The human knee is a marvel of engineering. Our knee is a complex joint that facilitates our mobility and bears the weight of our bodies. However, it is also susceptible to a wide range of injuries and conditions that can lead to knee pain. Whether you are an athletic or sedentary individual, knee pain can affect anyone at any stage of life. Understanding the various types of knee pain is crucial in identifying the underlying causes and seeking appropriate treatment. In this article, we will explore the different types of knee pain and providing you with insights to better treat this common ailment.
What is knee pain?
Knee pain is a common medical condition involving discomfort, soreness, or discomfort in the knee joint area. The knee joint is a complex structure that connects the thigh bone (femur) to the shinbone (tibia). It is supported by ligaments, tendons, cartilage, and muscles. It serves as a critical hinge joint that allows us to walk, run, bend, and perform various movements.
Knee pain can vary in intensity, location, and duration. It may arise from a wide range of causes. It can be the result of acute injuries, such as sprains, strains, or fractures, or chronic condition. Overuse or repetitive stress on the knee joint, improper biomechanics, and age-related joint changes can also contribute to knee pain.
What are the common types of knee injuries or pain?
Knee pain is a multifaceted condition that can be classified into various types. Each arise from distinct underlying causes and affecting specific structures within the knee joint. Understanding these different types of knee pain is crucial for accurate diagnosis and effective treatment. Let’s discuss into some of the most common classifications of knee pain:
Knee Osteoarthritis
Degenerative joint disease is a common condition that affects the knee joint. It is often referred to as osteoarthritis. It occurs as a natural part of the aging process and involves cartilage changes on the knee joint over time. Osteoarthritis can also be triggered or exacerbated by factors such as joint injuries, obesity, or genetic predisposition.
The knee joint is covered by a layer of smooth, protective cartilage that allows for smooth and pain-free movement. With degenerative joint disease, this cartilage gradually changes. As the cartilage degrades, the rubbing of bones may lead to pain, discomfort, and inflammation.
What are the symptoms of knee osteoarthritis?
In osteoarthritis, you may experience hallmark symptoms like a dull ache or stiffness in your knee. This pain tends to worsen after periods of inactivity or when you engage in weight-bearing activities. As the condition progresses, you might find that joint stiffness becomes more pronounced, making it challenging to move your knee freely.
As a result of osteoarthritis, you may notice reduced joint function, making everyday activities like walking, climbing stairs, or getting up from a seated position more difficult. Your range of motion in the affected knee could also decrease, impacting your overall mobility and quality of life.
Osteoarthritis can affect either one or both of your knee. Its severity can vary in severity from person to person. Effectively managing the condition is crucial to minimise pain, improve joint function, and maintain an active lifestyle.
Rheumatoid arthritis
Unlike osteoarthritis, rheumatoid arthritis is an autoimmune disorder that affects your knee joint and various other joints throughout your body. This condition is characterised by chronic inflammation. This occurs when your immune system mistakenly attacks the synovium, a thin membrane lining the joints. As a result, the synovium becomes inflamed, leading to pain, swelling, and stiffness in your knees and other affected joints.
Rheumatoid arthritis is a systemic condition. It can affect multiple joints across different body regions. In the case of knee involvement, both knees are often affected simultaneously. This widespread inflammation can cause significant discomfort, making it difficult to perform everyday activities.
The persistent inflammation in rheumatoid arthritis can also lead to joint deformities over time. As the inflammation erodes the cartilage and bone within the knee joint, it can alter the joint’s structure. This may result in joint deformities, which further contribute to pain and reduced mobility.
What are the 4 stages of inflammation of rheumatoid arthritis?
Stage 1: SynovitisÂ
The initial stage of rheumatoid arthritis involves inflammation of the synovium, a thin membrane lining the joints. The synovium becomes swollen and inflamed, causing pain, warmth, and redness around the affected joints. During this stage, the immune system starts to attack the synovium, triggering the release of inflammatory substances that lead to joint damage.
Stage 2: Pannus Formation
As RA progresses, the inflammation in the synovium leads to the formation of pannus. Pannus is an abnormal tissue growth that spreads over the cartilage and bone within the joint. It is highly aggressive and causes further destruction of the joint structures, leading to irreversible damage.
