Knee Pain: Symptoms, Exercises, Relief and Treatment

The location where knee joint pain occurs and the intensity of the trouble varies depending on the cause of the problems.

The most common symptoms include:

• Swelling of the knee,
• stiffening of the joint,
• redness of the skin,
• weakness and impaired stability of the joint,
• an unpleasant squeaking or crunching sound,
• inability to fully straighten the leg at the knee.

Concurrent pain in the knees and feet is not uncommon. What is the reason? Problems with the hip or feet can change the style of walking and, because of the relief of pain in another part of the leg, it is the knee joint that is excessively loaded. ^[1]

Before we get into the issue of knee pain itself, let’s first clarify its anatomy. How vulnerable a joint is it, anyway?

The most common causes of knee pain can be divided into three groups:

Injuries

• Injury to the anterior cruciate ligament, the ligament connecting the tibia and femur.
  If torn, it is usually during sports (skiing, hockey, football) when there is a sudden change of direction or a quick stop.
  Sudden knee pain, a sensation of peeling and instability occurs.
  Patients feel knee pain when bending.
• Torn meniscus. The cause of this injury is usually rotation of the knee under load or sudden movements such as jumps and impacts.
  Severe, sharp pain in the knee occurs, making it impossible to load.
• Fracture of the patella, the flat bone at the front of the knee.
  The fracture occurs when one falls directly on the knee or when the bone is weakened by osteoporosis.

The range of injuries affecting the knee is much greater, and any structure in the knee joint can be affected.

Mechanical problems

• Degeneration of the articular cartilage or the bones themselves can lead to the separation of parts of the cartilage and release into the joint space.
  These “foreign” elements prevent the joint from moving smoothly.
• Dislocation (displacement) of part of the joint, for example, displacement of the kneecap from its position on the front of the knee outside the joint space.

Arthritis and arthrosis

• Arthrosis A degenerative disease of the articular cartilage affecting many joints, including the knee.
  Wear and tear worsens with age and limits the natural pain-free movement of the knee joint.
  A typical symptom is knee pain when walking up stairs or knee pain when loading.
• Rheumatoid arthritis is an inflammatory disease of the joints in which they are damaged.
  The joints affected include the knees.
  Patients may suffer from long-term knee pain.
• Gout an inflammatory joint disease with increased uric acid concentration in the blood and crystal formation in the joints; it most commonly affects the toes but can also cause knee pain.
  The affected joint is swollen, red and painful. ^[3]

Pain, the main symptom of knee injury and disease, can be acute or chronic.

Acute pain is usually the result of an injury and is usually only temporary.

Chronic pain goes hand in hand with longer-term knee problems and often involves multiple factors (long-term overuse of the joint, overweight, previous untreated injuries, musculoskeletal disorders). A typical example where patients have chronic knee pain is knee arthritis. ^[4]

With knee pain, the first place to go is for a physical examination. The doctor will examine and palpate the knee joint and its surroundings. They will observe for soreness, any swelling, redness or change in skin temperature. Checking the mobility of the knee and its integrity is another clue to the diagnosis.

Depending on the findings, the doctor will decide on the use of imaging methods and other tests.

• X-rays reveal fractures and signs of degenerative joint disease.
• A computed tomography (CT) scan may reveal other bone problems, including minor fractures.
• Ultrasound shows the soft tissues around the knee joint.
• Magnetic resonance imaging (MRI) can confirm injuries to ligaments, tendons, cartilage and muscles. ^[5]

Note: Pain below the knee may be related to increased muscle tension and overuse of the knee. An MRI will help clarify the cause.

• Every half-kilogram of excess weight puts four times the load on the knee when walking, running or climbing stairs. ^[6]

The treatment of knee pain involves the use of tablet and injectable medications, physiotherapy and, in the most severe cases, surgery. Often it is a combination of various procedures along with regimen measures. The exact procedure depends on the cause of the difficulty and the specific diagnosis.

