Need to Know
Causes of Knee Pain
The key cause of knee pain is pressure. Too much pressure on the wrong part of the knee causes pain. There are various specific conditions that cause knee pain, which we will discuss in-depth here.
Ligaments connect the lower leg bone to the thigh bone and can be injured, causing pain. Injuries to ligaments can cause symptoms such as swelling, pain, stiffness, and even immobility.
Cartilage is a durable, adaptive connective tissue that serves mainly as a padding at the body’s joints. There are three main types of cartilage: elastic cartilage (or yellow cartilage), hyaline cartilage, and fibrocartilage. All types of cartilage can become damaged.
The cartilage in the knee and other joints is a type of hyaline cartilage, called articular cartilage. The cartilage on the inside of the knee can tear, often because of a twisting injury in the knee. Damage to this cartilage is really common, especially as we age. In Americans over 60 years old, 1 in 5 men and 1 in 4 women suffer from knee pain.
The symptoms of cartilage damage include pain, inflammation, rigidity, and reduced mobility. Cartilage damage can be caused by lack of exercise - joints must be worked out routinely in order to maintain strong functionality. Cartilage damage can also be from long-term deterioration. Stress on joints causes wear and tear, especially in people who are overweight or obese. Cartilage damage can also come from a trauma, or sudden and immediate impact. A huge amount of force can be directed at a joint without warning, as in a sports injury or car accident, for example. If a joint isn’t properly treated when cartilage damage occurs, it can become unstable and cause long-term, serious problems.
The bursa is a sac under the skin above the knee that holds fluid. Falls, repeated bending, and overuse can irritate the bursa, leading to pain and swelling. The bursa can also become inflamed when kneeling, squatting, or with excess joint friction. Prepatellar bursitis occurs when the bursa become inflamed, often caused by repetitive kneeling.
Patellar tendinitis and patellofemoral pain syndrome can happen from overuse. Tendinitis is another typical sports injury that can also arise from everyday life from overuse with tendons.
Rheumatoid arthritis (RA) is a chronic inflammatory condition that occurs when your immune system mistakenly attacks your own body’s tissues. RA affects joints on both sides of the body, so both knees would be affected. RA does not come from wear-and-tear as it does with osteoarthritis. Instead, RA affects the linings of your joints, causing painful swelling and eventually damaging or deforming the joint.
People with rheumatoid arthritis may not experience any redness or swelling in their joints, but they may feel tenderness and pain in their joints. As RA symptoms get worse, you may also have stiffness in the morning that lasts for about an hour. You may also experience joint pain, tenderness, and swelling or stiffness that can last for 6 weeks or longer. Additional symptoms of RA include pain in the small joints, pain in the same joints on both sides of the body, fatigue, loss of appetite, or a low grade fever.
Rheumatoid arthritis symptoms can come and go, often with long periods of time with no pain. When symptoms worsen, this is known as a flare. A flare can last for several days or months at a time. If you experience frequent flares, it’s best to work with your physician so that you can have a treatment plan in place to help manage flare ups.
Post-traumatic arthritis occurs in knees after an injury. Old injuries can also turn into post-traumatic arthritis. Sometimes bones might not heal properly after surgery, impacting joint alignment. Post-traumatic arthritis causes about 12% of osteoarthritis cases and it happens to about 5.6 million Americans.
The symptoms of post-traumatic arthritis include joint pain, swelling, and joint instability. Fluid can also accumulate in the joint. People with post-traumatic arthritis can also have pain while walking, doing sports, etc. Post-traumatic arthritis can also cause deformity of the joint, as well as bone spurs or lumps in the joint.
Osteoarthritis is a type of arthritis that commonly happens with age. It is caused by repetitive wear and tear on the knee. Factors like genetics, obesity, diet, and damage can cause stiffness, swelling, and weakness in adults as young as 25 years of age. If using the stairs causes you to have pain behind your knee, it could be as a result of osteoarthritis.
Obesity leads to increased pressure on the knees. Additionally, muscles typically shrink 40% from age 20 to age 60, meaning that a loss of strength leads to more pressure on the knees and decreased joint support.
Bone On Bone Pain
Osteoarthritis can also cause what is known as bone on bone pain. Cartilage is a smooth, rubbery, connective tissue at the end of bones that allows for perfect sliding between bones. The synovial membrane frames the joint and secretes hyaluronic acid in the synovial fluid, which fills the small space in the joint between the two bones.