Stage 3: Fibrous Ankylosis
Formation of fibrous tissue or scar tissue is observable within the knee joint. As the inflammation progresses, the body produces excessive fibrous tissue around the knee joint in an attempt to heal the damage. However, this fibrous tissue can restrict the knee’s movement, causing it to become stiff and immobile. Over time, the knee joint may lose its ability to move freely and may become “frozen” in a fixed position. In advanced cases of fibrous ankylosis, the knee joint may fuse completely, resulting in a permanent loss of knee movement.
Stage 4: Bony Ankylosis
Bony ankylosis is rare. When it does occur, it involves the fusion of bones within the affected joint. The fusion of bones leads to a stiff and immobile joint. This is particularly problematic when major weight-bearing joints, such as the knees, hips, or spine, are affected. Bony ankylosis significantly impacts an individual’s ability to move and perform daily activities.
Patellofemoral Pain Syndrome (PFPS)
Patellofemoral Pain Syndrome (PFPS), also known as “runner’s knee,” is a widespread and bothersome type of knee pain that affect the patella or kneecap. This condition is particularly common among athletes, especially runners. It is considered a repetitive strain injury and can affect individuals who engage in activities that involve frequent knee bending.
The pain associated with PFPS typically arises from an irritation of the cartilage and soft tissues surrounding the patella. The patella plays a vital role in the smooth movement of the knee joint. Knee irritation and inflammation occur when this tracking is disrupted.
What causes runner’s knee?
One of the primary factors contributing to PFPS is repetitive overuse. Engaging in repetitive activities that involve bending the knee, such as running long distances or participating in high-impact sports, can strain the knee joint if you do not have proper training. Over time, this repetitive stress can lead to the development of PFPS.
Additionally, muscle imbalances around the knee joint can exacerbate the condition. Weakness or tightness in certain muscle groups, such as the quadriceps or hamstrings, can affect the alignment and stability of the patella, increasing the risk of patellar misalignment and PFPS.
What does it feel like to have PFPS?
People experiencing PFPS often describe the pain as a dull, aching sensation on or around the kneecap. It may worsen during activities that involve repetitive knee bending or prolonged periods of sitting with the knees flexed. Climbing stairs, descending slopes, and running downhill can be particularly uncomfortable for individuals with PFPS.
Is exercise bad for my knees?
Although PFPS is commonly associated with sports like long-distance running and basketball, participating in these sports doesn’t automatically mean they are bad for you. The development of PFPS is often more related to overtraining and repetitive stress on the knee joint, rather than the sports themselves. The impact of repetitive stress largely depends on the strength and robustness of your knees and how frequently you engage in these activities.
Supervised strength and conditioning play a significant role in supporting your knee health and reducing the risk of developing PFPS. Through tailored training programs, many athletes can effectively build up the necessary muscle strength, joint stability, and flexibility to better cope with the demands of high-impact sports that involve repetitive knee movements. By focusing on strengthening the muscles around your knees, such as the quadriceps and hamstrings, you can reduce the likelihood of experiencing knee pain or discomfort.
It’s important to remember that each individual’s body responds differently to training and sports activities. Some athletes may naturally have stronger knees and experience minimal pain or discomfort even with repetitive knee movements, while others may need additional conditioning and support. Proper guidance from qualified coaches and trainers can make a significant difference in preventing injuries like PFPS and optimising your athletic performance.
Ultimately, it’s not about avoiding sports with repetitive knee movements, but rather finding a balance between training intensity, proper form, and recovery to support your knee health and overall athletic endeavors. With the right approach and attention to knee care, you can continue to excel in your chosen sport and achieve your fitness goals without compromising your knee well-being.
IT Band Syndrome
The iliotibial (IT) band is a robust band of connective tissue that runs along the outside of your thigh. It extends from your hip to your knee and plays a crucial role in stabilising the knee.
Overuse of the IT band can lead to a condition known as iliotibial band syndrome (ITBS). ITBS is a common cause of knee pain, especially among athletes and individuals who engage in activities that require frequent knee flexion and extension, such as runners, cyclists, and hikers.
When the IT band becomes tight or inflamed, it can rub against the lateral (outer) part of the knee joint. The friction and repetitive stress can result in irritation and inflammation of the IT band. This causes pain and discomfort in the outer knee region.
What does IT band syndrome feel like?
Individuals with IT band syndrome may experience knee pain that worsens during specific movements, such as going downstairs or downhill, running on banked surfaces, or cycling with a high seat position. The pain is typically localised to the outer side of the knee. In some cases, it can radiate up the thigh or down the lower leg.
