My Knee Hurts

We ask a lot of our knees.

When they are in top form, knees can withstand tremendous pressure, allowing us to walk, jump, bend, run and perform our favorite activities – from taking a walk to competing in professional sports. They get us up and down stairs, in and out of vehicles, onto the dance floor, into position to make a marriage proposal. They work hard for us.

The knee joint is formed by the thighbone (femur), lower leg bone (tibia) and kneecap (patella). Tough bands of tissue called ligaments connect the bones, tendons attach muscles and cartilage acts as a shock absorber. It's a complex hinge joint – the largest joint in the body – but it is extremely vulnerable to injury, sending nearly 15 million Americans to their doctors every year.

The knee is usually the first joint "to go," and you don't have to be a pro athlete for it to happen. Even normal wear and tear can bring people to their knees in pain.

Common causes of knee pain

  • Kneecap (patella) disorders
  • Degenerative arthritis
  • Cartilage tears
  • Inflammatory arthritis
  • Osteochondritis dissecans
  • Hip arthritis

Pain in the kneecap is at the root of many knee issues and it is likely to be the first part of the joint to develop a problem. This movable bone in the front part of the knee is wrapped inside a tendon that connects the thigh muscle to the lower leg bone. Wear and tear of any type can damage the cartilage underneath the kneecap and cause a misalignment – the kneecap shifts from its normal position and causes pain, usually underneath or around the edges of the kneecap. If the thigh muscle is weak it can cause an imbalance and also lead to a misalignment. Certain activities, such as kneeling or sitting for a long time, may make it worse. The knee may also begin to make a crunching noise or popping or clicking sensation.

Common kneecap disorders

  • Patellofemoral pain syndrome
  • Chondromalacia
  • Dislocation
  • Osteoarthritis

Diagnosing a knee problem should begin with your doctor listening carefully to your story and doing a thorough physical examination. Expect him/her to consider:

  • How you walk
  • Range of motion
  • Level of tenderness
  • Condition of the ligaments
  • Crunchiness (also called crepitus) or popping sound

A series of x-rays with the knee bent at different angles can visualize a variety of issues.

  • Alignment (x-ray taken when standing)
  • Degenerative changes
  • Calcifications
  • Bone defects (osteochondritis)
  • Presence of a tumor

An MRI, which uses magnetic waves instead of x-rays to show soft tissue, may be useful in detecting problems that can't be seen well on x-ray – meniscus or ligament tears, for instance.

If the diagnosis still can't be determined, arthroscopy may be necessary. A small fiber-optic television camera is inserted into the knee joint, so the doctor can look directly inside.

Osteoarthritis

A significant cause of knee pain is osteo- or degenerative arthritis. Many people don't realize that the condition is not related to activity level, but is the result of normal wear and tear. As we age, the cartilage in the knee deteriorates and causes pain.

Treating osteoarthritis without surgery

The key elements in treating osteoarthritis are to keep active and reduce symptoms, primarily pain.

  • Leg strengthening exercises
  • Weight loss
  • Non-steroidal anti-inflammatory medication
  • Braces
  • Hyaluronan injections (A slippery substance that lubricates the joint.)
  • Steroid injections to reduce inflammation

Treating osteoarthritis with surgery

If conservative measures don't relieve the pain, surgery may be the best option.

  • Arthroscopic debridement (cleans out the joint)
  • Osteotomy (removes a section of bone)
  • Cartilage restoration
  • Knee replacement

Preventing knee problems

Our knees are designed to handle a great deal of pressure, but how we use them – and abuse them – can have a huge impact on just how much they can withstand.

  • Maintain a healthy weight. When you walk, the force on your knees is three to six times your weight. The pressure increases with each extra pound. Obesity is one of the biggest risk factors for developing osteoarthritis.
  • Get regular exercise. Daily moderate exercise is better for your knees and other joints than strenuous exercise every once in a while. Choose low impact exercises or activities with a low risk of knee injury, such as walking, yoga, swimming or biking.
  • Warm up by stretching or walking before playing sports.

If one of your knees is already speaking to you in some manner, pay attention. Never ignore knee pain that won't go away. If it limits what you can do or interferes with your quality of life, get it checked out.