Knee pain

Our knees are in constant use, and when we experience knee pain it can impact every aspect of our lives. We use our knee joints to perform almost every movement, and it can be almost impossible to escape from knee pain. Damage to your knees can also bring with it additional symptoms, in particular swelling, stiffness, and a lack of mobility or reduction in your range of movement.

People often think of knee pain as something that holds you back from an active lifestyle, but in reality knee pain holds you back from everything. It can affect the smallest parts of our day, from chores to groceries, as well as impacting how we function at work, how much of a social life we are able to have, and even our relationships with our loved ones. Sleep is often affected by knee pain, too, with many people finding their knee pain is worse at night, so they don't feel well.

With all of this going on, it's no surprise to learn that knee pain can cause stress, and with stress shown to increase pain, it can become a vicious cycle.

Sadly, all too many people put off seeking help for knee pain, not realising how many treatments there are available. So many of us are living with pain when we don't need to.

How joint pain affects your life: the findings of our Joint Pain Matters survey

Knee joint pain can significantly impact many areas of your life. Our Joint Pain Matters report found that 50% of people with joint pain feel it significantly reduces their quality of life and 39% rated their quality of life as 'poor' as a result of joint pain.

The same report found that 44% of people had missed work because of their joint pain, 37% of people felt it affected their sleep every night, and 49% had felt the impact of joint pain on their romantic relationships.

69% of our respondents felt that joint pain had negatively affected their mental health, with women tending to report a greater impact.

When you meet with a knee specialist, some of the first questions they will ask you will be about where you feel your knee pain, for example do you have back of knee pain or pain behind your knee, kneecap pain, or pain on the inside of your knee, and when do you have pain? Do you also have swelling and stiffness, and is your movement limited? Does your knee catch or lock?

Pain is very personal, so your consultant will want to know how it affects you and why. Some people's pain might be constant, others will have knee pain when bending, or knee pain when running, you might have a sharp stabbing pain in your knee that comes and goes, or perhaps pain in the back of your knee when straightening your leg. Knee pain at night is another common problem, which can significantly affect your ability to sleep.

These questions can also help us to identify the root of your knee pain. Different knee pain causes can present in different ways - pain on the outside of your knee, for example, might mean something different to pain in your kneecap.

How your knee works

Your knee is the largest and strongest joint in your body. It is made up of several components:

• The lower end of your thighbone (femur)
• The upper end of your shinbone (tibia)
• The kneecap (patella)

The ends of the bones in your knee joint are covered with articular cartilage. This is a smooth material that cushions the bones during movement. Two crescent-shaped structures made out of cartilage, called the lateral meniscus and medial meniscus, sit between your thighbone and shinbone and act as shock absorbers. This rubbery material helps to cushion your joint and keep it stable. A thin lining called the synovial membrane surrounds your joint. It helps to lubricate the cartilage and reduce friction.

Due to its location in your body and the demands placed upon it by normal daily life, your knee joint is a common place to feel pain or suffer injury. The basic function of your joint is to allow movement of your leg in a front to back direction. However, your knee is in fact a modified hinge joint that allows some rotation. This is needed for two reasons.

First, this rotation allows your knee a degree of extra mobility when performing tasks such as squatting and jogging, especially when changing direction simultaneously. This is essential for the type of movements needed when playing sports.

Second, this small amount of rotation allows your knee joint to be able to lock when fully straight (full extension). You may feel the benefit of this with a healthy knee in standing if you tense your knee muscles to fully straighten your knee. This allows us to stand in a stable position with less effort.

The other unique aspect to the knee is the addition of the kneecap (patella) to the joint anatomy. The patella is present to protect the front of the knee joint when kneeling or if it is struck. However, the other key function of the kneecap is to act as an interim lever to attach the large muscles at the front of the thigh (quadriceps muscles) to the top of the lower leg bone (tibia).

This lever action provides a great deal more force for the quadriceps muscles, which are the main stabiliser and mover of the knee joint during functional tasks. Research has demonstrated that this system increases the quadriceps effectiveness by more than 200% at some angles of knee flexion.

