Knee Pain FAQs

Knee pain has a wide array of different potential causes that include both pathology within the knee joint itself as well as pathology that presents with pain referred into the knee and felt in and around the knee joint. Example of this includes hip pain, lower back pain, and less commonly, pelvic pain.

Causes from within the knee joint include arthritis, meniscal tears, osteochondral defects, osteonecrosis, patella maltracking, patellofemoral syndrome, cruciate ligament damage, collateral ligament damage, and other rare causes such as pigmented villonodular synovitis (PVNS).

Any knee pain that is persistent and refractory to over-the-counter analgesia, exercise, rest or sustained physical activity should be brought to the attention of a healthcare professional. Our specialist orthopedic surgeons would be happy to see you in consultation for any knee pain that you may be having.

The process begins with a formal history and physical examination, which will include discussion of the knee pain and its duration, nature, characteristics and exacerbating or alleviating factors. We will then perform a physical examination of the knee joint and arrange for you to undergo plain film radiographs, x-ray studies that will give us more information about the anatomy of your knee and potentially give us the diagnosis at that point.

If at this point the diagnosis is still unclear, then further imaging studies such as a CT or MRI scan may be ordered in order to ascertain exactly what is causing the underlying knee pain based on the clinical suspicion from the history and physical examination.Depending on the cause, in some cases your knee pain may be able to be diagnosed in the office during your first visit, but for other causes that are less clear-cut it may require you to undergo a further scan of some kind and return to the office when the scan has been completed for us to discuss the results with you.

The first line treatment for any type of joint pain should be rest of the affected joint for a short period of time. Over-the-counter analgesics such as Tylenol or nonsteroidal anti-inflammatory medications are also the first protocol for analgesia.

If neither of these strategies are effective then you may require a full course of dedicated physical therapy and if this does not work either then, at this point, consultation with a healthcare professional in regards to your knee pain is essential to investigate the underlying diagnosis so that appropriate treatment can be initiated.

Bracing of the knee is indicated in a number of conditions that include both osteoarthritis and patellofemoral causes. If your healthcare provider feels that you would benefit from a course of bracing, they will inform you as such as give you recommendations as to the best type of brace for you to purchase.

It is worth mentioning, however, that braces will only provide relief from knee pain for the duration that they are worn. Many patients find that with some of the bulkier braces, they are uncomfortable and find they are unable to tolerate them for significant periods of the day. This leads some patients to not wear their brace and if this is the case then clearly bracing is not the appropriate intervention for these patients, as not wearing the brace defeats the purpose of the bracing strategy for treating the patient’s complaint.

Although it is possible for alteration in a patient’s gait pattern as a result of knee pain to adversely effect other joints as part of the gait cycle (these do include both the hip, lower back and even in some cases the ankle) it is actually more common that pathology in the hip can present with knee pain.

This is well known to be the case in younger patients who sustain injuries known as a slipped capital femoral epiphysis (SCFE). These patients will often present with knee pain and have their knee extensively investigated only to reveal no major clinical abnormality responsible for the ongoing pain and these critical injuries can often go missed causing long-term problems with the hip and leading to surgical intervention much earlier on in life than it would have been necessary had the hip pain been investigated at an earlier stage.

Therefore it is important to bear in mind that while you may be feeling the pain in and around the knee joint it is the responsibility of your treating healthcare practitioner to investigate both the joint above and below and, if done properly, this will reveal pathology within the hip that is presenting as referred pain in the knee. This can also happen in certain cases with osteoarthritis.

Although many patients choose to begin with their regular family physician to investigate their knee pain, and this is entirely appropriate, our specialist orthopedic surgeons who have years of experience treating common and complex knee complaints will be more than happy to see you in consultation for any knee pain that you may be having.

They will utilize their specialist expertise to achieve a definitive diagnosis for your knee pain and will be happy to explain all of your potential treatment options including any surgical procedure or if nonsurgical procedures are more appropriate, we will offer those or offer a referral to practitioners who provide them for you.

There are multiple reasons that can cause knee pain without injury. This may include inflammation of the tendon, gradual long-standing injury to the articular cartilage or the meniscal cartilage, inflammation of the plica inside the knee joint, inflammation of the capsule, inflammation of the surrounding muscles and tendons etc.

Pain in the back of the knee can be caused by tendonitis, strain of the muscles of the back. It can also be caused by degenerative changes in the knee causing a formation of cysts in the back of the knee. Occasionally, meniscal tears can present with pain in the back of the knee. Unusual cause of pain there may be a clot in the vein or injury to the ligament.

VMO means vastus medialis Obliquus. It’s the lower part of the inner side of the quadriceps muscle. This muscle helps in the last stages of straightening of the knee joint and is very important in the function of the knee joint. This is the first muscle to weaken and the last muscle to strengthen in patients of injury of the knee joint.

Walking is a good exercise for knee pain. It should be done as much as possible, without aggravating the knee pain. It helps not only in general body exercise, but also strengthening muscles of the knee joint, which help in decrease in pain throughout the knee.

Running, especially on hard surfaces, can be bad for the knee. Especially if they are already injured or have degenerative changes. Person should have proper shoe and should try not to run on hard surfaces. They should also do dedicated knee muscle strengthening exercises as well as warm up before the running.

Patellar tendonitis means inflammation of the patellar tendon which is found between the kneecap and the leg bone called tibia. It does usually involve the upper part of the tendon where it attaches to the kneecap. It is usually treated with rest, ice, compression, and elevation along with anti-inflammatory medication. Patient is advised not to involve in contact sports and avoid activities that will worsen the pain. Bracing may help also.

There are soft tissue reflections inside the knee joint called plica. The knee joint has multiple plica bands in the knee, the most remarkable being on the inside, and on the upper part of the kneecap. They are usually present and do not cause any problems. Sometimes, a plica may be thickened or inflamed and may start rubbing on the articular surface and cause pain. In these patients, they are initially treated with anti-inflammatory medications, ice, elevation, and rest followed by physical therapy. If they are not improved with conservative management, then surgical treatment may be required.

Tendonitis in the knee is usually treated in the same way as it is in any other part of the body, by using the RICE protocol (rest, ice, compression and elevation). The patient can also be sent for physical therapy as well as use anti-inflammatory medications. Bracing may also help.

The IT band, or the iliotibial band is a thickening of soft tissue, which extends from the hip to the knee joint. It functions in stabilizing the hip as well as the knee joint and also functions in the movement of the knee joint.

IT band syndrome is caused due to rubbing of the IT band over the outer part of lower thigh bone leading to inflammation and causing pain. It usually occurs in runners and cyclists. It is usually relieved with rest and anti-inflammatory medications. Occasionally a steroid shot may help.

Fluid in the knee is usually reactionary to some other pathology in the knee like injury to the ligament, the meniscus or the cartilage. To decrease the fluid these pathologies are to be taken care of accordingly. In an acute setting, if the fluid is causing pain and discomfort, the fluid can be aspirated by needle from the knee joint. Cortisone injection may also be given at the same time if appropriate which may help in decreasing the swelling and pain.