That fluid provides lubrication for movement and nutrition to the cartilage on either end of the bones of the joint. Decades of wear and tear cause the cartilage to break down (osteoarthritis) causing pain, swelling, and difficulty with movement. As osteoarthritis progresses, bones can develop bone spurs, or bony splinters that develop along the edges of bones, especially in your joints.
Along with this, pieces of bone or cartilage may chip off. The body’s inflammatory process, which signals the release of proteins and enzymes, will cause further cartilage damage in the process. Eventually, the cartilage wears away and bone rubs against bone, leading to more damage and severe pain.
Sprains are a typical injury that can occur during athletics or during everyday life. A sprain is an overstitching of issue, but it is not a permanent injury. Elevation and ice can help with pain from a sprain.
Anterior Knee Pain Syndrome
Anterior knee pain syndrome is often experienced due to sports, obesity, and even adolescence among girls. The main way to prevent this from happening is building up the quadricep muscles.
Meniscal tears can often occur without your knowledge. To heal meniscal tears, rest is absolutely critical. Surgery is an option for recovery, but there are various other options for therapies as well.
When posture is compromised, a large amount of stress is created on the knee. Having poor posture can result in pain and injury.
Runner’s knee develops as a result of repeated bending of the knee joint. It can also happen as a result of a direct blow to the knee, poor alignment, or flat feet and weak thighs. Symptoms of runner’s knee include swelling, knee pain while bending, and crepitus (or noises in the knee).
As the name would suggest, running can lead to runner’s knee, as it results from a degradation of the cartilage below the kneecap. Surprisingly enough, hips can also play a major factor in runner’s knee. Because of this, hip strengthening is now commonly built into treatment programs for runner’s knee.
Sciatica is pain, pins and needles, or lack of feeling in the legs, caused by pressure on the sciatic nerve. The sciatic nerve extends from your toes all the way to your lower back. Problems with the sciatic nerve can often lead to knee pain.
When the sciatic nerve is compressed or irritated in the lower back, it can cause pain that radiates down your hip, outer side of your leg, and your back. It can also cause numbness and tingling in the legs and feet.
Symptoms that Accompany Knee Pain
There are a wide variety of symptoms that can accompany knee pain, depending on the specific case. One major symptom is crepitus, or knee noises.
Crepitus, or noises in the knee, can sound like snaps, crackles, and pops. These noises are sometimes harmless, and sometimes not, depending on what other symptoms go along with them.
When bending your knee, if there is noise but no pain, there is likely no reason to worry. However, if your noisy knees are painful while bending, it is important to seek medical treatment. Grinding, rubbing, crunching, or crackling can mean bone on bone because cartilage is deteriorating or that the meniscus can be torn. Swelling along with knee noises can mean that it is arthritis or another degenerative problem.
Swelling can often accompany knee pain, leading to increased discomfort. Swelling can be as a result of various conditions, and should be treated and monitored carefully. If swelling does not go down after a few days of using at-home methods, be sure to visit your doctor to determine treatment options.
How to Deal with Your Knee Pain
Don’t Ignore Your Knee Pain
The key to maintaining knee health is knowing when you can and can’t ignore your pain. Pain is your body’s way of communicating that something is wrong. Make sure to rest and rehab when necessary. If the pain has not subsided using methods outlined below, be sure to make an appointment to have a doctor check it out.
The movements of knee joints are complex and it is easy to develop poor habits. Lack of flexibility and weak muscle are the primary cause of knee injuries. Make sure to work on muscle imbalances, as strong outer muscles and weak inner muscles will pull unevenly on structures of the knee. Make sure to vary your workouts and activities to strengthen your knees without straining them.
Regular exercise keeps your joints flexible for as long as possible. It also helps you avoid knee pain. Make sure to slowly build your endurance and strength, and it will ensure that you reach your goals instead of injuring yourself. Be sure to listen to your body’s cues when increasing your physical activity, and balance out your daily strain with some rest and relaxation.
For a swollen knee, over the counter anti-inflammatories can often help in the short term. Exercise can help strengthen and protect the knees.
