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Symptoms of knee pain

Knee pain is an extremely common issue.

How can knee pain affect your quality of life?

Knee pain could affect different sections of your knee, for example at the back of your knee, or the inside of your knee. Sudden or sharp knee pain can have a devastating impact on your ability to perform everyday activities.

We look at the different types of knee pain and their possible causes. We also shed light on how knee pain at night can affect your mental health

Knee pain is an extremely common issue. From the time we get out of bed in the morning to the time we go to sleep at night, we will usually have spent quite a bit of time moving. Whether that's from exercising, walking to the shops or just pottering around the house, nearly every time we move our body from one position to another, our knee joints are actively involved in the process.

In a healthy knee joint, we can usually move around without any awareness of just how much work the joint is doing. On the other hand, if we have pain anywhere in the knee, we are often extremely aware of it. Knee pain can make a real difference in our ability to do many of the things we normally take for granted. For example, we may:

  • Find it increasingly difficult to stand up from a chair (or to sit down onto a chair);
  • Struggle to kneel down to play on the floor with our grandchildren;
  • Not be able to walk around shops as easily;
  • Take longer going up and down stairs;
  • Have to reduce the amount of walking we do in the hope that will stop the pain getting any worse, and
  • Realise that we need to stop exercising for a while, because the knee pain gets worse during or after exercise.

Knee pain is a common problem and most of us will experience it to some degree in our lives. If you are suffering with knee pain, it's important to know that you are not alone.

An occasional niggle or soreness in the knee may be fairly easy to ignore, especially if it clears up by itself over time. Longer-lasting or more severe pain is much harder to ignore and can be incredibly frustrating and demoralising to live with.

Fortunately, good, effective help is available to get you out of pain and back to being able to do more of the things you love.

Where knee pain has come on suddenly and for no obvious, is severe or has been going on for a long time, it's always sensible to see an experienced knee doctor for expert assessment, diagnosis and advice on any treatment options.

Knee pain is a fairly generic complaint, and your doctor will want to learn as much as possible about the:

  • Type of pain: For example, is it a dull ache or a sharp stabbing pain?
  • Position of the pain: Is it only in a particular part of the knee or is it a more general pain?

When you first meet with your knee doctor, they will talk with you about your symptoms and how they are affecting the quality of your life. Knowing the type of knee pain have, how long you've had it and its severity can all help the doctor to narrow down the potential causes. Their experience in helping many other people with similar knee problems will often mean they'll be able to pinpoint the cause of your pain before they've even examined your knee.

Some of the most common complaints about knee pain a doctor hears include:

  • "I have pain in the back of my knee",
  • "I have pain on the inner side of my knee",
  • "I have pain on the outer side of my knee",
  • "My knee hurts when I bend it",
  • "I have a sharp pain in my knee",
  • "My knee hurts when I bend it",
  • "My knee keeps on giving way without any warning",
  • "My knee hurts when I walk on it",
  • "My knee looks swollen. What's going on?"

As you can see, there are a number of places and ways that knee pain can show up. Maybe slightly surprisingly, the exact location of your knee pain is not always a good indicator of the cause. This is because the knee is a bad localiser of pain.

Certain parts of the body (for example, the lips or the tips of the fingers) are extremely sensitive as they contain a lot of nerves. Other parts of the body have far fewer nerves, making them far less reliable when trying to pinpoint specific pain points. The knee is one of these areas.

One way of demonstrating this is by using the two-point discrimination test (you can easily try this yourself at home). The test involves unbending a paper clip, putting the ends close together and then gently touching both ends to a point on the skin.

On some parts of the skin, such as the tips of the fingers, you will usually be able to feel both ends separately when the two points are about 2-5 millimetres apart. On the back of your knee, they will probably need to be about 1 - 1.5 inches apart for you to be able to feel both ends.

Areas with lots of nerves send the brain lots of information, which makes it easier to be very specific about where problems are coming from. In areas with a lower density of nerves, like the knee, it is far harder to pinpoint an exact location for the pain.

For example, if you have pain in the back of the knee, it may be caused by a problem in that area or from a completely different part of the knee. This makes self-diagnosis of a knee problem far more difficult, and once again highlights the value gained from talking with an experienced knee doctor. 

