Knee Pain

What is it?

Your knee is like a hinge. Cartilage covers the ends of the bones, to allow smooth movement when you bend or straighten it. 

Osteoarthritis is when the cartilage is gradually worn away with age or after injury, mainly at the points of greatest pressure.  The two surfaces rub against each other - sometimes you can hear or feel it.  This can lead to pain, stiffness, loss of movement, swelling and deformity. 

It can lead to your knees giving way because the muscles around the joint can become weak. 

How to deal with it? 

In the case of osteoarthritis, the following tips may help:

• Straighten your knees fully when standing and avoid lying down with your knees up. Also, reduce the amount of time you spend sitting and aim to bend and stretch your legs a few times every half hour and just before you get up.
• Wear sensible, well fitting, soft-soled shoes with low heels.
• Your physiotherapist may give you an exercise programme to reduce knee stiffness and strengthen the muscles which control your knees. Try this daily, starting gently at first.

Osteoarthritis can be managed in several ways.

• Heat and ice: Heat can be soothing and help decrease pain, ice can reduce swelling and pain. 
• Painkillers and/or anti-inflammatory tablets/gels but discuss with your GP or Pharmacist before taking

What is it? 

Anterior knee pain (AKP) is pain in the front of your knee which is very common - it's the second most common musculoskeletal condition after lower back pain. AKP affects an estimated 25 per cent of the population at some point in their lives.

It is usually not related to any significant injury. The pain is usually caused by overusing the joint and repeatedly placing strain on the knee by carrying out repetitive activities such as kneeling, squatting and walking up stairs.

How to deal with it? 

In general, anterior knee pain (pain at the front of your knee) is the result of overusing the joint. Therefore, by allowing your knee the right amount of rest, whilst following the guidelines below and avoiding any activity that is worsening the pain, you can make a full recovery.

• Try to reduce any activity that is making your knee hurt more
• Identify any changes in your lifestyle that could have resulted in knee pain, both internally (e.g. have you gained weight?) or externally (e.g. have you started wearing new shoes?) If you do, try reversing the changes and see what effect it has on the pain
• Physiotherapy can be helpful and there are a variety of exercises you can do at home to stretch and strengthen the muscles in your legs. 
• Please perform this stretch 3 times twice a day. All stretches should be held for 30 seconds and while it’s important that the pain does not worsen while stretching, you should be able to feel a comfortable pull in your muscles. Please see the inset picture for the correct way to stretch. Please hold a sturdy object if required whilst performing this stretch.  
• Strengthen the various muscles in your legs by performing exercises such as squats and lunges within comfort. Again, it’s important to stop if the pain worsens, but the muscles should feel well-stretched
• As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity once the pain has gone

 Surgery is generally not a good treatment option for this condition.

What is it? 

Lateral (outer)  knee pain can be caused by several things, but the most common cause is Iliotibial Band Syndrome, an overuse injury due to the Iliotibial band rubbing on the outside of the joint.

This pain on the outside of your knee, is also called Runner's Knee.

The iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg, works in coordination with several of the thigh muscles to provide stability to the knee and to help in flexion of the knee joint. When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.

 

How to deal with it? 

Reducing inflammation is key to decreasing pain. This involves rest, ice, and anti-inflammatory medications. This should improve pain, swelling and tenderness.

Stretching the muscles on the outside of your leg will also help to increase flexibility of the Iliotibial Band, quadriceps, hamstrings, gluteals and calf muscles. The final phase of treatment includes a strengthening program and a progressive return to activities, such as running, once pain free.

What is it? 

Knee ligament injuries are very common and are often sports related, although they can occur from a trauma during everyday activities. The most common are:

• a sprain/strain - one or more ligaments is overstretched through twisting or pulling
• a tear - either a partial tear or complete rupture of the muscle
• damage to the cartilage in your knee - the cartilage is a crescent-shaped disc called a meniscus, that acts as a 'shock absorber' in your knee
• this could be caused by an acute injury or trauma or due to a more gradual onset because of deterioration/wear and tear

Ligaments connect one bone to another. The ligaments outside your knee joint are called the medial collateral ligament (inner knee) and the lateral collateral ligament (outer knee). They provide your knee with stability and limit the amount it can move from side to side. 