Most knee pain causes can be categorised as either an injury or a degenerative joint condition. Common causes of knee pain include:

Knee osteoarthritis

Osteoarthritis is the most common type of arthritis. It happens when the cartilage in our joints wears down over time, which is why it's often referred to as wear and tear arthritis. Cartilage is a smooth and flexible tissue that protects our joints; without it, our bones start to rub together.

Osteoarthritis can also lead to scarring and adhesions to the soft tissue joint capsule, as well as weakness to the muscles and tendons supporting the joint.

Our knees are one of the most common joints to suffer with osteoarthritis, and this is one of the most common causes of painful knees, and the most frequent type of knee arthritis, as well as the leading reason for having knee surgery.

Knee osteoarthritis is more common the older we get, because the nature of the condition is that it develops over time as we use our knees more and more. However, if you are an athlete or a manual worker, or just someone who uses their knees more than most, the condition can develop earlier in life due to what we call 'overuse'. Other people are more at risk of early arthritis because of genetic factors, or because they've suffered a knee injury at some point.

Rheumatoid arthritis

Rheumatoid arthritis (RA) currently affects more than 400,000 people in the UK. It is caused by an autoimmune process, which happens when your body attacks its healthy cells by mistake. This often causes pain, swelling, and inflammation in your joints.

Joints affected by RA are commonly surrounded by inflamed tissue, which often results in chronic pain. Unlike osteoarthritis, rheumatoid arthritis often affects two or more joints. The condition causes other challenging symptoms too, including fatigue.

Anterior knee pain (patellofemoral pain syndrome)

Patellofemoral pain syndrome is one of the most common causes of knee pain. It is sometimes called runner's knee because it is particularly common with joggers. It is also associated with sports that involve a lot of running. However, it is worth noting that knee joint pain can also affect non-athletes.

Knee bursitis

A bursa is a small, fluid-filled sac that sits near a joint. It acts as a cushion between the bones, muscles and ligaments. It protects a joint from shock and impact.

The bursa reduces the friction between these structures and allows them to slide past one another when a joint is moved. When a bursa becomes inflamed or irritated, it is called bursitis. While bursitis will often resolve itself naturally after a couple of weeks, more severe or long-lasting cases may require treatment with a specialist.

Patellar tendonitis

This injury is caused by overuse of the knee. It normally causes pain in the front of the knee and is sometimes called jumper's knee (the term refers to athletes who can suffer from this condition due to excessive training).

It happens when tiny tears in the tendons that hold the patella in place begin to form. If these tears are not allowed to heal, they will worsen. This is called tendinopathy, which increases the pain and swelling around the knee causing further pain.

Sports injuries

Knee injuries account for 41% of all sporting injuries. There are various types of knee injuries, and the most common are knee ligament injuries, sprains, torn or swollen tendons, and fractures.

Knee injuries are most common in contact sports such as rugby or football, but they can happen while playing any sporting activity, from tennis to running or hiking. Injuries either happen as a result of trauma, such as a collision or a fall, or as a result of overactivity. The latter might be referred to as an overuse injury.

Anterior cruciate ligament (ACL) injury

This is the most common knee ligament injury, which is frequently suffered by athletes. It can make your knee unstable and will usually need treatment.

It's one of the strongest ligaments in the knee joint, connecting the femur to the tibia, so as you can imagine, if this tears or ruptures, it not only causes severe pain, but can debilitate movement completely.

Torn meniscus

The menisci play an important part in absorbing shocks to the knee and thigh bone as we know, but they also help regulate the stability of our knees and provide lubrication and nutrients to the knee joint.

The term meniscus comes from the Greek and translates as 'crescent', which is more or less the shape of these two important parts of the knee. They are made up mostly of water (72%) and collagen (22%).

If we make a sudden turn, while playing sport for example, it's possible to tear either or both of the menisci, which results in swelling and stiffness along with pain, especially when trying to do anything involving movement of the knee (twisting or extending the leg).

Whilst it's possible for minor meniscus tears to naturally heal over time given enough rest and pain relief treatment, in more extreme cases surgery will be required.

Baker's cyst

A cyst is a fluid filled sac that can form more or less anywhere in the body including the knee. There are primary cysts, which form without any underlying conditions, and there are secondary cysts which happen because of underlying conditions.

In the case of the knee, a Baker's cyst is a secondary cyst formed by leakage of synovial fluid from the cartilage in the knee joint (from a torn meniscus or a bursa for example).

