Knee Pain

Not only is the knee the largest joint in the body, it is also responsible for absorbing and supporting a lot of a person’s weight as they move. There probably isn’t a day that goes by where someone doesn’t use their knees. Due to the use, and over use, of our knees, knee pain is incredibly common, and can be a temporary symptom from an injury or the result of a chronic medical condition. If you’re tired of knee pain and are looking for treatment options, the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas can help. 

What is Knee Pain? 

Simply stated, knee pain is pain or discomfort that is felt in or around the knee joint. Depending on the issue that is causing pain, discomfort can be felt: 

• Close to the surface of the skin, above or behind the knee: usually caused by an issue with muscles, ligaments or tendons
• Deeper inside the knee: pain that comes from bones or cartilage
• Several different parts of the knee or leg: pain that originates in the knee but spreads or radiates to different parts of the body, such as to the lower leg or thigh area

The specific location and severity of knee pain can vary depending on the cause of pain. Additional signs and symptoms that can accompany knee pain include:

• Swelling and stiffness
• Weakness and irritability
• Redness and warmth to the touch
• Popping or clicking noises
• Inability to fully extend or straighten the knee
• Inability to place weight on the knee
• A feeling that the knee is going to “give out”

Knee pain affects people of all ages. It can be the result of an injury that involved a torn cartilage or ruptured ligament, or can be from a medical condition such as arthritis. Many types of knee pain respond well to at-home, self-care methods, but in the event that the pain becomes unbearable, worsens or is chronic, medical attention is necessary. 

Why Does Knee Pain Happen?

The knee is one of the largest joints in our body, and is a complex joint at that. Four bones, the femur, tibia, fibula and patella, make up the knee, and are all supported by muscles in the front (quadriceps) and back (hamstrings) of the knee. These bones and muscles are connected by a network of ligaments and cartilage that allow the knee to move. The ACL (anterior cruciate ligament) keeps the femur (thigh bone) from moving backward, and the PCL (posterior cruciate ligament) prevents the femur from sliding forward. The medial and lateral ligaments, on the inner and outer side of the knee, respectively, help to provide support. 

The meniscus (medial and lateral) is tissue that is located in between the femur and tibia that work by providing ease of movement between the two bones, reducing friction and and adding support. There is also articular cartilage, which is tissue that lines the ends of bones, that sits behind the patella, that enables the knee joint to withstand weight-bearing movements. The last but not least crucial part for knee function is the bursae, which are fluid-filled sacs that help to cushion the joint and reduce friction between the moving structures. 

All of these parts help to allow a person to comfortably enjoy a mobile life, complete with standing, sitting, running, jumping, etc. Due to the fact that the knee is a constantly used joint, as well as the fact that there are many parts that makeup the knee, the opportunity for injury and symptoms of wear and tear are great. But, the key to treating knee pain is to first understand what exactly is causing knee pain in the first place. 

What Causes Knee Pain?

The most common causes of knee pain are overuse, mechanical problems, arthritis and traumatic injuries. Because the joint is so complex and performs so many different movements including bending (flexion), straightening (extension) and twisting, there are no shortage of ways that the knee can accidentally overextend or twist too far, causing damage. 

The main causes of knee pain include: 

