doctor may recommend a complete knee replacement surgery in which the damaged parts of the knee are replaced with metal and plastic implants. As it is a surgical procedure, it requires complete recovery after the operation by taking adequate bed rest for at least 2-3 months and minimum use of artificial knee till it recovers completely. Total knee replacement surgery can help to relieve pain and improve mobility.
  • Debridement
    In this procedure, an instrument known as arthroscope is inserted in the knee joint through a small aperture and loose debris (small waste tissues) is removed, along with, any adhesions present in the knee joint. These adhesions can be described as the attachment of connective tissues with fibrous bursa, or attachment of any tissue, bone or tendons with each other due to an injury or trauma. This allows the proper functioning of the knee joint.

Lifestyle management

Lifestyle management can be somewhat helpful in preventing knee pain, but, factors like advanced age are not modifiable. Hence, taking a doctor’s advice will be beneficial in such cases. Following are a few tips that you may incorporate in your daily life to ease your knee pain:

• Losing weight
  In the case of obesity, reduction in weight can be very helpful in relieving knee pain. For weight reduction, you should follow a healthy diet plan consisting of fewer carbohydrates and more proteins. Also, drink at least 8-10 glasses of water along with exercising for a minimum of 30 minutes for at least 5 days a week. (Read more - Weight loss diet chart)
• Strengthening exercises
  Instead of performing vigorous exercises, try doing strengthening exercises like lower body workouts which will help reduce knee pain and improve the strength of your knee joint. Always take advice from an expert trainer to follow proper exercising technique.

Prognosis

The outcome of knee pain, whether acute or chronic, is usually good, but, it may require surgery or other necessary interventions.

Complications

Usually, knee pain is completely treatable, therefore, there are only rare instances of developing complications. But, if you ignore your knee pain or do not follow proper treatment, you may develop the following complications:

• Worsening of pain
  Ignoring pain and not taking any medication can lead to worsening of pain over time. To avoid this, consult your doctor if your symptoms do not improve over time or if they tend to worsen.
• Difficulty in walking
  Ignoring the need for the treatment of knee pain can cause extreme pain because of which you may have difficulty in walking and restrictions in movement.