Knee pain is one of the most common problems that can occur at any age, but often in the later age. It affects 1 in 10 people across the world, above the age of 60 years. It is usually associated with any of the structures of the knee area, like the knee joint (bony parts-tibia, fibula, and femur), cartilage, ligament, patella or knee-cap. Depending on the involvement of the structure, the location of your knee pain varies. So, the knee pain can occur as a result of an injury like torn ligament or tendon, problems in the bony structures, or due to other medical conditions. Diseases like osteoarthritis, rheumatoid arthritis too can take a toll on the knee joint.
Knee pain in the elderly people, occurs as a result of the side effect of these long term medical issues, which impacts the bones or joints. But, in the majority of the cases, it occurs due to the weakening of the bone structure, caused by the aging process.
Anatomy of the knee:
Knee is the most complex joint in the body, which comprises bones, cartilage and ligaments. It connects the two bones called femur (thigh bone) and tibia (shin bone). The small bone, which runs along the side of the tibia, is called fibula and the convex bone, present in the front of the knee, is called patella or knee cap.
Cartilage of the knee:
There are 4 major cartilages, which helps keep the bones (femur and tibia) in the position, and prevents them from sliding in the wrong directions.
- Anterior cruciate ligament:
- Posterior cruciate ligament:
- Medial collateral ligament
- Lateral collateral ligament
There are 2 c-shaped cartilages, called as medial menisci, and lateral menisci. They work as shock absorber between the two main bones, femur and tibia.
Causes of knee pain:
Our knee is a joint, which is used extensively throughout our routine work. So, if it does not function properly, it can heavily impact our normal activities of life. There are a number of factors which can cause knee pain. As mentioned above, injury is one of the most common reasons, but one may have a painful knee due to the following reasons as well:
- Tendinitis: It occurs due to the inflammation of the tendon. The tendon is the tissue that binds the muscles to the bones. In tendinitis, the patient develops pain in front of the knee, which aggravates in climbing, taking stairs, or other heavier activities.
- Meniscus tear: A damage of one or more cartilage of the knee.
- Bone tumor: It is a common problem, and often occurs in the knee. It is also considered as the second leading bone cancer, which is also known as osteosarcoma.
- Dislocation: It is the convex bony part of the front of the knee. Medically, it is called as the patella. Dislocation of the knee cap may also cause chronic knee pain with serious trauma.
- Chondromalacia of the knee cap: The term chondromalacia means breakdown of any cartilage in the body. So, damage or breakdown of the knee cap/patella can cause severe pain, which can impact the range of motion.
- Obesity: Your knee can withstand the normal body weight. When your body weight exceeds the normal range, it starts straining your knee joint. It causes the tissue loss in the joint, resulting in friction between the joint bones (tibia, fibula and femur), and pain.
- Sprain and strain: Usually, the sprain and strain occurs in the knee ligament and muscle tissues. It often happens due to the blunt trauma, and when you twist the knee in the wrong way. It is mostly triggered by sports and a sudden movement.
Types of knee pain:
- Anterior knee pain:
It is the most common type of pain, complained by a large number of patients. Anterior knee pain (AKP) is usually seen in adolescents and young adults, but is more common in sport persons. In most cases, it occurs as a non-specific symptom, and can be diagnosed properly by a radiological examination like MRI. It may cause mild to severe knee pain in the patients. In a research, published in the Journal of ‘Skeletal Radiology’, it is mentioned that AKP may occur due to the soft tissue and osseous abnormalities like chondromalacia patella, instability and dislocation of the patella, anterior knee bursitis, etc..
- Posterior knee pain:
It is a less frequently occurring knee problem as compared to the other types of knee pain like anterior, medial, and lateral pain. It is mostly experienced by the adults. According to the Journal of Current reviews on Musculoskeletal Medicine, it is said that posterior knee pain has a broad line of differential diagnosis. So, it is important for the clinician to evaluate carefully the problem with a proper physical examination and medical history.
- Lateral knee pain:
Lateral knee pain is less common as compared to the anterior pain, usually occurs on the lateral or the outer surface of the knee. It may occur suddenly after any injury, or it develops gradually. The lateral knee pain may occur due to many causes, like lateral meniscus tear, lateral collateral ligament sprain, etc.