The RICE method (rest, ice, compression, and elevation) is also helpful in getting the swelling to go down. Resting your knee, using ice to reduce pain, wearing a compression bandage, and keeping your knee elevated can help ease knee pain. The RICE technique can offer short-term pain relief and can help reduce pain and swelling for some people.
Rest for a period of 24 hours or longer to give the joint time to recover. Icing for 20 minutes three to four times each day can decrease swelling and help with healing. Do not put ice directly on your skin. Wrapping your knee with an elastic bandage can help limit swelling, but make sure that it is not too tight. Finally, elevate the knee to help reduce blood flow to the area which will hopefully reduce swelling. With the RICE method, swelling should go down in one to three days. If the swelling does not go down in one to three days using the RICE method, it’s time to call a doctor.
Don’t Carry Extra Weight
The Johns Hopkins Arthritis Center reported on a study that found that for overweight women, losing just 11 pounds reduces the risk of knee OA by more than 50%, and for men, the numbers were still impressive at 21.5%. Your knees receive up to 4 times your bodyweight in pressure, meaning that increased weight puts significantly more pressure and strain on your knees.
When to Seek Treatment for Your Knee Pain
There are several reasons why you should seek a doctor for your pain. Here is a list:
- If the swelling does not go down within one to three days using RICE
- If the knee has a pronounced abnormality
- If the knee cannot fully straighten
- If there is severe knee pain
- If the knee cannot support weight
- If the skin near the knee is hot or red
- If you have a fever along with your knee pain
- If you feel something moving inside of your knee
- If you hear a snap, crackle or pop along with pain or swelling
- If you have pain when climbing the stairs
- If you’ve had a sports injury that is not improving
Considering a Knee Replacement
Studies show that up to one in three knee replacements were unnecessary and inappropriate. A study from Virginia Commonwealth University with Daniel L. Riddle found that patients often have their knees replaced when symptoms are relatively minor. Because of this, be sure to get a second opinion if you are considering a knee replacement. Even though so many knee replacements are inappropriate, the number of total knee replacements performed has risen dramatically over the years.
According to a 2013 study from the New England Journal of Medicine, some real knee surgeries have no better results than “sham” ones. This study addressed arthroscopic partial meniscectomy, so while it isn’t directly tied to knee replacements, the takeaways can likely be applied to knee replacements as well. This randomized, multi-center study found that “arthroscopic partial meniscectomy was not superior to sham surgery, with regard to outcomes assessed during a 12-month follow up period.”
Total knee replacement overuse is a concern to physicians worldwide. They are recommended even when not medically necessary, or even appropriate. The root problem behind knee pain may be coming from elsewhere depending on the case - whether from issues with the spine or with the hip.
Additionally, knee replacement surgery is not a permanent cure even when it is medically recommended. The artificial joint will only last from 10-15 years depending on care. As the majority of the population gets increasingly overweight, knee replacements will last even less time because of the increased pressure on the joint. One significantly underutilized method of avoiding total knee replacement surgery is adding physical conditioning and physical therapy into your routine.
5 Questions to Ask Before Considering Knee Replacement Surgery
There are 5 very important questions that you should ask before considering knee replacement surgery:
1. Is the surgery necessary for me?
As discussed above, 34% of total knee replacement surgeries that are performed in the US are not appropriate. According to a report from the June 2014 issue of Arthritis & Rheumatology, over 1 in 3 knee replacements failed to meet the standards of medical appropriateness.
2. What are the potential risks and complications?
As with any major surgery, there are always risks that go along with the procedure. These include a risk of infection, negative response to anesthesia, blood clots, problems with the implant, continued pain, and even neurovascular injury. Additionally, there is a possibility that there will be an allergy to the metal implant, so this is something that should be discussed with your doctor. For those who smoke, there is an increase in likelihoods of complications. With heart conditions, people with atrial fibrillation consistently have longer stays in the hospital, increased costs of care, and higher complication rates with knee replacements.
3. What are my alternative, non-surgical treatment options?
Things like weight management and physical therapy can help reduce the amount of pressure on the knees, removing some of the problems that would warrant the need for a knee replacement. Additionally, bracing and joint realignment can help relieve some of the bone on bone grinding that would cause severe pain.. Lastly, injections of hyaluronic acid can help increase lubrication and cushioning, as well as decrease inflammation and friction, which can be effective enough to avoid knee replacement surgery altogether.
