Knee Pain
Knee pain refers to any discomfort or pain in and around the
knee.
The location of knee pain can help identify the problem. Pain on
the front of the knee can be due to bursitis, arthritis, or softening of the patella
cartilage as in chrondromalacia patella. Pain on the sides of the knee is commonly related
to injuries to the collateral ligaments, arthritis, or tears to the meniscuses. Pain in
the back of the knee can be caused by arthritis or cysts, known as Baker’s cysts.
Baker’s cysts are an accumulation of joint fluid (synovial fluid) that forms behind
the knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments,
osteoarthritis of the joint, or infection.
Instability, or giving way, is also another common knee problem.
Instability is usually associated with damage or problems with the meniscuses, collateral
ligaments, or patella tracking.
Description of knee pain.
Knee pain is very common. Each year, millions of Americans visit the doctor for knee
pain. It is the most frequent reason for visits to an orthopedist (bone and joint
surgeon).
To understand the various causes of knee pain, it is important to know how the knee
functions. The knee refers to the joint where the femur (thigh bone) meets the tibia
(largest lower leg bone). In front of this joint lies the patella (knee cap). The joint is
lined by a membrane called a synovial sac. The synovial sac produces synovial fluid which
acts as a lubricant much in the way that oil lubricates the moving parts of machinery.
Other tissues that make up the knee joint include cartilages, muscles, tendons, and
ligaments. The upper end of the tibia has cartilaginous shock absorbers called
"menisci" (meniscus). Other protective structures are the bursae, which cushion
areas of friction in the joint. Most of the muscles involved with joint mobility originate
in the thigh, cross the knee joint, and attach to the tibia.
The knee supports two to three times a person's body weight. It is a complex joint that
allows for a considerable range in mobility. In addition to simple flexion (bending) and
extension (straightening) movements, the knee joint is designed to allow for rotation,
gliding, and rolling movements. To allow for complex mobility and joint stability, joint
strength was sacrificed, making the knee very prone to injury.
Causes & symptoms of Knee Pain
Common Causes of Knee Pain
Causes & symptoms
Knee pain is a symptom of many different diseases and conditions. Short-term knee pain
may be the result of excess stress on the knee. Possible causes of knee pain include:
- Arthritis. Osteoarthritis (joint degeneration), rheumatoid arthritis (joint
inflammation), and septic arthritis (joint infection) can cause knee pain.
- Bursitis. Inflammation of the bursae of the knee can cause knee pain. Bursitis can be
caused by infection, gout, rheumatoid arthritis, injury, illness, or chronic irritation
(crawling or kneeling)
- Cysts. A cyst is a fluid-filled sac. Cysts associated with the knee can cause swelling
and knee pain or discomfort.
- Fracture. Breakage or crack in any of the bones associated with the knee joint can cause
knee pain.
- Gout. A faulty chemical process leads to high levels of uric acid in the blood which causes inflammatory
arthritis, crystal deposits in joints, joint destruction, and joint pain.
- Ligament injury or instability. The ligaments supporting the knee may be injured or
strained by persons who participate in sports, particularly football, rugby, lacrosse,
basketball, skiing, soccer, and volleyball. Accidents can also cause ligament damage.
- Loose bodies. This condition refers to any loose objects that float around the knee and
cause problems. They also are called "joint mice" because of their elusive
nature.
- Meniscus conditions. Damage, usually in the form of a tear, to the menisci can be caused
by degenerative changes associated with advancing age or are sports-related. Sports which
commonly cause menisci damage include football, basketball, soccer, tennis, lacrosse, and
skiing.
- Osteonecrosis. Degeneration of the bones associated with the knee causing pain and
deformity.
- Patellofemoral pain. Also known as anterior knee pain syndrome, this condition is
characterized by pain around the knee cap. The exact cause of patellofemoral pain is
unknown but probably related to muscle inadequacy, lack of flexibility, rapid growth, or
bone positioning
Diagnosis
Knee pain can be diagnosed and treated by an orthopedic surgeon. Diagnosis is based
primarily on medical history and physical exam. The diagnosis begins with a detailed
medical history to fully characterize the knee pain. The knee will be bent to determine
the range of motion and palpated (felt with the hands) to detect the presence of any
abnormalities. The physical exam may include any of a number of different tests designed
to detect injuries by manipulating the knee and leg. X rays may be taken. In some cases
more advanced testing may be carried out using magnetic resonance imaging (MRI), computed
tomography (CT), or contrast arthrography (x ray following injection of a contrast
solution).
Treatment
Most alternative treatments for knee pain aim at reducing pain, inflammation, and
stiffness. Persons experiencing long-term or severe knee pain should consult a physician
to determine the underlying cause.
Herbals
Several herbal remedies are recommended to relieve knee pain. Some remedies are used
externally, while others involve internal use of herbs.
