With approximately 25% of adults in America suffering from frequent or chronic knee pain, you are not alone in your struggle to overcome this obstacle in the pursuit of overall wellness and health. New studies are continuously being published that bear the ill-tidings of increasing knee pain and joint replacement statistics – especially in the older population. But this doesn’t have to be the case for YOU.
Knee pain limits both function and mobility; oftentimes impairing the quality of life for those affected. And while knee pain is most common in men and women aged 50 or older, it can be a negative influence at any age as it comes from various causes. According to a study conducted for the Annals of Internal Medicine, knee pain has substantially increased over a 20-year period independent of age and body mass index. With this in mind, it is of the utmost importance to understand the causes, risk factors, and prevention techniques so that you can navigate current or potential knee pain.
A variety of causes can lead to knee pain: injuries, mechanical problems, and types of arthritis, for example. To better understand the cause of your knee pain, first, you must understand your knee.
Our knees are composed of four bones, with the femur at the top of the joint and the tibia and fibula making up the joint’s lower part. On the top of the knee, a fourth bone (the patella) slides in a shallow groove at the end of the femur. Likewise, to the four bones, four main connective tissue bands secure the femur to the tibia and create a hinge-like structure out of the joint, allowing it to rotate as it bends. This unique ability is why the knee is called a swivel joint.
In addition, the knee includes fibrous bands of tissue known as tendons that connect the muscle to the bone. Our knees have two major tendons – the quadriceps tendon and the patellar tendon. You guessed it. The quadriceps tendon connects the long quadriceps muscle (found at the foundation of the thigh) to the patella, and the patellar tendon connects the patella to the tibia. These tendons are responsible for you being able to straighten and extend your leg while the hamstring muscles at the back of the leg help stabilize the knee joint.
Finally, there is the meniscus and bursa – your knee’s cushioning system. The meniscus, a C-shaped cartilage, curves around the inside and outside of the knee while the bursae (fluid-filled sacs) help the many ligaments and tendons to slide smoothly across the knee joint. Altogether, the bones, tendons, ligaments, meniscus, and bursa construct one of the most dynamic and essential joints of the body. Since they support and stabilize, weakness in any of them greatly increases the likeliness of injury.
Knee Pain with Injury
Injuring the knee is a widespread occurrence. The National Library of Medicine presented a study that found that the knee is the most commonly injured joint by adolescent athletes, with an estimated 2.5 million sports-related injuries presented to emergency departments annually. Additionally, doctors often discover that meniscus tears, torn cartilage, or patellar fractures are among the top 30 injuries older patients suffer from.
The following are the most prevalent knee-related injuries found in all ages:
ACL Tear – The most common of the various knee injuries is the ACL tear or rupture. This occurs when the anterior cruciate ligament (ACL), one of the four ligaments that connect your shinbone to your thighbone, is overstretched, partially torn, or completely torn (in which case it is referred to as an ACL rupture). It is estimated that there are 100,000 to 200,000 ACL ruptures in the United States alone every year. This type of injury is most common among athletes of specific sports such as soccer, football, skiing, or tennis.
Fractures – An unfortunate consequence of vehicular accidents or falls, typically the patella ( kneecap) that suffers a fracture or break. As it sits in front of the entire joint, acting like a shield, it is most vulnerable to direct falls onto the knee for impact, such as hitting the dashboard in a vehicle collision.
Patellar Tendinitis – Found most often in runners, skiers, cyclists, and those involved in activities that contain lots of jumping, patellar tendinitis is the irritation and inflammation of the patellar tendon, which connects the quadriceps muscle to the shinbone.
Torn Meniscus – A torn meniscus is very similar to the ACL tearing, except the meniscus is a tough, rubbery cartilage, not a ligament. The meniscus is the knee’s shock absorber and can be torn if suddenly twisted while bearing weight.
Knee Bursitis – Like patellar tendonitis, knee bursitis is a type of inflammation. It comes from three main causes: frequent or sustained pressure (such as kneeling), overuse, and a direct impact to the knee. If such an injury occurs, the bursae (small sacs of fluid that cushion the knee joint) become inflamed and painful.
Knee Pain without Injury
The most common cause of knee pain that does not result from an injury is arthritis. More than a hundred different types of arthritis exist, but the varieties listed below are most likely to affect the knee.
Osteoarthritis – The most common type of arthritis, and the most common cause of disability in older adults, osteoarthritis is sometimes referred to as degenerative arthritis. It is a wear-and-tear condition that occurs when the cartilage in the knee deteriorates with age and use.
Rheumatoid arthritis – This type of arthritis can affect almost any joint in the body and is the most debilitating form of arthritis. It is an autoimmune condition and considered a chronic disease, although pain and severity can vary.
Septic arthritis – If the knee joint becomes infected, septic arthritis may quickly cause extensive damage to the knee’s cartilage. There is usually no trauma before the onset of this knee pain, although it often occurs with a fever.
While there is no specific guarantee relating to the cause of knee pain, there are several factors that increase the risk of injury and problems. Such factors include:
Excess weight – While knee pain can be independent of a person’s body mass, it should be noted that the knee absorbs a huge amount of pressure with every step. This pressure equals one and a half times your body weight. Consequently, the pressure of excess weight takes a toll over time – weakening muscles and ligaments or deteriorating the cartilage. One of the first treatment angles doctors take is to assess the patient’s weight and ascertain if it is contributing to the knee pain or injury.