4. Can knee replacement surgery wait?
More than 54,000 revisions are done annually in the United States. Knee replacement revisions are done to correct a failed or incorrectly performed knee replacements. Therefore, every year, 54,000 people have to go through a second major surgery to correct their original knee replacement. This also means that the exhaustive rehabilitation process that goes along with knee replacements must be done for a second time.
5. What is the recovery process?
As with any major surgery, there will be a long and exhaustive process to getting back on your feet. This will be at least 3 to 12 months of commitment, and it will require dedication and diligence to achieve the most desirable outcome.
Knee Replacement Alternatives
There are a number of alternative options when considering knee replacements. These options range from short term, at home relief to non-surgical, longer term relief. For short term options that you can do at home, consider using the RICE method (rest, ice, compression, and elevation), heat and cold therapy, and low impact exercises. Over the counter pain medication and anti-inflammatories can also help in the short term.
Additionally, weight loss can drastically improve knee pain. Even losing as little as 5 pounds can help decrease the symptoms of osteoarthritis, especially in joints such as the knees and hips. One pound of bodyweight can put as much as 4 pounds of pressure on the knees.
Viscosupplementation is a procedure where fluid is injected into the joint, as an effective knee pain treatment. With Flexogenix®, the Knee-Flex 5-Step Protocol is a viscosupplementation technique that has helped over 40,000 patients avoid knee replacement surgery.
- Immediate Pain Relief: Our day 1 priority is for our patients to experience life without knee pain. Using our advanced imaging techniques, we map the sensory nerves around the knee. Next, utilizing innovative procedures to reduce nerve pain around the joints, the nerves are prevented from continuing to transmit pain signals. This replaces the use of steroids and protects patients from the long-term damage often associated with steroid injections. While the pain relief is significant, it is temporary and we must remind patients that it does not replace the reconditioning necessary in steps two through five of the Knee-flex 5 step protocol.
- Lubricate & Protect the Knee Joint: Using the latest image-guidance technology, our medical team administers the injection of hyaluronic acid with pinpoint precision. The HA provides lubrication and tempers the friction within the joint to reduce cartilage wear and tear, diminish bone-on-bone pain, and increase mobility. The precision and accuracy of the image-guided injection ensures the gel-like fluid is injected directly into the joint capsule for optimal results.
- Initiate Kineti-Flex®: With the knee pain controlled and mobility restored, the process begins to research the true health, strength and integrity of your joints, and design your individualized medically supervised reconditioning program. This is the step where we assess the many contributing factors that actually caused your knee/joint pain, and develop a detailed conditioning prescription to correct the problems, and prevent the pain from returning again.
- Knee Alignment & Bracing: In concert with Kineti-Flex®, our medical team carefully examines the alignment of the joint, and whether it can benefit from either short-term or long-term bracing. As with every aspect of Flexogenix® treatments, we have extensively researched the latest innovations and advancements in bracing. When prescribed correctly, bracing can be extremely effective in unloading and redistributing pressure off the worn areas of the joint. Again, our goal is long-term joint pain relief. Effective bracing and alignment can be a key to this success.
- Continuously Promote Healing: Our final step is an advanced injection protocol to stop any further degradation of the knee joint and cartilage by promoting the body’s natural healing response with Platelet Rich Plasma (PRP). This step is essential and introduces growth factors that create a strong foundation to restore the integrity of the joint. Together with Kineti-Flex® and bracing, PRP completes a comprehensive treatment plan that has helped thousands avoid surgery. With a continued commitment to your Kineti-Flex® regimen, you can achieve a level of health and success that you never thought was possible.
The use of orthobiologics is a technique that combines regenerative treatment and gene therapy to create a “living” implant that is a viable alternative to joint replacement therapy as we know it. This could also be a better technique for younger patients, as it will last longer and have less recovery time than traditional knee replacements.
If you’re dealing with chronic knee pain, and you are considering a knee replacement, be sure to know your options before deciding on surgery. Flexogenix® offers minimally-invasive, non-surgical solutions for your pain. We have helped over 40,000 patients avoid knee replacement surgery. Contact us today to schedule your no-cost consultation and let us get you back on your feet and back to the active lifestyle you deserve!