The following herbs may relieve knee pain and/or associated symptoms when used
externally:
- basil and sage oil rub: knee pain
- comfrey (Symphytum officinale) oil rub: joint stiffness and aching joints
- eucalyptus (Eucalyptus globulus) essential oil rub: swelling
- ginger (Zingiber officinale) root hot compress or bath: joint stiffness,
arthritis, and degenerative joint disease
- lavender (Lavandula officinalis) essential oil rub: joint stiffness and aching
joints
- mustard (Sinapsis alba) powder bath or paste (with alcohol): knee pain
- red pepper (Capsicum) lotion: arthritic pain and swelling
- St. John's wort (Hypericum perforatum) oil rub: joint stiffness and aching joints
- wintergreen (Gaultheria procumbens) oil rub: chronic pain
The following herbs may relieve knee pain and/or associated symptoms when used
internally:
- celery (Apium graveolens) decoction or tincture: swollen joints and gout
- chamomile (Matricaria recutita): spasms and swelling
- deadly nightshade (Atropa belladonna) plaster: swollen joints
- devil's claw (Harpagophytum procumbens) tablets: swollen joints
- flaxseed (Linus usitatissimum) oil: lubricates joints
- feranium (Pelargonium odoratissimum): chronic pain
- jamaican dogwood (Piscidia erythrina): pain and swelling
- lemon (Citrus limon) juice: swollen joints
- prickly ash (Zanthoxylum americanum) tea: joint pain
- white willow (Salix alba) tablets or decoction: swollen joints and joint pain
- wild lettuce (Lactuca virosa): pain and swelling
Other remedies for knee pain.
Various other alternative treatments that can be helpful in relieving knee pain
include:
- Acupressure. Pressing the Stomach 36 point located below the knee caps tones muscles and
relieves joint pain anywhere in the body. Pressing the Spleen 9 points located below the
kneecap on the inside of each leg relieves knee pain.
- Acupuncture. Inflammation and pain may be
relieved by acupuncture. The large intestine meridian is the most effective channel for
pain relief. A National Institutes of Health consensus panel found that acupuncture may be
an effective treatment for osteoarthritis pain.
- Aromatherapy. Aromatherapy with essential oils is sometimes recommended. The essential
oil of peppermint relieves pain and decreases inflammation. The essential oil of rosemary
relieves pain and relaxes muscles.
- Chinese medicine. Knee sprain and contusion (bruise) are treated by application of Shang
Ke Xiao Yan Gao (Relieve Inflammation Paste of Traumatology) and ingestion of Die
Da Wan (Contusion Pill). Once the initial pain and swelling have been reduced, the
patient can apply Shang Shi Zhi Tong Gao (Relieve Damp-Inducing Pain Medicinal
Plaster).
- Exercise. Regular moderate exercise can reduce pain by improving the strength, tone, and
flexibility of muscles. The endorphins released while exercising may also be helpful.
- Food therapy. Following a detoxification diet may restore nutritional balance to the
body and relieve joint pain. Animal proteins may induce joint pain caused by inflammatory
conditions, such as arthritis, so following a vegetarian diet may be helpful.
- Homeopathy. Rhus toxicodendron is recommended for joint and arthritis pain that is worse
in the morning and relieved by warmth. Kali bichromicum is indicated for persistent,
severe pain. Other homeopathic remedies can be designed for specific cases by a
homeopathic practitioner.
- Hydrotherapy. A warm compress can relieve joint stiffness and dull pain. A cold compress
or ice pack can relieve sharp, intense pain.
- Magnetic therapy. Magnetic fields may increase blood flow and block pain signals.
- Massage. Joint pain may be relieved by massaging the area above and below the painful
joint. Massaging with ice packs may interfere with pain signals and replace them with
temperature signals.
- Reflexology. Knee pain may be relieved by working the knee reflex points.
- Rolfing. This deep, sometimes painful, massage therapy may speed healing and reduce
pain.
- Supplements. Knee pain may be relieved by taking vitamin C to promote healing, the B
vitamins to balance the nervous system, which reduces pain, and calcium to increase bone
strength.
Allopathic treatment of Knee Pain
Knee pain may be relieved by taking nonsteroidal anti-inflammatory drugs such as
acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). More severe pain
may be treated with prescription pain relievers such as tramadol or a narcotic. Additional
treatment for knee pain depends upon the underlying cause and may include injection of
drugs into the knee, surgery, wearing a brace, and/or physical therapy.
Prevention of Knee Pain
Strengthening the leg muscles may help prevent knee pain caused by overworking the
joint. In addition, a stronger knee may prevent injury to the joint. Squats are an easy
exercise that will strengthen the quadriceps (front thigh muscles) and hamstrings (back
thigh muscles). The yoga warrior posture strengthens the muscles around the knee and
increases range of motion. |
