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Knee pain

Knee pain can be debilitating, but there are effective treatment options available to resolve your pain

Senior-woman-sitting-on-couch-massaging-her-painful-knee
Knee pain is a common condition that can affect anyone of any age. Pain might come on suddenly after an injury, or it may come on gradually due to another medical condition such as arthritis or infection. Getting the right knee care at the right time is vital to ensure your condition does not get worse.

Knee pain may present in various ways. It could be a sharp, intense pain resulting from an injury or dull, aching pain that has become worse over time. Knee pain is highly individual and can impact your quality of life and your ability to do the physical activities you enjoy.

Effective treatment depends on identifying the cause of your knee pain.

In this article, we will examine the common causes of knee pain, as well as how it is diagnosed and treated at The London Independent Hospital in East London.

The knee joint is a complex hinging joint with many different structures. An injury to any one of these components can cause pain. The complexity of the knee also makes it susceptible to both overuse and wear and tear.

Anatomy of the knee

The knee is made up of bones, cartilage, ligaments (connective tissue that attaches bones to bones) and tendons (connective tissue that attaches muscle to bone).

The main structures of the knee include:

  • Bones – three bones come together in the knee joint: the femur (thigh bone), the tibia (shin bone) and the patella (kneecap)
  • Cartilage – the back of the patella and ends of the femur and tibia are covered with cartilage to allow the knee bones to move without friction
  • Menisci – between your femur and tibia is the meniscus, a C-shaped piece of cartilage that acts as a shock absorber to help cushion and stabilise the joint
  • Ligaments – ligaments are strong bands of tissue that connect bones to bones. There are four major knee ligaments: two cruciate ligaments and two collateral ligaments
  • Tendons – muscles are attached to bones by tendons. The main tendons of the knee are the quadriceps tendon, the hamstring tendon and the patellar tendon

Additionally, the knee joint is supported and powered by two muscle groups: the quadriceps in the front of the thigh and the hamstrings in the back of the thigh.

Symptoms of knee pain

The location and severity of your knee pain will vary depending on whether or not the pain is a result of an acute injury or a more chronic condition.

Signs and symptoms of knee pain might include:

  • Swelling
  • Stiffness
  • Redness and warmth to the touch
  • Weakness or instability (feeling as if your knee will give way)
  • Popping or crunching sound
  • Catching or clicking sounds
  • Inability to straighten the knee

Knee pain can range from mild soreness to intense and debilitating pain. If you are concerned, it’s always a good idea to see a medical professional.

Where is your knee pain located?

The location of your pain can give some clue to the cause of your knee pain.

Knee pain is broken down into four main areas:

  • Anterior knee pain – pain at the front of your knee
  • Posterior knee pain – pain at the back of your knee
  • Medial knee pain – inner knee pain
  • Lateral knee pain – pain on the outer sides of your knees

Problems with any one of the knee’s structures can cause knee pain. Problems may also arise as a result of a sports injury, general ‘wear and tear’ or inflammation.

Common knee injuries

You don’t have to be an athlete to have a knee injury. In many cases, an injury might involve damage to several knee structures.

Some of the most common injuries to the knee are:

  • Sprains and strains – these can occur when one of your knee muscles (strain) or knee ligaments (sprain) is stretched, torn or pushed beyond its limits
  • Fractures – direct blows to the knee, falls or trauma can cause fractures to the kneecap or ends of the tibia or femur
  • Torn meniscus – this is a common sports injury that occurs as a result of aggressive twisting motions or contact to the knee
  • Ligament tears – any of the four ligaments can be partially torn or fully ruptured, but the anterior cruciate ligament (ACL) is particularly susceptible to injury
  • Tendonitis and tendon tears – overuse or repetitive motions such as running, jumping or cycling can cause inflammation of the tendon (tendonitis) or tears. Tendonitis of the patellar tendon is sometimes called ‘jumper’s knee’

Mechanical problems

Problems with your knee’s structures don’t always occur due to injury. Sometimes, repetition, overuse or inflammation can lead to knee pain.

Other common causes of knee pain include:

  • Patellofemoral pain syndrome – sometimes called ‘runner’s knee’, this can feel like a dull, aching pain under the kneecap. It commonly develops in adolescents and young adults (sometimes due to abnormal kneecap alignment) or older adults with osteoarthritis
  • Knee bursitis – when the fluid-filled sacs that protect the knee joint called bursa become inflamed, it is called patellar bursitis. It can be caused by frequent kneeling or bending of the joint
  • Iliotibial band friction syndrome – the iliotibial band (IT band) is a tough band of tissue that runs from the outside of your hip across the knee to the outside of the shin. When this becomes too tight, it causes friction and pain on the outside of your knees. It’s common with long-distance runners
  • Baker’s cysts – These are fluid-filled sacs that form at the back of the knees, often due to a meniscus injury, osteoarthritis or rheumatoid arthritis

Arthritis

There are many different types of arthritis. Depending on the type, you might be affected in one or both knees.