Managing IT band syndrome involves addressing the underlying causes of the condition and implementing appropriate treatment strategies. Rest and avoiding activities that exacerbate the pain are essential for allowing the inflamed IT band to heal.
Meniscus tears
In your knee, the menisci play a crucial role as C-shaped, rubbery cartilage discs positioned between the femur (thigh bone) and tibia (shinbone). These menisci act as shock absorbers. They distribute the weight and forces that pass through your knee joint during various movements like walking, running, or jumping. However, these essential structures are susceptible to injury, particularly meniscal tears.
When a tear occurs, it can cause localised knee pain on the sides of your knees where the meniscus is located. You may experience swelling and bruising in the affected area. It may also be uncomfortable to put weight on the injured leg. Additionally, some people report a feeling of the knee “locking” or “catching” during movement due to the torn meniscus getting caught between the femur and tibia.
What causes meniscus tears?
A meniscal tear can occur due to a sudden twist or forceful movement, often during activities that involve pivoting or changing direction quickly. Sporting activities like soccer, basketball, and skiing, as well as accidents or falls, are common scenarios that can lead to meniscal tears.
The severity of meniscal tears can vary, ranging from minor, small tears to larger, more extensive tears that may impair knee function significantly. Some tears may heal with conservative treatment like rest, ice, and simple exercises. More serious cases may require surgical intervention, especially if the tear is causing persistent pain, limited mobility, or mechanical symptoms like the knee “locking” or “catching.”
Ligament Injuries
In your knee joint, stability is provided by four primary ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and the medial and lateral collateral ligaments. These ligaments play a crucial role in maintaining the integrity and proper alignment of the knee during movement.
The ACL is located in the center of the knee and prevents the tibia (shin bone) from sliding too far forward in relation to the femur (thigh bone). It also helps to stabilise rotational movements of the knee.
The PCL, located at the back of the knee, prevents excessive backward movement of the tibia in relation to the femur and provides stability during flexion of the knee.
The medial collateral ligament (MCL) runs along the inner side of the knee and helps prevent excessive inward movement of the knee, providing lateral stability.
The lateral collateral ligament (LCL), on the outer side of the knee, prevents excessive outward movement of the knee and offers additional lateral stability.
How do ligament injuries occur?
Injuries to these ligaments can occur due to sudden twisting movements, direct impact, or high-energy forces, often during sports activities like football, soccer, skiing, or basketball. Accidents or falls can also result in ligament injuries.
Knee pain, swelling, and instability happens when one or more of these ligaments are injured. Depending on the severity, individuals may experience limited range of motion and difficulty with bearing weight.
Ligament injuries are often graded based on their severity:
– Grade 1: Mild ligament stretching without joint instability
– Grade 2: Partial ligament tear with mild to moderate joint instability
– Grade 3: Complete ligament tear with significant joint instability
More severe ligament tears may require surgical intervention, particularly for athletes or individuals with persistent instability or functional limitations. Rehabilitation and guided exercises are essential in the recovery process to restore knee strength, flexibility, and proprioception (sense of joint position). This helps individuals regain normal knee function and reduce the risk of future injuries.
Tendinopathy (tendonitis, tendinosis)
Tendons play a vital role in our musculoskeletal system by connecting muscles to bones. However, when tendons undergo excessive stress or suffer from injury, it can lead to a conditions known as tendonitis or tendinosis
In the context of the knee, tendonitis can occur when the tendons around the knee joint become inflamed and irritated due to overuse or repetitive movements. The two most common tendinopathy of the knee are patellar tendinitis or the quadricep tendonitis.
The symptoms of knee tendonitis include localised pain and tenderness around the affected tendon. You may experience discomfort when walking, running, or jumping. The pain may worsen during or after physical activities. Swelling and redness in the affected area can also occur due to the inflammation.
How to prevent knee tendonitis?
Preventing knee tendonitis involves gradually increasing the intensity and duration of physical activities, using proper techniques during exercise, and incorporating rest days into your routine. Warming up before exercise and cooling down afterward can also help reduce the risk of tendonitis and other injuries.
If you experience persistent knee pain or suspect knee tendonitis, it’s crucial to seek medical evaluation and advice for an accurate diagnosis and appropriate treatment plan. Early intervention can lead to quicker recovery and help you get back to your normal activities with reduced pain and discomfort.