- Medial knee pain:
It occurs in the medial or inner side of the knee. Medial knee pain can occur due to a number of factors. Like lateral pain, it may come suddenly after an injury, or develops over time. The pain can be mild to sharp in nature, and may impact movement. The major causes of the medial knee pain are, tear of medial collateral ligament, meniscus tear, and arthritis.
Symptoms of the knee pain:
The signs and symptoms of the knee pain vary from person to person, and the intensity ranges from mild to severe. Some of the common symptoms are:
- Stiffness of the knee
- Difficulty in bending and straightening the knee
- Skin over the knee feels warm to touch
- Popping or clicking sound during the movement of the knee
- The pain is constant in nature
- It is dull and burning and causes discomfort
- Difficulty in standing
- Swelling, sore knee
- Patient feels numbness in the affected knee
Risk of knee pain:
Elderly people, who have joint or bone problems, are more likely to have knee pain. But, it is more commonly seen in the women above the age of 60 years, as compared to the men. Apart from this, the children and adolescents, who are more active in sports, like jumping, running, or other similar activities, may suffer from painful knee. Some lifestyle factors can also trigger the pain, which are:
- Overweight or obesity
- Previous accidental injury
- Lack of exercise
Diagnosis of the knee pain:
When you visit your doctor, he/she will do a physical examination, and take a medical history. For diagnosing the knee pain, your doctor may advise you the following tests, to identify the underlying cause:
- Ultrasound: It is advised in most of the cases of knee problem.
- X-rays: It is advised to rule out any injury, deformity, or any condition. The X-ray is taken by using the electromagnetic radiation.
- Magnetic resonance imaging (MRI): It helps the doctors to examine the anatomy of the structure, giving a 3D image of the structure.
- Computerized tomography scanning (CT): It helps to evaluate the problem from different angles and position. It is advised if there is any problem with the joints, tissues, and bones.
- Arthrocentesis: It is used in some cases of knee joint problem, by taking the fluid from the joint structures like capsule, synovial membrane, etc.
Treatment of knee pain:
Depending upon the diagnosis and the causes of the pain, your doctor may advise you any of the following treatment options, such as:
- Medication: Medication is the initial step to treat the pain, and other associated symptoms. For mild to moderate pain, drugs like NSAID (non-steroidal anti-inflammatory drugs), and paracetamol are prescribed. It will help reduce the muscle pain and stiffness, and inflammation. Topical drugs are also available for relieving the pain. If you do not get any relief, your physician may give you strong analgesics, muscle relaxants, prescription analgesics, anti-anxiety medication, etc. In worst cases, steroid injection is prescribed to give you relief from the inflammation and swelling.
- Physiotherapy: Physiotherapy along with medications, works great in reducing the knee pain. However, you should always do it under the supervision of an expert. Proper exercise and physiotherapy can provide significant improvement and restore functions of the knee in a short period of time. According to a Journal of Nursing Standard, exercise is the best option for the older and middle aged knee patients as compared to the surgical intervention.
- Surgery: Even though, the surgical intervention is considered as the most effective treatment options for knee problems like chronic knee pain, arthritis, etc. But, it should always be your last choice, if and when non-surgical treatments fail.
Surgery with arthroscopy can be performed in both older and younger patients. Before, going for any surgery, do enough research about your condition, and talk to your surgeon about all the post-operative consequences, to take an educated decision. Always prefer a second opinion.
Simple steps you can practice to manage knee pain, are:
- Give proper rest to your knee, and avoid working for some days.
- Ice your knee for 15 minutes for every 2-3 hour; continue it for a few days. It works great in decreasing the pain and swelling.
- To prevent the swelling, you can compress the knee by using an elastic bandage or a strap.
- Always use a pillow under the heel when you sit or lie down. It gives you relief from the swelling.
- Take an anti-inflammatory drug to reduce the pain and swelling. It may cause some side effects. So, you should always talk to your doctor before stating any dose of such drugs.
- Do some regular exercise and stretching, which will help you maintain the health of your knee, and also your weight.
Knee pain is one of the most debilitating conditions, which can rob your ability to enjoy your life. You can get rid of it by taking proper care at the right time with the right regimen. So, if you are experiencing knee pain, visit your health care provider without any delay before it becomes a serious issue. Don’t miss out the things you love to do!
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Author: Dr Mehjabin Ahmed