Human Performance and Rehabilitation Centers, Inc.

Knee Pain Explained

Knee pain is something nearly every person experiences at one point or another, usually related to a particular injury or provocative activity, such as lots of kneeling for spring planting in the yard or playing the occasional game of basketball. How do you know the difference between a serious injury versus simple overuse? The causes of knee pain typically fall into one of three categories: traumatic, overuse, and degenerative.

Traumatic is self-explanatory; a fall, collision, twist, or awkward landing can create enough force to damage the structures inside the joint. When this type of damage occurs, the person may experience severe and immediate swelling, severe pain, a loss of ability to move the joint, and an inability to bear weight through the limb; a safe bet is when two of the three exist, the person should seek medical attention from a physician and/or physical therapist immediately. Attempting to “walk it off” is not recommended.

An overuse injury can be a little tougher to recognize. Starting a fitness program or a dramatic change in a person’s activity level (more or less) can provoke this type of pain. So can rapid increases in body weight, such as pregnancy. Adolescents who are going through growth spurts will often have pain in the knees because of changes in the way the muscles and joint function together. The pain may show up immediately or gradually, appearing more and more frequently until it is constant. Swelling may appear but is typically not severe and disappears overnight. Depending on the structure inside the knee that is taking the abuse, surgery may be needed, but many times this is treated quickly and effectively with a short course of rest, stretching and strengthening.

“Degenerative” describes the normal changes our joints experience with aging, specifically thinning of the articular cartilage and the loss of quality in the soft tissue of the joint. Knee pain from degenerative changes generally does not produce swelling and is provoked by remaining in one position for a great deal of time.

Besides pain, a problem within the knee (or any joint) will also cause the muscles around the joint to stop working effectively. Over time this will produce a loss of muscle size as well as a loss of control of the joint. The longer the joint remains untreated, the more severe the muscle atrophy and loss in function will become. Other joints may become painful as a result, particularly the areas above and below the injured joint or the opposite side. Medical treatment should begin before the body learns bad movement patterns.

Unless severe structural damage is present, a course of physical therapy will often be successful in getting rid of pain and restoring a person’s usual activity level. Any physician can refer to physical therapy and in many states no referral is required; in most cases, the therapist can make an accurate assessment of the problem and begin treatment immediately. If the problem is severe enough that a specialist should be involved, the therapist can facilitate the referral and also make recommendations for any diagnostic testing.

Front of knee pain: How to treat Patellofemoral Pain Syndrome

If you’ve experienced pain in the front of your knee around the kneecap, it’s probably a condition called Patellofemoral Pain Syndrome. Known also as “runner’s knee” or “jumper’s knee,” this condition can occur at any age, but it’s most common in teenagers, young adults, athletes and those who have recently hit puberty.

Patellofemoral Pain Syndrome is typically not caused by trauma; instead, it can seem to just appear. Because no single incident is the culprit, a person experiencing it may be inclined to work through the pain, or keep participating in sports or activities. When the pain doesn’t resolve, and, in fact, it gets worse, everyday knee flexion and extension can become intolerable.

Younger athletes are particularly vulnerable to Patellofemoral Pain Syndrome. During puberty, a young person’s bones grow fast –  outpacing the growth rate of ligaments, tendons and muscles and putting more stress on the joints. In addition, females have wider hips compared to their male counterparts and this can change the alignment of the knee and impact the patella’s movement in the trochlear groove. Athletes who engage in running, soccer, volleyball, cheerleading and dancing could experience this kind of knee pain.

Other causes for Patellofemoral Pain Syndrome include muscle weakness, stiffness, fatigue, improper shoe wear and poor movement patterns. Other contributing factors include overtraining or poor training techniques. And, prolonged sitting behind a desk during the week coupled with extreme “weekend warrior” activities can create an opening for Patellofemoral Pain Syndrome.

Patients should avoid irritable activities and apply ice two-to-three times daily to decrease inflammation. Physical therapy plays a big part in getting back to normal. In PT sessions, we work with patients on improving flexibility, stretching the hamstrings and strengthening the quads and hips by using very specific exercises. I usually like to see patients with this condition twice a week for four to six weeks.

Because of the multitude of contributing factors for each individual experiencing Patellofemoral Pain Syndrome, it’s important to let an experienced PT evaluate your case and develop a therapy plan that fits.