A Baker's cyst happens when the fluid leaks into the popliteal space at the back of the knee (it's other name is popliteal cyst), resulting in a visible bulge and swelling, which can become quite painful depending on the severity of the trauma. The most common symptoms of Baker's cysts are pain in the back of the knee or a lump in the back of the knee.

Gout of the knee

Although most people think of gout as being a foot (and in particular, big toe) disease, it can and does affect other joints, including the knee.

Uric acid is a waste product in the blood created from the breakdown of purines found in many food types. The kidneys usually deal with it as they clean the blood by extracting it and passing it out through our urinary system.

If your kidneys are unable to cope with excess uric, gout then becomes a possibility.

Gout is a buildup of uric acid that forms into small needle-like crystals within a joint. This build up then causes inflammation with increasing pain. In the worst cases, this can be debilitating and last from days to weeks.

As the crystals build up over time, they form into extremely painful nodules called tophi, which can affect movement of the joint too.

Dislocation of the knee

In severe accidents, the femur and tibia can become dislocated at the knee joint. This type of knee dislocation can result in extreme trauma, and surgery will be necessary to restore movement back to the knee.

Dislocation of just the kneecap is more common though. This is where the kneecap slips out of its groove at the lower end of the femur. That can happen if the cartilage and muscles around the knee become weakened or through an injury. Usually you won't need surgery to correct it, but in some instances you will.

Referred pain

Referred pain is the term given to pain felt in your knees but caused by a problem elsewhere in your body. You might have a problem with your lower back or hips that affects your knees because of how these different parts of your anatomy interact. Sciatica is a common form of referred pain, which radiates down from your back to your legs and knees. It is usually caused by something like a slipped disc.

Because referred pain is quite a common explanation of knee pain, a specialist will often want to examine your back and hips as well as your knees, even if you only feel pain in your knees.

If you have an accident or trauma and your knee hurts a lot, it's always a good idea to get it checked out. Injuries that are not treated early enough can have long-term effects. If you've had an accident or injury and your pain is extreme or your knee has become very weak, if you can't stand or use your knee properly, go to your local accident and emergency department.

If you have knee pain without an obvious cause and it lasts a week or more without improving, again it's a good idea to speak to a specialist to see if they can help you take control of your knee pain.

Pain is relative, but if you are living with knee pain that is affecting your quality of life, stopping you from doing the things you used to do, or affecting your sleep, mood or stress levels, it's so important to speak to someone about it. There are lots of different treatments available, and most people will find that they are able to significantly reduce their knee pain and knee problems, with many finding their pain can be eliminated altogether.

When you visit one of our consultants for help with knee pain, they will want to learn as much as possible about your symptoms. They may ask you questions like:

• How long have you had the knee pain?
• Was there an obvious cause, such as a knee fracture?
• Has the pain stayed the same, or has it been getting progressively worse over time?
• Where exactly is the joint pain?
• Do any specific movements, positions or activities make the pain worse?
• Have you tried any treatments for your knee pain? If so, have they helped?

They will also take a detailed medical history, perform a short physical examination, and possibly arrange for tests or scans to help make a diagnosis of the cause of your knee pain.

Once they are confident in their diagnosis, they will talk you through the available treatment options, making recommendations based on your personal circumstances. Together, you will decide what is best for you, and your consultant will finalise your bespoke treatment plan. Once this is agreed, you can start booking in your treatment. We don't have waiting lists for knee pain treatment at Circle Health Group, so you will be able to get started without delay.

The various causes of knee pain can almost always be reliably diagnosed by an experienced musculoskeletal doctor or physiotherapist. To reach a diagnosis, a careful history of any previous pains or issues with joints is undertaken, as well as performing a physical examination.

The physical examination of your knee is an important part of any assessment. As part of this, your doctor may bend or move your leg and knee into various positions to see how the joint is functioning and when and where you are getting pain. They might also examine other areas of your body, especially your hips and back, as problems in these areas can contribute to knee pain.

To help with diagnosis, additional investigations may be needed. These might include:

X-ray

X-rays are a type of radiation. They can be used to produce images that show the bones of the knee clearly, and can be used to identify fracture, dislocation or arthritic damage to the knee.