How do you know if knee pain is serious?
In determining whether your knee pain is serious or not, consider factors such as the intensity, location, duration, and presence of other symptoms. If you experience intense discomfort that significantly limits your ability to walk, stand, or bear weight on your affected leg, it may be a sign of a serious issue. Pay attention if the pain suddenly appears without any apparent cause or injury, as this could warrant further investigation.
Look out for signs like swelling and redness around your knee joint. This may indicate inflammation or other underlying problems. If you find it difficult to bend or straighten your knee, it could signify a structural problem or injury that requires attention.
Be aware that knee pain accompanied by fever, chills, or other systemic symptoms could indicate an infection or an inflammatory condition that requires immediate attention.
Don’t overlook knee pain that do not improve despite trying self-care measures. Some conditions can worsen over time and may lead to complications if left untreated. Seek medical advice from a qualified healthcare professional, such as an chiropractor to get an accurate diagnosis and appropriate treatment plan.
While it’s natural to try and self-diagnose, remember that professional evaluation is necessary to determine the underlying cause of your knee pain and develop an effective management strategy. Early detection and intervention can help prevent further damage and improve the chances of successful recovery. Your health and well-being are paramount, so don’t hesitate to seek medical attention when needed to maintain an active and pain-free life.
What is the most common cause of knee pain?
There are different types of knee pain. Your injury can be briefly classify into the location, when they start (i.e. acute vs. chronic), or how they start (i.e. traumatic vs. non-traumatic).
If you are an athlete, your knee pain is most likely coming from a traumatic sports injury (e.g. tackling another soccer player) or a repetitive overuse injury (e.g. running). For non-athletes, knee pain tend to be chronic without a clear incident to attribute your pain to.
Disorders of the knee cap (patella) that contribute to knee pain include patellofemoral pain syndrome (PFPS) or patellofemoral instability (PFI). If the patellar tendon is involved, patella tendinitis is a likely contribute. Other potential causes of knee pain may include iliotibial band syndrome or IT band dysfunction, ACL injury, torn meniscus, osteoarthritis*, or rheumatoid arthritis.
Some people may experience pain on the inside of the knee while others may have side knee pain. It is good for you to be able to identify knee pain symptoms, however, on its own they are not very useful. We highly don’t recommend you try to self diagnose knee pain.
*Osteoarthritis, also known as degenerative arthritis, was previously mistaken to be a ‘wear and tear’ condition. The latest research shows that osteoarthritis is more likely to be a progressive, natural, age-associated phenomenon that is no different from wrinkles and white hair. Furthermore, studies have also shown osteoarthritic finding on knee MRIs to poorly correlate with pain. In other words, it is common for people who show ‘degenerative’ changes in their knee MRIs to experience NO symptoms.
What are the signs and symptoms of a knee injury?
The most common symptom of knee pain is of course pain itself. Depending on the cause of your knee pain, swelling or warmth to touch may also be observable at the joint. Some knee injuries are accompanied with weakness and instability in the early stages.
For patients experience knee stiffness, it is important to determine if the stiffness is a sensation or a true stiffness (i.e. reduce range of motion or mobility at the knee joint). Most of you will experience a sensation of knee stiffness, without any true loss of knee movement, with your knee pain.
It is also important to note if your knee pain is activity related. For example, some of you may only experience knee pain from running.
What is the first signs of knee ‘problems’?
There are multiple signs that may suggest a potential knee problem. Please note that none of these signs or symptoms should be interpreted in isolation. If you are experiencing knee symptoms, you should consider seeking professional advice. Your chiropractor or physiotherapist will perform an assessment of your knee joint to determine if further investigation or treatment is necessary. If you experience one of the following, we highly recommend you seek professional help:
- Pain with weight-bearing e.g. unable to stand on one leg
- Pain during sports or exercise (e.g. hiit class, running, rugby, swimming)
- Pain with climbing stairs
- Loss of range of motion e.g. unable to completely straight or bend your knee
- Loss of function e.g. unable to get into a squat position or unable to stand from a seated position without assistance
Knee pain from running
There are multiple reasons why your knees might be hurting from running but knee pain “wear and tear” is not a thing.
