Knee Pain

It’s no surprise that our knees are one of the most overworked joints in our body. We need our knees to sit, stand, run, walk, jump – you name it! They take us everywhere we need to go and allow us to enjoy a physical lifestyle. That is, until knee pain occurs. Knee pain can unfortunately be the cause of numerous factors, and can be either acute or chronic. While most knee pain can be treated with conservative options, there are times when additional treatment is needed. Start by partnering with a pain management specialist for an accurate diagnosis and treatment plan. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas can explain the ins and outs of knee pain and recommend the best treatment options to help each patient comfortably get back on their feet. 

What is Knee Pain?

Knee pain is any pain or discomfort that is experienced in the knee joint itself, or around the joint. The knee joint is where two bones, the femur (thigh bone) and tibia (shin bone), meet. The fibula (calf bone) connects to the tibia, and the knee joint is protected by the patella, which is the kneecap. The knee joint connects the thigh to the lower leg and is the largest and one of the most complex joints in the body.

The knee joint is supported by the quadriceps muscle in the front and the hamstring muscle in the back. There is also a network of ligaments and cartilage that help the knee to bend and flex. The ACL prevents the femur from moving backward, and the PCL prevents it from moving forward.

The medial and lateral ligaments support the knee, while the menisci reduce friction between the femur and tibia. Articular cartilage covers the joint and patella, while bursae (fluid-filled sacs) cushion the joint and absorb shock.

The knee is often injured because it supports body weight and absorbs shock. If knee pain lasts more than a few days, seek help from a medical professional. They can identify the damaged area and provide targeted treatment.

What Does Knee Pain Feel Like?

Knee pain varies from person to person. It also depends on which part of the knee has experienced trauma or the effects of an underlying condition. Pain can be a temporary issue, but it may become chronic if not properly treated.

A person might feel knee pain: 

• Close to the surface of the skin, above or below the knee. This might indicate an issue with ligaments, tendons or muscles. 
• Deep inside the knee, which could point to a problem in the bones or cartilage
• In different parts of the knee and leg, meaning the pain might have developed in the knee but is radiating to other parts of the body. 

The most common signs and symptoms of knee pain include: 

• Weakness or instability
• A popping or crunching noise in the knee
• Swelling and stiffness
• Redness and warmth to the touch
• Inability to straighten the knee without experiencing pain

Knee pain can also come and go. It might be felt after certain movements, like running or lifting, and get better with rest. Some people feel pain when they first wake up due to stiffness in the knee from sleeping. Others experience pain at night after a day of activity.

What Causes Knee Pain?

The knee joint’s main functions are to flex (bend) and extend (straighten). Extending too far, bending too much, or twisting can cause a tear in the soft tissues. Or, if a person falls or is involved in an accident, the bones in the knee could fracture, which could lead to pain. Generally speaking, a person might experience knee pain due to overuse, injuries or arthritis. 

The most common causes of knee pain include: 

• Dislocated kneecap: this happens when the patella slips out of place, usually because of a sports injury. More often than not, the patella can be popped back into place, but if not, medical attention will be necessary. 
• Knee bursitis: when one or more small fluid-filled sacs, called bursae, near the knee joint become inflamed, it can lead to pain and limited motion
• Degeneration: osteoarthritis is the most common cause of degeneration in the knee joint and the most common form of arthritis overall. It’s a result of repeated wear and tear, and is generally found in people who are older. 
• Patellofemoral pain syndrome (PFPS): this is a broad term used to describe pain that is felt in the front of the knee around the patella. It’s also known as “runner’s knee” or “jumper’s knee” because it is commonly experienced by athletes, especially women and young adults. PFPS most often occurs when cartilage under the kneecap breaks down due to overuse, but can also be attributed to improper alignment of the kneecap. The most common symptom is knee pain that increases with stair climbing or squatting movements.

• IT (iliotibial) band syndrome: A painful condition in which the iliotibial band, a tough band of connective tissue,  rubs against the thigh bone causing friction and inflammation. Distance runners and cyclists have a great chance of experiencing this syndrome. The main symptom is pain between the hip and knees that worsens with activity and bending the knee past 45 degrees. 
• Gout: while most common in the big toe, gout can also occur in the knee. It happens when there is a build-up of uric acid in the blood, and is most often diagnosed in and around joints. 
• Loose tissue or bone: a traumatic injury can cause little pieces of tissue or bone to break off and become lodged in the joint, which can lead to feelings of pain
• Tendinitis and tendinosis: Tendonitis is an acute, short-term, inflammatory problem that comes with inflammation of the tendon cells, and tendinosis is the chronic state of tendonitis. Both are characterized by pain and limited mobility. 
• Torn ACL: a torn ACL is one of the most common reasons an athlete or someone who regularly exercises might experience knee pain. The ACL connects the back of the femur to the front of the tibia and keeps the shinbone from moving past the knee. It accounts for the majority of the knee’s stability. 