CT scanning

Computerised tomography (CT) uses X-rays to produce cross-sectional images of the knee joint. These 'slices' can vary in width and are used to build up a very accurate three-dimensional image of the knee joint.

MRI scanning

Magnetic resonance imagining (MRI) uses strong magnets and radio waves to produce very detailed images of the knee. Similar to CT, an MRI scan produces cross-sectional images of the knee.

Ultrasound

Uses high-frequency sound waves to create an image. Unlike other imaging options, ultrasound can be used to show movement of the joint in real time.

Knee arthroscopy

If your doctor thinks you may have damage to a cartilage or ligament, they may recommend an arthroscopy. This is a form of keyhole surgery, where a small cut is made in your knee and a thin tube (arthroscope) placed through it into the joint. The arthroscope has a bright light and camera at one end and allows the doctor to see clearly inside the knee joint.

We offer a wide variety of treatments for the relief of knee pain, from the conservative and non-invasive to the surgical. Some you will be able to do at home, while others you will have done at our private hospitals.

Usually, we will start by recommending some of the conservative approaches before we suggest surgery. However in some cases, for example with a knee fracture or severe knee dislocation, surgery will be our first point of call.

Lifestyle changes for knee pain relief

Certain lifestyle factors can increase the risk of knee pain. Making small lifestyle changes to improve your health will most likely be the first advice you are given to try and reduce or even cure your knee pain.

For example, if you need to lose weight, doing so can ease the pressure on your knees, while non-strenuous exercise can help strengthen the muscles around your joints and increase synovial fluid production that lubricates your knee.

Making small changes like this can offer significant relief for painful knees, and even stop you from needing more invasive treatments in the future.

Heat therapy

Heat treatment (in the form of heating pads, hot baths, or warm paraffin wax) can relieve pain, relax muscles and reduce joint stiffness.

Cold treatment (in the form of cold packs, ice packs, frozen peas or local sprays) physically numb pain and reduce the swelling and inflammation of joints.

You should always speak to a specialist before starting heat therapy, because while it seems simple, it is actually possible to hurt yourself using either hot or cold therapy. Used correctly, though, it can provide significant pain relief.

Medication

Your doctor might prescribe ant-inflammatory medication to help manage your knee pain. You can also purchase this form of medication from your local pharmacy, if needed. Talk to your doctor about how to ease knee pain through the use of medication. They can suggest which form of medication might be best for you.

Exercises for knee pain

We understand that it can sometimes be difficult to exercise with knee pain. However, avoiding exercise due to knee pain can lead to muscle weakness and stiff joints, which can actually aggravate your knee pain.

Staying active with knee pain can be quite difficult, but it's usually the best approach. Ignoring the pain won't make it go away. Nor will avoiding all motions that spark discomfort. In fact, limiting your movements can weaken muscles, compounding joint trouble, and affect your posture, setting off a cascade of further problems.

The right set of exercises can be a long-lasting way to manage knee pain. If practised regularly, joint pain relief workouts might help to postpone, or even avoid surgery on a problem joint that has been worsening for years, by strengthening key supportive muscles and restoring flexibility.

It can be a good idea to avoid high impact activities and instead focus on gentle movement and gradually building up your strength and resistance. A physiotherapist is the best person to speak to for advice on what exercises can help knee pain in your personal situation.

Some people try yoga for knee pain as a form of alternative therapy. While yoga classes can help improve your general flexibility and relieve muscle tension, it is always best to discuss the stretches you perform with your doctor or Physiotherapist to ensure they are the best stretches for you.

Physiotherapy for knee pain

If exercising with knee pain seems daunting, book an appointment with one of our chartered physiotherapists. They'll be able to assess your knee and they'll build a bespoke programme of knee pain exercises based on your personal needs and guided by your lifestyle and your fitness levels.

At Circle Health Group the cost of physiotherapy start from £64 for an initial assessment and £50 for a follow up appointment.

Joint injections for knee pain

There are a range of knee pain treatments given via injection, including steroid injection therapy and platelet-rich plasma injections.

Steroid injections deliver corticosteroid medications into painful joints or soft tissues to reduce pain and inflammation in that area.

