Knee Pain

What is knee pain?

Your kneecap (patella) is a thick, round bone that covers and protects the front portion of your knee joint. It moves along a groove in your thighbone (femur) as part of the patellofemoral joint. A layer of cartilage surrounds the underside of your kneecap. This layer protects it from grinding against your femur.

When this cartilage softens and breaks down, it can cause knee pain. This is partly due to repetitive stress. The stress irritates the lining of the joint, and this causes pain in the underlying bone.

Knee pain is very common, especially in highly active people who put a lot of pressure on their knees, like runners. It affects women more often than men.

What causes knee pain?

Several different overlapping causes contribute to knee pain. Some of these include:

  • Overuse of the knee joint
  • Misalignment of the patella and surrounding structures
  • Damage to small nerves in the region
  • Damage to the retinaculum, a ligament-like structure, which holds the patella in place
  • Degeneration of the bone beneath the cartilage
  • Inflammation in the soft tissues around the patella
  • Injury

Who is at risk for knee pain?

You might be at increased risk of knee pain if you:

  • Exercise heavily, or have recently increased the intensity of your workouts
  • Have a body mass index greater than 25
  • Have poor alignment of your patella
  • Walk with your feet turned overly outward or inward
  • Have weakness in surrounding muscle groups (like weak inner quad or hip adductor muscles)
  • Have excess tightness in surrounding muscle groups (like tight hamstrings or iliotibial band)
  • Have a recent history of trauma to the area
  • Are female

You can’t modify many of these risk factors. Losing weight and correcting excess muscle tightness or muscle weakness may help decrease your risk.

What are the symptoms of knee pain?

This type of knee pain is characterized by a dull, aching pain in the front of the knee in the area under and around the kneecap. This pain may start quickly or slowly. Your pain might be worse when you squat, run, or sit for a long time. You might also sometimes feel like your knee is giving out. You might have symptoms in one or both of your knees.

How is knee pain diagnosed?

Your doctor will begin with a medical history and ask about your other medical problems as well as your current symptoms. Be sure to describe any activities that aggravate your knee pain.

You’ll have a thorough medical exam of your knee. This will include tests of your range of motion, strength, and areas of tenderness of your knee. Your doctor will also assess your knee alignment. Your doctor will need to rule out other possible causes of your knee pain, like arthritis or instability.

Usually, you will not need any additional tests. If your diagnosis is unclear, you might need additional imaging tests, like an X-ray or magnetic resonance imaging (MRI) to rule out other possible causes.

How is knee pain treated?

Your doctor might suggest several different treatment strategies to help relieve your symptoms. These might include:

  • Avoiding activities that make your pain worse for a while, returning to activity only gradually.
  • Icing the outside of your knee when it causes you pain.
  • Taking over-the-counter pain medications.
  • Wearing a knee brace or taping your knee to support it.
  • Wearing special shoe inserts to help keep your feet in the proper alignment.
  • Practicing special exercises to stretch and strengthen the muscles around your hip and your knee. Your doctor or physical therapist can show you how.

These steps help most people manage knee pain. Your doctor might recommend surgery if you still have significant symptoms after 6 months of trying these other therapies. Depending on the underlying cause of your knee pain, your doctor might suggest one of several surgical options, like surgically realigning your kneecap. You can discuss all of your surgical options with your orthopedic surgeon.

How can I prevent knee pain?

In some cases, you can prevent knee pain. To help prevent a flare-up of knee pain, you can take the following precautions:

  • Regularly perform all the exercises your doctor or physical therapist recommends
  • Support your knee as recommended by your doctor or physical therapist
  • Ease up on your training when necessary and increase your training gradually
  • Have an expert check your running stance or your stance for your sporting activity
  • Learn how to properly stretch before and after exercise
  • Replace your running shoes regularly

When should I call my healthcare provider?

If your symptoms do not start to improve after several weeks of treatment, see your doctor. You may have a different kind of problem with your knee.

Key points

Knee pain is a common medical condition. Irritation to the tissue around the kneecap causes the condition. Excess repetitive stress makes knee pain much more likely to occur.

  • Your doctor will probably be able to diagnose you with a simple medical history and physical exam.
  • Most people respond to conservative treatment, like pain medications, ice, stretching and strengthening exercises, and avoiding aggravating activities for a while.
  • In rare instances, some people need surgery to treat their condition.
  • Taking simple precautions, like performing your physical therapy exercises, may help prevent your symptoms from coming back.
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