Medication for knee pain

• Analgesics (painkillers),
• corticosteroids (injections with anti-inflammatory effect are injected directly into the joint),
• hyaluronic acid (injections that improve joint mobility),
• Enriched plasma treatment (platelet-rich plasma is injected into the joint to “heal” the defects in the joint and slow the development of arthritis).

Physiotherapy

• Rehabilitation under the guidance of a physiotherapist helps strengthen the muscles around the knee.
  The aim is to improve the stability and mobility of the joint.
• Regular home exercise as recommended by a physiotherapist is part of a regimen for knee pain.
• For some patients, adjusting movement habits or posture helps.

Surgery

• Arthroscopic surgery (insertion of a metal probe with a camera directly into the joint) is used to diagnose and treat an injured knee, for example, when ligaments or cartilage are injured.
• Partial knee replacement – the surgeon replaces only the most damaged part of the joint during surgery.
• Total knee replacement – Replacement of the joint with a new one made of metal, plastic and polymer materials.
• Osteotomy – a surgical procedure on a joint that corrects, for example, the knee’s misalignment.
  This procedure can delay total knee replacement or prevent it altogether.

The following measures are important in preventing knee pain.

• Maintain the right weight.
  Obesity and overweight are a big burden on the knees.
• Incorporate regular sport into your programme.
  Be sure to stretch and warm up before any physical activity.
• In case of knee problems, prefer sports that save joints (swimming, water aerobics, yoga, walking) ^[8].

Exercise should become a daily routine for knee pain. Properly chosen and correctly performed exercises are very beneficial for the knee.

A suitable combination of stretching and strengthening exercises improves the mobility and function of the joint.

Remember that knee pain can also be caused by problems in another part of the leg – for example, when the muscles around the hip are weakened, the load is transferred to the knee. ^[9]

In some diagnoses, such as arthritis, knee pain can worsen at night. How to improve sleep in such a situation?

• Find the most comfortable sleeping position, for example with a pillow between your knees.
• If you take medication for knee pain in the evening, try a gradual-release analgesic.
• Get a firmer foam mattress that distributes the weight of your body better. ^[10]

If you want to maintain as active a lifestyle as possible despite knee pain, first and foremost follow the recommendations of your doctor and physiotherapist.

• Pay attention to the way you sit and stand so that you don’t, for example, twist your knees or put strain on only one leg.
• Buy good quality shoes, especially for sports.
• Don’t ignore the pain and enjoy the relief position during the day.
• If you experience knee pain while running, your body is signaling you that it’s time to rest or do a less strenuous activity.^[11],[12]

Taping for knee pain can be a good help.

• It helps with pain, promotes joint stability and serves as injury prevention.
• Taping can be used, for example, if there is pain inside the knee.
  This accompanies tendonitis, a torn meniscus or some knee ligament injuries.
• Learn the correct application of the tape on the knee with a physiotherapist. ^[13]

• Eat plenty of vegetables and fruit (they contain vitamins and antioxidants that protect cells from damage).
• Include omega-3 fatty acids in your diet.
  They reduce inflammation and can relieve painful sensations.
• Think about getting enough vitamin C, which is important for joint health. ^[14]

A number of research teams are looking at new ways to treat knee pain.

• The University of Basel has introduced a surgical procedure in which patients with damaged cartilage or arthritis of the knee have their own cartilage tissue injected directly into the affected joint. Doctors extract a small amount of tissue from the nasal septum and let it grow to several times its size in laboratory conditions. They then insert it into the damaged knee during surgery. The operated leg must remain at rest for about a week, and patients then begin rehabilitation. Moderate physical activity is possible after three months, full weight-bearing one year after surgery. ^[15]
• Another innovative procedure by American doctors is based on replacing damaged cartilage with a hydrogel material that is three times more resistant to wear than the original cartilage.
  Testing is still underway in animals and clinical trials will be conducted in the next phase. ^[16]
• On the other hand, findings from the University of Vienna did not confirm that cannabidiol (a substance found in cannabis) has any pain-relieving effect in patients with advanced knee arthritis.^[17]