Platelet-rich plasma (PRP) injections are a form of platelet therapy that harnesses the healing power of your platelets. It involves injecting plasma taken from your own blood platelets directly into the knee for speedy pain relief.

Surgery for knee pain

Surgery will only be recommended if you and your consultant both think it's the best choice for you.

There are many different types of knee surgery available. The one you are recommended will depend on what condition is affecting your knee, as well as your personal circumstances.

For example, procedures to repair a torn anterior cruciate ligament or meniscus are quite common after these injuries, which can't always heal on their own.

If you have very advanced arthritis and your pain or lack of mobility is stopping you from doing the things you love, you might be recommended knee replacement surgery. This involves removing part or all of your damaged knee joint and replacing it with a prosthesis.

Knee replacement surgery can have huge benefits to a person's quality of life, but it won't be recommended unless you've tried less invasive methods and they haven't worked.

Mr Bobby Anand is a consultant orthopaedic surgeon at Shirley Oaks Hospital in Croydon. He explains what injuries and conditions can lead to knee pain.

"Knee pain can occur for many reasons. An injury might damage the cartilage, the meniscus, the ligaments or the tendons of the knee.

"There are also many common conditions that can cause pain in the knee. For example, the knee can wear out over time, and this can lead to osteoarthritis.

"The most common symptom of knee damage is knee pain itself. The pain can be very varied. Often the level and type of pain can give us an idea of the type of problem that's occurring.

"Swelling is another symptom. If the knee starts swelling up, it's a sign that there's something in the joint that's irritating it. It's your body's way of telling you there's something wrong with your knee.

"The three most common problems that I tend to see are:

• Tears to the meniscus
• Damaged or torn ligaments, in particular the anterior cruciate ligament (ACL)
• Osteoarthritis of the knee

"If you develop pain in your knee, try resting it for a few days. You can also use an ice pack and/or use mild over-the-counter painkillers. Your local pharmacist will be able to give you advice on these options.

"If your pain and swelling persist after this, it's best to speak to your GP, a physiotherapist, or a specialist consultant. They'll help you identify what's wrong.

"Most knee pain is not caused by anything serious, however it is still best to get it checked out sooner rather than later in case you need a particular treatment or a prolonged period of rest."

We answer your commonly asked questions about knee pain and knee problems.

What can cause knee pain without injury?

If you have not had an obvious injury or accident but you're suffering from chronic knee pain, you may have a joint pain condition such as arthritis or bursitis. Or you may have overexerted your knee and need a rest. A physiotherapist or consultant will be able to help you diagnose your knee pain cause and find a way to manage or treat it.

If you have sudden, sharp or severe knee pain with no obvious cause, it could be a sign of something that needs urgent treatment, so you should go to A&E.

What is the best painkiller for knee pain?

The best painkiller for knee pain will depend on the type of knee pain you have and what is causing it. Speak to your pharmacist or consultant for advice.

Why is my knee clicking and painful?

Knee clicking or a crunching sound can be symptoms of knee arthritis, but they can also be caused by a variety of other knee conditions. Speak to a physiotherapist or a specialist consultant about getting a diagnosis so that you can find a suitable treatment.

How can I relive knee pain at night?

If your knee pain is worse overnight, look for a sleeping position that puts as little pressure as possible on your knees, and try supporting your knees with a cushion.

Some people find that taking a warm bath before bed helps to release tension and stiffness and reduce swelling.

It is also a good idea to improve your overall sleep hygiene, for example by keeping a regular schedule, making sure your bedroom is peaceful and your bed is as comfy as possible, and avoiding caffeine in the evenings.

How painful is a total knee replacement?

Although you will have some postoperative pain for a while after knee surgery, we can usually manage this with traditional painkillers. A knee replacement removes the source of your chronic knee pain, so the pain you felt before your operation should be gone immediately.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led Specialty plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for knee pain, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in March 2023. Next review due March 2026.

1. Knee pain, NHS
2. Knee pain, Mayo Clinic
3. Knee pain, Versus Arthritis
4. Knee pain and problems, Johns Hopkins
5. Knee problems, NHS
6. Knee pain dos and don'ts, WebMD
7. When knee pain may mean arthritis, Arthritis Foundation
8. Arthritis of the knee, Ortho Info