Lack of muscle strength and flexibility – As discussed above, the bones, muscles, and other dynamics of the knee all work together to stabilize and protect the joint. If there is a weakness in one or multiple areas, the risk of injury becomes far greater. Strong muscles are essential to stabilization, while muscle flexibility ensures that you can achieve a full range of motion protecting against injuries like ACL ruptures.
Certain sports or occupations – For those in sports that put greater stress on the joints than others, injuries are always at a higher risk. This is true concerning knee injuries as well. Basketball players, runners, and skiers all face the same conflict: do what they love and risk injury. Additionally, jobs such as farming or construction that require repetitive pressure or stress on the knees also increase the risk of injury.
Previous injury – This may sound repetitive, but it is worth reconsidering. There is a much higher risk of pain currently or in the future for those of us who have had previous knee injuries. Which is why the next segment of this article is so important. Preventative measures are a must in order to keep knee pain from impairing quality of life.
As they say, the best defense is a good offense. While it is not always possible to prevent knee pain, the following suggestions can reduce or prevent injuries, pain, and joint deterioration altogether.
Get Strong, but Stay Flexible – With weak muscles being a leading cause of knee injuries, you will benefit greatly from building up balance and stability. This comes from strengthening the hamstrings and quadriceps, but also other exercise routines and target areas. Many fitness industry professionals recommend that the best way to alleviate knee pain is to get moving. Swimming, yoga, walking, and cycling are all approved (and suggested) exercises associated with improving arthritic knee pain or general knee pain symptoms.
Be Smart About Exercise – Exercising is a great way to stay fit and healthy and keep joint pain at bay, but it can also do more harm than good if done improperly. If you are already experiencing knee pain, or are in the categories for those potentially at risk, try switching your exercise routines to low-impact activities such as swimming or stationary biking.
Keep extra pounds off – As mentioned before, excess weight does not always cause knee pain. However, it has the potential to do so in many cases. Each extra pound puts additional strain on your joints (not just your knees), increasing the risk of injury and pain. This is why it is important to stay focused on protecting your joints from any unnecessary strain.
Treatments for knee pain will vary depending upon the underlying cause of the knee pain. These treatments can include medication, therapy, and in severe cases surgery.
Medication – The type of medication prescribed by a doctor fluctuates with the exact diagnosis. Typical medications for anti-inflammatory treatments (common for simple sprains and even arthritis) are over-the-counter drugs like acetaminophen (Tylenol), aspirin, or ibuprofen, and naproxen (Aleve). Injectable medications are also a rising choice of treatment, as discussed below.
Therapy – In some cases, knee pain can be easily corrected through physical exercise (such as movements designed specifically to strengthen the weak areas causing pain). Additionally, certain types of corrective wedges worn in the shoes or even braces can lessen or eliminate your discomfort.
Surgery – If surgery is needed to treat your knee pain, the options you have may include: arthroscopic surgery, partial knee replacement surgery, and total knee replacement surgery. In the first procedure, the doctor can examine and repair your joint damage using fiber-optic cameras and small incisions around the knee. Arthroscopy can be used to remove or repair damaged cartilage, reconstruct torn ligaments, or remove loose bodies from the knee joint. In the second and third procedures, the doctor either replaces the most damaged parts of your knee with small parts of metal and plastic or replaces the entire joint with an artificial one made of metal alloys and high-grade plastics and polymers.
Injectable medications are a common treatment, and are usually the step between taking oral medication and surgery
Corticosteroids – Injections of a corticosteroid drug into the joint may work to reduce symptoms of an arthritic flare-up and provide relief for weeks or months. However, these injections are not always successful and may lead to cortisone abuse in later years.
Hyaluronic acid – The human body naturally produces this thick, gooey substance. Found in large amounts in your skin, its main function is to retain water and keep the tissues lubricated and moist. When used to treat knee pain (particularly osteoarthritis), it can provide relief through one or a series of shots up to six months.
A third possible treatment is the injection of stem cells and growth factors into the knee joint. Dr. Dana Churchill, an established Naturopath specializing in regenerative and fully integrated healthcare at his clinics in California, sees many patients suffering from knee pain. So much so that one of his areas of expertise in treating joint pain. In an interview with Top Doctor Magazine, he shared that his “gold standard” for treating knee pain is the injection of Wharton’s Jelly. This gelatine-like substance is found within the umbilical cord and contains hyaluronic acid and chondroitin sulfate. Both of which are already used widely as a dietary supplement to treat osteoarthritis. A regenerative agent, Wharton’s Jelly regenerates the tendons, ligaments, and cartilage in the knee. It can postpone and even stop deterioration. Dr. Churchill reports that with the injection of Wharton’s Jelly, he has seen an improvement of symptoms and pain in as soon as two weeks and as long as six weeks.
Nguyen, U. S., Zhang, Y., Zhu, Y., Niu, J., Zhang, B., & Felson, D. T. (2011). Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Annals of internal medicine, 155(11), 725–732. https://doi.org/10.7326/0003-4819-155-11-201112060-00004
Gage BE, McIlvain NM, Collins CL, Fields SK, Comstock RD. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 2012;19(4):378-385. doi:10.1111/j.1553-2712.2012.01315.x