Knee Pain
Knee pain is annoying and gets in the way of general day-to-day activities including climbing the stairs, kneeling down, gardening, getting up/down off a chair, playing with the kids or grandkids, and playing sport. Knee pain is quite a large ‘catch-all’ for a number of different things that can be causing it. I see it quite a lot across my clinics and I’ll help you figure out what is causing your pain and put a plan together to help.
What knee pain can feel like
Patients describe their knee pain, and the ways it affects them, to me in lots of ways and the most common ones are:
- A pain or ache at the front of the knee, around, under or behind the kneecap
- Pain that feels worse going up or down stairs, squatting, kneeling, or after sitting for long periods
- Pain on the sides of the knee
- Pain from running that comes on right away or after a certain distance and usually calms down once you stop
- Pain and/or stiffness that is often worse first thing in the morning, or after periods of inactivity
- Difficulty getting up or down from a chair, going up and down stairs, or getting in/out of a car
- Clicking, popping, catching or a feeling of weakness in the knee
- Swelling or a ‘puffy’ look to the knee that comes on after activity
- A difficulty in fully bending or straightening the knee
- Pain during sports that require jumping, hopping, or changing direction
If some of these sound familiar to you then it’s worth getting an assessment to find out what is causing it and what to do about it.
Why knee pain happens
There are a number of different causes of knee pain, including:
- ‘wear and tear’ in the joint, or behind the kneecap
- Irritation in the muscles and tendons around the knee from overuse or injury
- Irritation or injury to the ligaments of the knee
- Strain or tear to the cartilage in the knee, including the meniscus
- Pain as a result of compensation from issues in the foot/ankle, hip or even the lower back
These different causes often result in pain in different places in the knee, though there is a lot of crossover too. Typically, pain in the front of the knee is often due to load going through the tendons that cross the kneecap, and typically is worse with climbing stairs, bending, squatting, running, cycling and similar activities. Runners may be familiar with pain on the outside of the knee, often called “iliotibial band syndrome” or ITB syndrome. This is also typically a load issue and often a result of how the whole limb is working rather than just the knee.
More traumatic or sudden causes, typically through twisting or impact, can injure the ligaments or cartilage (meniscus) of the knee. These often feel like a deeper pain and may cause swelling. Aches or stiffness can be a result of age-related arthritis.
Injuries to the meniscus or age-related ‘wear and tear’ or ‘degeneration’ don’t necessarily require surgery, and this is a worry patients sometimes have. Many people manage well with conservative treatment and are able to get back to good levels of function. Age is not a limiting factor either, and many older patients do very well even when they have some arthritis in their knee.
How I assess and treat knee pain
I’ll ask you questions about when your pain started, how it started and how it’s affecting you, including some questions about your lifestyle. I’ll then examine your knee and the rest of your lower limb including your foot and ankle and hip. I’ll assess your movements, find out what hurts, what movements are limited and assess the look and feel of your muscles and joint. This all helps me figure out what’s actually causing your knee pain.
I’ll make sure there’s nothing going on that would require further investigation or that I don’t feel I’m best to help with. If there is, I’ll let you know and point you in the right direction for getting that investigated or to the right person who can help.
Once I know what’s causing your pain, I’ll build a treatment plan to help reduce it and get you moving comfortably again. I’ll treat using a combination of hands-on treatment, lifestyle advice and exercise. Hands-on treatment can involve massage, gentle joint mobilisations and dry needling or medical acupuncture, where appropriate and based on what you’re comfortable with. If we need to modify your activities in the short term, I’ll advise you on that, but my goal is to keep you doing as much of what you enjoy as possible.
There’s also an element of building confidence and trust in the knee. It’s not uncommon for patients to protect and guard a painful knee and be fearful of doing further damage. A big part of what I do is reassuring you while helping you rebuild that strength and tolerance to activity.
If you’ve got a knee issue that’s holding you back, let’s put a plan together to help.