Most running injuries or knee pain associated with running are due to poor load management. This will include increasing your mileage too much too soon or increasing your pace too fast too soon. Chronic repetitive overuse can lead to injuries such as patella tendonitis. While most people believe that tight muscles on its own contributes to knee pain, current research does not support that. Latest research has shown that stretching reduces risk of injury by only 4% while strength and conditioning reduces risk of injury by almost 70%.
If your knee hurts gradually overtime and you think running (or any sports for that matter) is the cause, look into your exercise routine and your knee function/health. Are your knees conditioned to support your current training?
Read more: How to Prevent Running Injuries: From a Sports Chiropractor Perspective
How to alleviate painful knees?
Believe it or not, we use exercise for knee pain relief at Square One. Most people think rest is the solution for painful knees. While it is true resting does help reduce knee pain, it is not actually beneficial in the long term. The alleviation of symptoms as a result of rest should not be confused with recovery. If your pain has subsided due to pain alone, it will most likely return once you resume usual activities.
Also, there is no research to support icing as a strategy for pain or injury. Pain medications should also be avoided unless absolutely necessary.
Read more: Everything You Need To Know About Pain: Elite Athlete Edition
What is the best way to treat knee injury?
Exercise. It might be true that your current workout routine is making your pain worse but exercise for fitness and exercise therapy for pain are completely different ball games. We have wonderful success rates at Square One using exercise programming to help our clients get back to pain-free living. Research has also shown that rehabilitative exercises that are painful have a significant benefit over pain-free ones.
Virtually all clinical guidelines do not recommend passive therapy such as chiropractic adjustments, soft tissue therapy (IASTM, cross friction massage), dry needling, or even ultrasound/laser therapy as first choice treatment for knee pain. There is no reason why you should choose those treatments over exercise to achieve pain-free living.
How long does it take to recover from a knee injury?
Most soft tissues will take at longest three to six months to heal. If your pain is lasting for more than three to six months after the initial injury, there might be other factors that you will need to address to achieve full recovery. Most of our clients take four to seven visits across a three month period to achieve full recovery – that is to be pain-free AND to return to sport if applicable.
You may be surprise to hear that ACL tears respond just as well to exercise rehabilitation as compared to surgery. Your knees are more robust than you think. Sure, they may be hurting now but don’t the pain beat you down. With the right care, you can overcome your injury.
How to Prevent Knee Pain?
There is no 100% prevention that we know of but there are a few things you can do to keep knee pain at bay.
- Maintain a healthy weight: This is probably one of the biggest risk factors when it comes to knee pain. Overweight/obesity is associated with many health issues including pain at other parts of your body. If you are diagnosed with osteoarthritis and could do with losing a few pounds, this is 100% the first place to start.
- Be conditioned for your lifestyle: Doesn’t matter if you work in an office or play professional sports, keeping active and fit is a prerequisite to pain-free living. If you are getting knee pain as a sedentary individual, consider exercising more to keep your body and joints strong. If you are getting knee pain as an athlete, consider your training load: You can either cut back on the training or make sure your knees are adequately conditioned for the load you are putting them through.
- Be discerning and educate yourself: There are a lot of false information about knee pain being circulated on the internet. Advice such as running is bad for your knees or painful knees is an indication of damage are not based on the latest evidence. Such misconceptions often reduce sense of well-being and lead to negative health beliefs, which in turn increases susceptibility to pain. It’s a lose-lose situation!
What does a chiropractor do?
A chiropractor is a musculoskeletal health care expert. We are trained to diagnose, treat, and manage conditions pertaining to your muscles and joints health. While many chiropractors in Singapore only provides chiropractic adjustments, Square One offers customised pain solutions.
Our approach to recovery is exercise-based and we aim to get you discharge from our care within four to seven visits. We believe in empowering you.
For further information, check out our knee pain page.
Are you looking to visit us? Our office is at Bukit Pasoh Road – a two-minute walk from Outram Park MRT (Exit H, Dorsett Hotel) and Pinnacles at Duxton. If you are coming from Tanjong Pagar, a stroll through Duxton Plains Park will bring you to us.
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Based in Singapore, Square One Active Recovery offers treatments with a very big difference. With our evidence-based exercise approach, you can achieve your recovery goals in just 12 weeks. Not getting results from your chiropractor, TCM doctor or physiotherapist? Talk to us and find out how we can take your recovery to the next level.
Our goal? To make our own services redundant to you.
*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.