Most occurrences of a torn ACL happen when a person suddenly stops, twists, makes a quick directional change, or jumps, and it sounds like a popping noise. Reconstructive surgery is most often needed to repair a torn ACL, and there is also a great chance that additional injuries to adjacent ligaments or tendons will happen as well. 

Torn meniscus: similar to a torn ACL, a torn meniscus if most often the result of an athletic exercise gone wrong. There are two menisci, located in between the tibia and femur. These pieces of cartilage help to absorb shock as well as stabilize the knee. A person will hear a popping noise, like a torn ACL, but sometimes surgery is not needed, which depends on the type of tear. The most common types of meniscus tears include longitudinal tears, which develop along the backside. Bucket handle tears occur along the inside curve, while flap tears affect a small piece of the inside curve. Transverse tears break the meniscus into two pieces, and torn horn tears affect the end of the meniscus.

• Rheumatoid arthritis: this chronic, inflammatory disorder causes extreme pain in joints in the body, including the knees

How Is Knee Pain Treated?

The best way to treat knee pain is to receive an accurate and in-depth diagnosis from a pain management specialist. Knee pain can have many causes. It’s important to identify the cause and find the best treatment to return to an active, pain-free lifestyle. Your specialist will review your medical history and health records. They will also use diagnostic imaging like X-rays, MRIs, and CT scans to create a treatment plan tailored to your knee pain.

The goal for knee pain treatment is to reduce pain and inflammation, and increase mobility. The most widely used treatments for knee pain include: 

At-home methods:

Due to the fact that most knee pain is minor, the best way to treat acute knee pain is by utilizing at-home methods. These include ice, light exercise like swimming and walking that help to build strength and promote stability, over-the-counter and prescription pain medications that help to reduce inflammation and pain, using a knee brace to support the joint while healing, opting for better walking or running shoes, taking supplements that help to lubricate the knee joint, as well as getting a gait analysis so you know if your knee pain is due to an improper imbalance. 

Physical therapy:

In addition to at-home methods, embracing a physical therapy routine helps to strengthen the muscles around the knee that in turn help to improve stability and mobility. Additionally, physical therapy helps to reduce knee pain now, as well as work to prevent knee pain in the future because the muscles connected to the knees will be stronger. 

Transcutaneous electrical nerve stimulation (TENS):

A non-invasive treatment option where patches are placed on the skin that deliver a mild electrical current that prevents pain signals from reaching the brain

Corticosteroid injection:

Delivered directly into the knee joint with a goal to immediately reduce pain and inflammation, corticosteroid injections help to restore mobility to the knee and offer the patient with increased quality of life without surgery

Nerve blocks:

A saphenous nerve block helps patients who suffer from a wide range of knee pain issues, and a genicular nerve block is helpful for patients who have severe osteoarthritis and for whom surgery is not an option. Overall, nerve blocks are a more long-term solution as they work by keeping pain sensations from reaching the brain. 

Spinal cord stimulation (SCS):

This method involves placing small electrodes within the epidural space of the spine, which help to block the sensation of pain. If a trial stimulator is proven useful, then a permanent device is placed, which helps for long-term pain relief. 

Peripheral nerve stimulation (PNS):

Similar to SCS, PNS involves placing small electrodes along the peripheral nerves. If a trial stimulator is proven useful, then a permanent device is placed, which helps for long-term pain relief. 

Surgery:

Often a last resort, surgical intervention might be needed if the patient doesn’t find needed pain relief with at-home or conservative methods.

There are a multitude of reasons why you might experience knee pain, which is why it’s important to seek professional help if your pain isn’t resolved after a few days. Treatment options are as varied as the cause of knee pain itself, so knowing the cause of pain is the first step to finding the best treatment. 

While knee pain is common, living with it doesn’t have to be. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas are highly trained in all aspects of knee pain as well as the best conservative and minimally-invasive techniques to help their family of patients get out of pain and get back to their active lifestyle. If you’re suffering from knee pain that has lasted for more than a few days, please schedule an appointment today.