What to expect
There’s no fixed timeline with knee pain and while some problems can start to feel better fairly quickly, longer-term problems or more complex problems might take many more weeks or months to resolve. Tendon issues, such as ITB syndrome, are generally slower to change but they do respond well to treatment, exercise and load management. Initially the changes you notice might be small and over time you should start to notice much less discomfort and more ability to do the things you want to do. Occasionally there may be setbacks along the way. This is entirely normal and part of the reality of managing a painful knee.
I’ll be honest with you about what to expect in terms of how long it will take and what the road to recovery will look like. We’ll make sure to reassess regularly and ensure we’re on the right path. If we’re not making headway in the first three to six treatments, we’ll either change the plan or consider whether another approach may be better suited for you.
Most knee pain is not serious and can be treated comfortably. There are a few symptoms that would require you to get checked out by your GP or NHS 111 before seeing me:
- You cannot move your knee at all or put any weight on it
- Your knee is very badly swollen or has changed shape
- You have knee pain with high temperature, feel hot, cold or shivery and have redness or swelling
Sources: NHS — Knee pain
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about knee pain
Osteopathy can help with managing and reducing pain, and improving movement and function. What I do specifically will depend on what problem you have, so I’ll assess you first and then let you know if I can help and what we’ll do about it. If I can’t help, I’ll refer you to someone who can.
There is a lot of overlap between an osteopath and a physiotherapist and both will assess your knee thoroughly and use a mix of hands-on treatment and exercise to help reduce pain and build up your strength and tolerance again. The important thing, more than the title of the person you see, is that you get a thorough assessment and an examination of not just your knee but your whole lower limb and how you move to ensure the right diagnosis is reached.
The majority of knee problems won’t need an x-ray or MRI and a lot of x-rays will show “wear and tear” that is present in many people without any pain. Sometimes, depending on the problem and how it happened, we may need to suggest a scan and if I think that’s the case, I’ll help you to get it.
If you have a meniscus tear, you don’t automatically need surgery. Many types, particularly age-related and non-traumatic meniscal tears do just as well with conservative treatment, including structured exercise, compared with surgery.1,2 Some tears may require a surgical opinion, particularly in younger people, after an injury, or if the knee locks or won’t fully straighten.3 I’ll assess you and determine how yours occurred and be honest about whether I think you can be managed conservatively, or if a surgical opinion is a sensible option.
Osteopathy can help with knee arthritis and works best with a mixture of hands-on treatment, exercise and lifestyle advice. Despite any arthritic changes in the knee, you can still retain function and stay active. Arthritis in the knee is by no means a guarantee that you’ll need a replacement further down the line and many people manage without ever needing one. If you do ever need one, I’ll let you know and help start that referral process.
Complete rest is rarely the best option. Sometimes we’ll need to reduce activity to allow things to calm down. I’ll discuss this with you and recommend the right movement and exercise for you to help build back your tolerance over time.
I always try to keep patients doing the things they love rather than stopping. Sometimes it may be necessary in the short-term to let things calm down so you can keep doing more of it in the long-term. This won’t always mean stopping completely, and may just mean modifying or lowering the amount you do for a period of time. I’ll advise you on what is right for you based on your problem.
I can still help you even if you’ve had knee pain for a long time. The longer you’ve had it, the more likely it is to take longer to recover. I’ll assess you fully and give you an honest opinion of how long I think it might take.
It’s hard to give an accurate number without knowing what type of knee problem you have, how long you’ve had it, and more about your lifestyle. What I can promise is an honest assessment of the situation and whether it’s a short or long-term prognosis. We’ll review progress regularly to make sure what we’re doing is working. If we haven’t made headway within three to six treatments, we’ll change the plan or consider whether you need referring to someone else.
Does this all sound familiar?
Let’s take a look.
If you’re suffering with knee pain that is affecting your daily life, let’s figure out where it’s coming from and what can be done about it.