What to do When You Have Knee Pain
Updated: Aug 3, 2022
Imagine you wake up on a Saturday morning with plans to lift weights, go for a run with a friend, and walk your dogs. But, to your surprise and dismay, bending and putting pressure on your knee causes a sharp pain. Can you still do your activities?
Knee pain is frustrating because the knee is involved in most physical activities. Continuing with our imagined saturday: running, lifting weights, and walking a dog all require a functioning knee. Most people can push through a bit of knee pain, but If your pain is bad enough, it’s going to be difficult to lift, run, and walk your dogs. If you’re zoning out because you don't enjoy these activities; think of any active hobby that you enjoy doing, it probably involves your knee.
Now thoughts are starting to spin through your head and you start asking Dr. Google questions
Did I injure something?
Should I do my normal exercise or just rest?
Will the pain go away on its own?
Can I foam roll it away?
Should I see a healthcare provider?
Do I need an x-ray?
Will I end up needing surgery?
The goal of the rest of this blog is to answer these questions.
Pain Overview
Not all knee injuries or knee conditions feel the same. Knee pain can be described as dull and achy, sharp, burning, pulling, tight, or sore. These sensations of pain can be deep in the joint or near the surface of the skin.
Knee pain may not involve the entire knee, either. Some individuals report having knee pain on one side of the knee. Knee pain can occur in the front, on the back, on the inner or outer sides, or deep within the knee joint. Sometimes pain can prevent proper movement and functioning, such as weight-bearing, on the knee (4). The location of the pain can be an important characteristic regarding knee pain treatment (4,5,6).
Pain from Injury
Your knee is a hinge-like joint composed of several bones: the kneecap (patella), the shin bone (tibia), and the thigh bone (femur) (1).
Between the bones is a rubbery, C-shaped cartilage called the meniscus that cushions and protects the bones (2). The meniscus absorbs internal and external forces on the joint. This function lets us run, walk, jump, and lift heavy things without knee pain or dysfunction.
Another type of cartilage lines the bones of the knee. This slippery cartilage, called articular cartilage (2), lubricates the knee joint. Like grease in a door hinge, this lubrication allows for smooth movement. Damage or degeneration of articular cartilage has the potential to cause pain (10,11).
Within and surrounding the knee are several important, rope-like ligaments connecting the bones. You have likely heard of the ACL, PCL, MCL, LCL, and IT band. Additionally, muscles such as the quadriceps, hamstrings, gastrocnemius (calves), TFL, adductors, and popliteus provide the knee with stability and strength. These muscles are attached to bones by rope-like tendons. Bursae and tendon sheaths allow muscles, ligaments, tendons, bones to function without rubbing against each other.
Injury or irritation of these tissues can cause pain. Bones break, cartilage tears, ligaments sprain, muscles strain, tendons develop tendinitis, and bursae get irritated. These injuries can occur from one traumatic event such as a fall, football tackle, or car accident. They can also be caused by repetitive trauma such as a heavy manual labor job or a workout program that does not allow you to recover.
Non-specific knee pain
Damage to the knee can cause pain, but knee pain does not always mean your knee is damaged (7). Doing physical activity you are not used to (ex, running 5 miles when you have not run in 6 months), skipping rest days in a workout program, sudden odd movements can all irritate nociceptors (sensorys of tissue irritation) (7). Letting your knee become weak (from lack of exercise) (8) or losing normal range of motion in the knee can also result in pain. What you think also matters; pain is highly correlated with fear of injury and pain (9). If you are scared to move your knee because you think it is fragile and damaged, you are more likely to have knee pain (9).
Serious causes of knee pain
Knee pain can also be caused by more serious conditions such as rheumatoid arthritis, gout, a deep vein thrombosis, arterial disease, cancer, and infection.
Should I see a doctor?
You should see a medical provider if you have red flags, you cannot self-manage your pain, or you feel as though you need help to manage your condition.
Red flags (12, 13)
Your pain is from a major injury
You can’t bend your knee past 90 degrees
You can’t fully extend your knee
You can’t bear weight or your knee feels unstable
Your knee feels unstable or loose
you have an obvious deformity in the knee/leg
Significant swelling
Your knee is hot and/or red
You have a fever or chills
Recent long bed rest or air travel
Losing a significant amount of weight without trying
Night sweets
Night pain
Cold feeling in the feet
Blueness of the leg or foot
Loss of pulse in the foot
History of hormonal treatment, cancer, infection, blood clots
Family history of RA or other autoimmune disease
If these red flags are not present, you should try to self-manage your pain. For more information on this, read our blog on self managing musculoskeletal pain. But here is a general overview of what to do.