The medial collateral ligament is strong can be sprained or completely ruptured (torn) if you twist your straightened leg at the same time as being knocked sideways, for example, when being tackled in rugby. 

The ligaments inside your knee joint are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament. These ligaments provide stability to your knee when it is in different positions, particularly in the forward and backward movements of the knee joint. People who sustain an injury to their ACL may complain of symptoms of the knee 'giving out'.

 

How to deal with it? 

• Rest the leg and apply ice for 10/15 minutes every few hours for the first 48 hours after the injury.
• Take some painkillers so you are comfortable.
• A simple strain of the medial collateral ligament should settle very quickly over two to four weeks. If things are not improving seek medical advice.
• For injuries to the cruciate ligaments seek medical advice immediately

There are some precautions you can take to try to reduce the risk of damaging your knee.

• Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven't been active for a while, start gently and gradually increase the intensity.
• Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however the benefit of stretching before or after exercise is unproven.
• Vary your knee movements: Anterior knee pain (pain in the front of your knee) is generally the result of overusing the joint, so it is important to try and vary the stresses you place on your knee. For example, runners should make sure they mix up the surfaces they run on to include uphill runs and flat ground
• Stretch regularly: Keep the muscles in your legs as flexible as possible by regular stretching.  
• Strengthen your leg muscles: Perform regular exercises such as squats and lunges to strengthen and keep your leg muscles in good condition. 
• Footwear: Ensure sports shoes are appropriate for the activity and are replaced regularly to avoid excessive wear. In osteoarthritis of the knee good, cushioned footwear has also been shown to be beneficial

Click the link for a patient information leaflet  Knee pain[pdf] 940KB

Click the link for a shared decision making leaflet  Shared Decision Making _ OA Knee [pdf] 858KB

It is important that you apply the advice and guidance provided above for around 8 weeks by which time we would expect you to notice improvement and in some cases complete recovery. If not, we have a team of trained physios who can help.

Self-refer into our service today

Think you need more urgent or emergency treatment? Follow the below guidance to see if you need to see someone quicker. 

Physiotherapy Triage

Physiotherapy Triage Red flag re-direction of patients to A&E/GP consultation

IMPORTANT 'Cauda Equina Syndrome’ although rare, can cause a permanent change to your bladder and/or bowel function, or foot strength.

IF you are suffering with low back pain and if you have any changes regarding the following since your pain started;

• Bladder or bowel function (i.e., Increasing difficulty when you try to urinate, increasing difficulty when you try to stop or control your flow of urine, loss of sensation when you pass urine, leaking urine or recent need to use pads, inabilityof knowing when your bladder is either full or empty, inability to stop bowel movement or leaking, loss of sensation when you pass a bowel motion)
• Loss of sensation/tingling around genitals, back passage, buttocks or inner thighs • Erectile or ejaculation problems or loss of sensation in genitals during sexual intercourse
• Loss of sensation/ tingling or numbness in both legs
• Weakness in foot (i.e. floppy foot or inability to lift front of foot when walking)

If YES call NHS 111 or go to A&E IMMEDIATELY

If you are suffering with low back pain and if you have any of the following;

• History of cancer
• Unexplained weight loss
• Feeling generally unwell/fever/lack of appetite

Please contact with your GP as soon as possible to discuss if other investigations are required rather than self-referring to physiotherapy.

You can also visit your GP for more information and advice on;

• Women's and men's health including pelvic floor and incontinence
• If you have had a series of falls and want to learn more to help avoid them
• If you have reduced mobility and require a stick or frame
• If you require neurological support for example if you have had a stroke or Parkinson's
• If you are housebound
• If you are under 16 years old