Knee pain can be really difficult as it affects your walking and weight bearing limiting movement and independence. In the majority of cases you should start to feel better in a few days.
Common causes of knee pain
Movement injuries or falls when playing sports or everyday tasks can cause local pain and tenderness. In which case it is more than likely you have either strained or torn your leg muscles. Moreover your tendons may have become inflamed (tendinitis) or caused a ligament strain or ligament tear. Irritated or torn the shock absorbers of your knee (menscisus).
Patellofemoral pain syndrome is particularly common with runners. When you walk or run ideally there should be a smooth gliding motion of the knee cap (patella) over the shin bone (tibia) and thigh bone (femur). When there is more tension in the muscles on the outside of thigh compared to the inside thigh muscles. This will cause the knee cap to drag across to the outside when running which causes friction and pain.
Knee Osteo Arthritis (OA) is the breakdown of the bone and cartilage, causing pain and stiffness. It is more common with the elderly population and can be debilitating.
How do I know if my knee pain is serious?
Knee pain can be a symptom of many different conditions. If your knee is badly swollen or has changed shape or if you have a very high temperature. Moreover if you feel hot and shivery, and have redness or heat around the knee you should telephone 111 or contact your GP (NHS 2020). Other knee pain causes include tumours, deep vein thrombosis and stress fracture. In addition, nerve entrapment, lower back or hip pain referral, bakers cyst and infection to name a few.
How is your knee pain diagnosed?
It’s not necessary to see your GP to gain a knee pain diagnosis. A Manual therapist (Osteopaths, physiotherapists or chiropractors) are able to diagnose knee pain more specifically. They will take a full case history, perform a physical examination with testing, explain what is going on so you understand the cause of your pains. After that proceed with treatment if appropriate.
Why can’t I bend my knee?
Generally an injured or torn meniscus causes pain and swelling and therefore prevents you from bending your knee fully. A damaged meniscus is very common after landing and rotating at the same time causing too much pressure through your knee joint, resulting in injury. It’s typical to hear a “pop” in the knee when a tear occurs. Also swelling and stiffness in the knee that gets worse over the first 2 or 3 days after the injury occurs will be experienced. You will feel like your knee ‘locks out’ or clicks when bending and it may not straighten. Your knee will feel like it will give way without warning. A damaged meniscus is a very common injury whilst playing contact and dynamic team sports.
An osteopath will provide hands on treatment aimed to reduce pressure onto your knee. A postural assessment will be performed to question why you have knee pain. After that, a combination of muscular stretching, joint articulations and joint manipulations (only when appropriate) techniques will be used to increase the functionality of movement and reduce pain. You will be given both muscular stretching and strengthening exercises. Also lifestyle and basic nutrition advice to optimise healing times to support you back into activity.
GP medication and referral
Considering how your knee pain started your GP will either refer you to a physiotherapist, orthopaedic consultant or A&E. Parcetamol may be prescribed for non traumatic knee complaints however the effectiveness has been questioned (Cochrane 2019). A physiotherapist will give muscular strengthening exercises for your knee pain. An orthopaedic consultant will discuss surgical options. You will be referred to A&E if your knee pain is considered to need urgent attention. Parcetamol may be prescribed for non traumatic knee complaints however the effectiveness has been questioned (Cochrane 2019).
If the pain is not too severe then light exercise has shown to be beneficial for people with knee OA for reduced knee pain and physical function (Cochrane 2018). At Wellthy Clinic we big believers in meaningful movement and Pilates exercises are great for knee pain. The combination of stretching and strengthening exercises can help take pressure away from your knees. Core and gluteal strengthening to help stabilise pelvis in particular are beneficial. Moreover safe stretching of your calf and hamstring muscles will help with your knee function. Exercise helps increase blood flow to optimise inflammatory processes. In addition, increase functionality of joints, strengthens muscles and self empowers you to feel a little bit better. Pilates exercises will be graded depending on the severity of your symptoms, regularly reviewed and changed to ensure progression.
Chronic knee pain affects all domains of people’s lives. People’s beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. Gaining reassurance and clear advice about the value of exercise in controlling symptoms will encourage greater exercise participation, which brings a range of health benefits (Cochrane Library 2018).
How long should knee pain last?
From an osteopath’s perspective typically an acute (experienced for less than 6 weeks) mechanical knee pain will resolve in 3-6 weeks. Longer lasting knee pains, depending on the cause and the individual will either take longer to recover. In both cases having a structured rehab plan will enable you to take control of your tensions and would be worthwhile.
NICE (2017) Knee pain assessment here
Cochrane Library (2015) Exercise for osteoarthritis of the knee https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004376.pub3/full
Cochrane Library (2019) Paracetamol versus placebo for knee and hip osteoarthritis https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013273/full?highlightAbstract=knee%7Cpain
Cochrane Library (2018) Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010842.pub2/full?highlightAbstract=knee%7Cpain