Don’t freak out
Catastrophizing makes pain worse in the short term and makes you more likely to develop chronic pain (9)
Try some simple pain management strategies
Self myofascial release with a Foam roller or lacrosse ball
A hot or cold bath (whichever you prefer)
Do pain-free movement
Bend the knee without load
Walk
Bodyweight squats (go as deep as comfortable)
Do these activities a few times every day, but try not to aggravate the pain too much.
Explore more complex movement, possibly painful movement
Running, lifting weights, playing sports, or any other activity that puts the knee under significant load.
start slow
Don’t jump right back into the same intensity of activity you were doing before your injury.
Is pain ok
an increase of pain to a 3-5/10 during the activity is ok, but the pain should go away within 2 hours (3).
Self management fails if your pain is not getting better within 1-2 weeks or the pain keeps coming back.
If you have any of the above red flags, self management fails, or you simply want a teammate who will help you manage your pain, book an appointment with us. We are happy to help!
If you want to see how chiropractic can help with pain and injury, book an appointment with Chirostrength Twin Cities at 612-314-0268.
References
1. Zeller, J.M., Lynm, C., and Glass, R.M. (2007). Knee Pain. JAMA. 2007;297(15):1740.
2. Netter, Frank H. Atlas of Human Anatomy. 1906-1991. Philadelphia, PA: Saunders/Elsevier, 2014.
3. Kolski, M., & O'Connor, A. (2015). A World of Hurt: A Guide to Classifying Pain. Thomasland Publishers, Inc.
4. Farrokhi, S., Chen, Y. F., Piva, S. R., Fitzgerald, G. K., Jeong, J. H., & Kwoh, C. K. (2016). The Influence of Knee Pain Location on Symptoms, Functional Status, and Knee-related Quality of Life in Older Adults With Chronic Knee Pain: Data From the Osteoarthritis Initiative. The Clinical Journal of Pain, 32(6), 463–470.
5. Foroughi, N., Smith, R.M., Lange, A.K., Baker, M.K., Fiatarone Singh, M.A., Vanwanseele, B. (2010). Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis. Knee. Jun;17(3):210-6.
6. Farrokhi, S., Piva, S.R., Gil, A.B., Oddis, C.V., Brooks, M.M., Fitzgerald, G.K. (2013). Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis. Arthritis Care Res (Hoboken). Apr;65(4):544-51.
7. Van Wilgen CP, Keizer D. The sensitization model to explain how chronic pain exists without tissue damage. Pain Manag Nurs. 2012;13(1):2019, 60-65.
8. Glass, N. A., Torner, J. C., Frey Law, L. A., Wang, K., Yang, T., Nevitt, M. C., Felson, D. T., Lewis, C. E., & Segal, N. A. The relationship between quadriceps muscle weakness and worsening of knee pain in the MOST cohort: a 5-year longitudinal study. Osteoarthritis and cartilage, 21(9), 2013, 1154–1159.
9. Quartana, P. J., Campbell, C. M., & Edwards, R. R. Pain catastrophizing: a critical review. Expert review of neurotherapeutics, 9(5),2019, 745–758.
10. Heir, S., Nerhus, T. K., Røtterud, J. H., Løken, S., Ekeland, A., Engebretsen, L., & Arøen, A. (2010). Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. The American journal of sports medicine, 38(2), 231–237.
11. Liu, Y., Joseph, G. B., Foreman, S. C., Li, X., Lane, N. E., Nevitt, M. C., McCulloch, C. E., & Link, T. M. (2021). Determining a Threshold of Medial Meniscal Extrusion for Prediction of Knee Pain and Cartilage Damage Progression Over 4 Years: Data From the Osteoarthritis Initiative. AJR. American journal of roentgenology, 216(5), 1318–1328.
12. Mayo Foundation for Medical Education and Research. (2021, May 11). Knee pain. Mayo Clinic. Retrieved September 13, 2021, from https://www.mayoclinic.org/diseases-conditions/knee-pain/symptoms-causes/syc-20350849.
13. Kim Y. J. Red flag rules for knee and lower leg differential diagnosis. Annals of translational medicine, 7(Suppl 7), 2019, S250.