The knee joint is formed by the thigh-bone (femur) and the shin-bone (tibia). The tibia also meets with a smaller, thinner bone (fibula) in the lower leg. The kneecap (patella) is a triangular bone found directly in front of the femur

The knee joint also contains:

  • Two crescent-shaped pieces of cartilage (the medial and lateral meniscus) which act like shock absorbers,
  • 4 main ligaments, which connect the femur to the tibia,
  • Articular cartilage at the end of the bones, which helps them to glide over one another without friction.

Any of these parts of the knee can have something go wrong, which then causes pain in the knee.

Pain in the front of the knee may be caused by a problem with the patella. This could be damage as a result of trauma, disease or age-related "wear and tear". A significant trauma to the knee can cause the kneecap to move out of its normal position (dislocate). 

This usually happens following a hard blow to the knee, or from a sudden change of direction while the leg is on the ground. There may be immediate swelling of the knee, and often it will be impossible to fully straighten the leg.

A dislocated kneecap can pop back into place again by itself, but if it doesn’t, or if you are in severe pain, you should get medical help as a matter of urgency.

Pain at the back of the knee is usually caused by some type of swelling within the joint. There are a number of reasons you may get a swelling in the knee (for example, a Baker's cyst) but the underlying problem is that something is causing this swelling, and then it is this swelling that is causing the pain in the back of your knee.

Your doctor will be able to diagnose what is causing the swelling and then discuss treatment options with you. Treating the cause of the swelling will usually mean that the pain goes away.

If you have pain in the outer (lateral) or inner (medial) side of your knee, it is sensible to have a doctor assess things. There may be nothing to worry about, and the pain may end up resolving naturally, but if you are concerned about your knee pain, talking with an expert in knee health can help put your mind at ease.

Outer knee pain is fairly common in long distance runners, people who suddenly increase the distance they run and cyclists. Inner knee pain can be caused by arthritis, damage to the meniscus or inflammation in a fluid-filled sac (bursa) in the knee.  

Whenever you have any type of pain anywhere in the body that is bad enough to wake you up at night, it is strongly recommended that you see a doctor for help. If you notice that you are more aware of the pain in your knee at night, it can make sleep difficult.

Short-term, most of us are able to cope with a bit of sleep deprivation, but long-term it starts to have more of a debilitating effect. Everything can become more challenging, and it can be difficult to focus on things.

The most common reason people wake up in the night with knee pain is because they are struggling with bad arthritis in their knee. Arthritis is a degenerative condition, which means the joint becomes more damaged as the disease progresses.

As the damage increases, so too does the pain. At its more advanced stages, arthritis can cause excruciating pain. The two most common types of arthritis seen in the knee are "wear and tear" (known as osteoarthritis) or inflammatory (rheumatoid arthritis). 

If you find yourself being woken up by knee pain, or suspect you may have some sort of arthritis, a consultation with a knee doctor can be incredibly helpful. Once they have assessed the condition of the joint and determined the cause, they'll be able to talk you through specific treatments

Knee pain can be caused by so many different things, including:

  • Inflammation,
  • Arthritis (osteoarthritis and rheumatoid),
  • Sports injury which causes damage to a ligament, muscle or meniscus,
  • Overuse (suddenly being more active).

An experienced knee doctor will be able to narrow down the potential cause(s) of your knee pain when they talk with you about your symptoms. When the pain started, how long you’ve had it and the type of pain (e.g. sharp stabbing or dull ache) are all things your doctor will talk through with you as they try to get to the bottom of things.

There are some specific clinical tests a doctor may arrange as part of their assessment. As well as a physical examination of the knee, they may sometimes also arrange for you to have an X-ray, MRI scan or CT scan of the knee. A blood test may also be carried out in some situations. (These additional diagnostic tests will not always be needed; you will always be assessed on an individual basis by your consultant, based on your specific symptoms.)

As with many medical conditions, proper assessment by an experienced doctor is the most reliable way of finding out what is causing your knee pain and then to get it treated properly. Whether you need physiotherapy, advice on pain relief medication or knee surgery to repair significant damage, we can help get you out of pain.

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