Knee Pain

February 8, 2017

Knee pain is an extremely common complaint. In most cases, particularly for people over 50, osteoarthritis is to blame. However, people of every age can be affected due to many other possible causes including patellofemoral pain, muscle imbalances, structural pathology, or deformity and iliotibial band friction syndrome. Whatever the source of chronic knee pain, it usually involves a certain level of structural damage and limited function.

The knee is the largest and strongest joint in your body. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The ends of the bones where they touch are covered with articular cartilage, a smooth slippery substance that protects the bones as you bend and straighten your knee.

Ligaments and tendons connect the thighbone to the bones of the lower leg. The four ligaments in the knee attach to the bones and act like strong ropes to hold the bones together.

Muscles are connected to bones by tendons. The quadriceps tendon connects the muscles in the front of the thigh to the kneecap. Stretching from your kneecap to your shinbone is the patellar tendon.

Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain. Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, the knee may require surgical repair.


Knee pain can have different causes. Being overweight puts people at greater risk for knee problems. Overusing the knee can trigger knee problems that cause pain. If patients have a history of arthritis, it could also cause knee pain.

Medical conditions

  • Arthritis — including rheumatoid arthritis, osteoarthritis, lupus, and gout
  • Baker’s cyst — a fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, like arthritis
  • Cancers that either spread to the bones or begin in the bones
  • Osgood-Schlatter disease
  • Infection in the bones of the knee
  • Infection in the knee joint

Injuries and overuse

  • Bursitis — inflammation from repeated pressure on the knee, such as kneeling for a long time, overuse, or injury
  • Dislocation of the kneecap
  • Fracture of the kneecap or other bones
  • Iliotibial band syndrome — injury to the thick band that runs from your hip to the outside of the knee
  • Pain in the front of the knee around the kneecap
  • Torn ligament — an anterior cruciate ligament (ACL) injury, or medial collateral ligament (MCL) injury may cause bleeding into your knee, swelling, or an unstable knee
  • Torn cartilage (a meniscus tear) – pain felt on the inside or outside of the knee joint
  • Strain or sprain – minor injuries to the ligaments caused by sudden or unnatural twisting

Risk Factors

  • Excess weight – Being overweight or obese increases stress on the knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts people at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
  • Biomechanical problems – Certain structural abnormalities — such as having one leg shorter than the other, misaligned knees and even flat feet — can make people more prone to knee problems.
  • Lack of muscle flexibility or strength – A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for the knee because they don’t absorb enough of the stress exerted on the joint.
  • Certain sports – Some sports put greater stress on the knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball’s jumps and pivots, and the repeated pounding the knees take when people run or jog all increase the risk of knee injury.
  • Previous injury – Having a previous knee injury makes it more likely that some may injure the knee again.


Signs and symptoms that sometimes accompany knee pain include –

  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully straighten the knee



  • Nonsteroidal anti-inflammatory drugs – There are more than a dozen different drugs in this category, some of which are available without a prescription.
  • Medications for Treatment of Knee Pain and Arthritis – Pain relievers, or analgesics, are an important part of treatment for many knee problems.
  • Analgesics – Analgesics are among the most commonly used drugs for many forms of arthritis.
  • Corticosteroids – These quick-acting drugs, similar to the hormone cortisone made by the body, are used to control inflammation.
  • Disease modifying anti-rheumatic drugs – Disease-modifying anti-rheumatic drugs (DMARDs) are drugs that work slowly to modify the course of autoimmune disease.
  • Gout medications – Some medications for gout are designed to reduce levels of uric acid in the blood to prevent future attacks of joint pain and inflammation.
  • Biologic response modifiers – The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents.

Injections – In some cases, the injection of a corticosteroid drug into the knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.


  • Total joint replacement – The most common knee surgery is total knee replacement, a procedure in which the damaged knee joint is removed and replaced with prosthesis of metal, ceramic and/or plastic components.
  • Arthroscopy – Arthroscopy is a minimally invasive knee surgery performed by inserting a lighted scope and narrow instruments through small incisions in the skin over the knee.
  • Osteotomy – If the damage to the knee is mostly limited to one section, ther doctor may recommend a surgery called osteotomy.

Alternative Treatment

Capsaicin – Derived from hot chile peppers, topical capsaicin may be useful for some people in relieving pain. Capsaicin works by depleting substance P, a compound that conveys the pain sensation from the peripheral to the central nervous system.

Glucosamine sulfate – Glucosamine sulfate provides the joints with the building blocks they need to help repair the natural wear on cartilage caused by everyday activities. Specifically, glucosamine sulfate provides the raw material needed by the body to manufacture a mucopolysaccharide (called glycosaminoglycan) found in cartilage. Supplemental sources are derived from shellfish.

Chondroitin – Chondroitin protects the cartilage and attracts fluids that give the tissue its shock absorbing quality.

Evening primrose oil – A source of gamma-linolenic acid (GLA) which may help maintain healthy joints by modifying inflammation.

Herbs and spices – Ginger, holy basil, turmeric, green tea, rosemary, scutlellaria and huzhang all have naturally occurring anti-inflammatory compounds known as COX-2 inhibitors.

Omega-3 fatty acids – Containing primarily EPA and DHA, which have been shown in studies to help maintain bone health and flexibility.

SAM-e (S adenosylmethionine) – SAM-e helps to reduce inflammation and may increase the feel-good brain chemicals serotonin and dopamine.

Qigong – Qigong is an umbrella term for traditional Chinese-medicine exercises or techniques that integrate body, posture, mind and breathing to improve the flow of energy, or qi.

Acupuncture – Relieve arthritis; migraines; low-back, menstrual, or post-operative pain.

Boswellia – This herb is sourced from the frankincense tree. Its resin is used to thwart chemical reactions that cause inflammation, and thus pain. Ayurvedic scientists have used Boswellia for centuries to treat arthritic conditions, as well as inflammatory bowel disease.

Transcutaneous electrical nerve stimulation (TENS) –  A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. It has been shown to help with short-term pain control in some patients with knee or hip arthritis.

Knee braces – For osteoarthritis with associated knee instability, a knee brace can reduce pain, improve stability and reduce the risk of falling.

Heat and cold – Many people find the heat of a warm bath, heat pack or paraffin bath eases OA pain. Others find relief in cold packs. Still others prefer alternating the two.


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