• Dislocated kneecap: most often the result of a sports injury, a dislocated kneecap occurs when the patella slides out of place. Sometimes this can be popped back into place, but if that proves to be unsuccessful then other treatments might be needed
• Bursitis: this happens when the bursae, the fluid-filled sacs that cushion spaces between the bones, become irritated and inflamed, preventing the tendons and ligaments from gliding smoothly over the joint. The most common causes of bursitis are overuse and putting too much pressure on one or both bursa.
• Osteoarthritis: the most common cause of degeneration in the knee joint, osteoarthritis occurs over time, with wear and tear and overuse
• Patellofemoral pain syndrome: most often occurring in athletes, young adults and those whose kneecap doesn’t track properly in the knee groove, this syndrome refers to pain that arises between the kneecap and the underlying thighbone. The pain, which persists in the front of the knee, is caused by cartilage that has deteriorated, softened or become rougher over time and with overuse.  
• IT (iliotibial) band syndrome: This occurs when the tough band of tissue (iliotibial band) that extends from the outside of the hip to the outside of the knee helping to stabilize the knee and hip becomes so tight that it rubs against the outer portion of the thigh bone. Distance runners and cyclists are especially susceptible to iliotibial band syndrome. Symptoms include pain or swelling on the outside of the knee or hip bone, as well as inability to extend the knee past a 45 degree angle. 
• Gout: gout is a type of arthritis that occurs when a buildup of uric acid in the blood in and around joints. This buildup forms needle-shaped crystals in the joints that lead to pain, swelling, redness and changes in joint mobility. 
• Loose material: sometimes due to injury or degeneration can cause little bits of bone or tissue to break off and float in the joint space, possibly lodging itself in an area where it shouldn’t be. 
• Tendinitis and tendinosis: the patellar tendon connects the leg’s front muscle, the quadricep, to the shinbone. If this tendon becomes inflamed or aggravated, it can lead to pain and possibly tendinitis. Tendinitis, an inflammatory condition, is the cause of small micro-tears in the tendon from overuse, while tendinosis, a result of weakened collagen in the tendon, occurs when the tendon continues to experience the same heavy and continued amount of overuse without rest. Both conditions lead to pain and limited mobility. 
• Torn ACL: a torn ACL is one of the most common sports-related knee injuries and generally occurs when a person is attempting to make a sudden directional change, like kicking a soccer ball or running across court to hit a tennis ball. The ACL is responsible for providing the majority of the knee’s stability by preventing the shinbone from moving forward beyond the knee. Most ACL tears happen during sudden stops, fast accelerations, twisting and jumping. A clear way to know if the ACL is torn is that the person will hear a popping sound followed by hyperextension of the leg. To add insult to injury, not only do most torn ACLs require reconstructive surgery to fully repair the damage, they also tend to damage additional parts of the knee, such as the meniscus, cartilage and/or ligaments. 
• Torn meniscus: while a torn meniscus is another common sports injury, this can also occur in older people who might have experienced an awkward walking or falling motion. The meniscus is the tough, rubbery cartilage that acts as a shock absorber between your shinbone and thigh bone that helps to absorb shock and stabilize the knee. It can be torn if you suddenly twist your knee while bearing weight on it. Several different types of tears can occur in regard to location, including longitudinal tears (backside), bucket handle tear (inside curve), flap tear (small piece of the inside curve), transverse tear (breaks the meniscus in two) and torn horn (end). Much like a town ACL, a person can expect to hear a popping sound and pain. Due to the fact that a large amount of blood is located around the meniscus, many meniscus tears can heal on their own, but surgery could be needed in some cases. 
• Rheumatoid arthritis: The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including the knees, causing incredible pain. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.

What Are Knee Pain Treatment Options?

The best way to begin treating knee pain is to get a diagnosis from a trained pain specialist who knows what to look for and how to best treat it. In addition to a physical examination and an in-depth look into the patient’s medical and family history, a specialist might also utilize X-rays and MRIs to get a greater understanding of the physical structures underneath the skin in and around the knee. 

The first and most often recommended treatment for knee injury is ice, low-impact exercise and physical therapy. Gait analysis helps to determine if there is any imbalance in the way a person walks or how the knees are used during normal activity. Investing in proper, or better, shoes can also help resolve minor knee pain issues. Supplements are also a great way to introduce more to the knee joint that helps to create more fluid movement, and certain anti-inflammatory medications can help to reduce acute flare-ups. TENS therapy is also a great way to provide pain relief through the use of patches on the skin that disrupts pain signals to the brain via a mild electrical current. If these options do not help to provide the intended level of pain relief, or the pain is still felt weeks or months after the initial pain-causing incident, the next step could include minimally-invasive options. 

Injections, most commonly corticosteroid injections, are used to provide a safe and comfortable way for patients to experience immediate pain relief so they can enjoy mobility in the knee again, which allows them to explore physical therapy options and light exercise to strengthen the knee. Nerve blocks, including genicular nerve blocks and saphenous nerve blocks, help to provide pain relief by blocking the pain sensations from the injured nerve from reaching the brain. These are a great option for patients who don’t want to rely on medication or surgical options. 

Spinal cord stimulation (SCS) is another safe and effective way to reduce the feeling of pain from being delivered to the brain by placing small electrodes in the epidural space in the spine. Similarly, peripheral nerve stimulation (PNS) uses electrodes that are placed along the peripheral nerves close to the area where pain is felt. For both SCS and PNS, a trial simulator that is connected to a stimulator is generally worn for up to a week. If the trial successfully relieves the pain, then the patient can decide to have a permanent device. 

If all else fails, orthopedic surgery might be the best and hopefully final option to help the patient experience a pain-free life. Sometimes this option might be the only option, especially if a traumatic injury occurred that caused the knee pain. But for most, surgery is a last resort and it is the most invasive, requires a longer healing period, and has a higher chance of experiencing risks and side effects.  

If you are dealing with knee pain and would like to know more about the myriad of pain-relief options out there, the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas is here to help. We are able to not only help you get out of pain as quickly and safely as possible, we can also make recommendations for helping to avoid future knee pain. Please call or click to schedule an appointment today with one of our expert and dedicated pain management specialists.