  • Osteoarthritis (OA) – in osteoarthritis, your knee’s cartilage is thinned and worn down, causing pain, stiffness and decreased mobility. It can affect anyone of any age, but it is more common in adults over 50
  • Rheumatoid arthritis (RA) – rheumatoid arthritis is an auto-immune disease, which means the body’s immune system attacks healthy tissue, in this case, the tissue of the knee
  • Gout – typically only affecting one knee, high uric acid levels cause the formation of uric acid crystals in the knee joint. Pain can come on suddenly and be severe
  • Pseudogout – similar to gout, pseudogout causes sudden and extreme inflammation of the knee joint due to the buildup of calcium-containing crystals in the knee joint capsule

Referred pain

Sometimes pain that is felt in the knee is actually a result of a problem in your lower back or hip. When this happens, it is called referred pain.

You can also feel pain in the knee due to a compressed sciatic nerve in the lower spine. Sciatica can feel like a painful, burning sensation travelling down the back of the leg and knee.

Minor knee injuries such as sprains or strains can be treated at home by following the general guidance called RICE (Rest, Ice, Compression and Elevation).

Although self-care can be beneficial, if you are in any doubt about your condition, you should see a doctor to confirm your diagnosis. Improper treatment can unintentionally worsen your knee or lead to further injury or chronic conditions later on.

You should see a doctor if you experience any of the following symptoms:

  • Your knee gives way, or you can’t put weight on it
  • Your knee is swollen and does not improve
  • Your knee is extremely painful
  • You cannot bend or straighten your knee fully
  • You experienced a fall or traumatic injury
  • You have a fever, and your knee is swollen, red or warm to the touch (this could be a sign of an infection, and you should seek prompt medical attention)

Knee pain from an expert’s perspective

According to Mr Vivek Gulati, Consultant Orthopaedic Knee and Hip Surgeon at Circle Health Group’s The London Independent Hospital, “People of all ages should get their knee pain looked at, and I don't say that to get more patients, but simply because if you’ve got early osteoarthritis, and you know about it early on, then you can do lots of things which may slow the progression of the osteoarthritis. If you don't know about it, you may soldier on, and you may get a quicker acceleration.”

He continues, “Likewise, if you get one type of knee injury, and you don’t deal with it appropriately, the biggest problem is that you will lose muscle on that side of the leg and use your other leg a lot more. And the process of losing muscle can be very painful — it can make it weaker, and it can make it more prone to further injury.”

“So, for example, if you had a ligament injury that you didn't know about and you didn’t treat it in the right way, your knee could be more unstable. And that could make you more likely to have a fall or more likely to develop osteoarthritis because your knee is undergoing excessive loading because it’s not stabilised properly. So one injury can lead to a chronic condition. And one injury can lead to other injuries, both directly and indirectly.”

When you book a consultation at The London Independent Hospital for knee pain, you’ll be seen by a consultant knee surgeon. This initial appointment will include a detailed personal and medical history, a physical examination of your knee and its range of motion and an examination of your spine and hips if necessary.

Your consultant will ask you a series of questions about the nature of your pain to help them diagnose your condition. You will likely be asked:

  • What is the location of the pain?
  • How severe is the pain?
  • Was there any trauma?
  • Do you have any associated symptoms like stiffness or swelling?
  • What are the provoking factors that make the pain worse?
  • What are the relieving factors?
  • It is a pain radiating anywhere?

Your consultant will likely suggest additional investigations to properly confirm your diagnosis based on your history and examination. This might include X-rays to check for fractures or bone problems and MRI scans to check for problems with your soft tissues.

One of the benefits of choosing private care at The London Independent Hospital is that you will be seen by a consultant quickly, and any additional tests will be booked promptly, no more than 3–4 days after your consultation.

Treatment for your knee pain will depend on your diagnosis. Some knee injuries and conditions can be managed with self-care at home, whilst others need different therapeutic treatments.

Self-care for knee pain

There are several self-care measures that you can take for minor knee injuries. For pain that is not severe and that has just started, you can:

  • Rest and avoid any activity that causes pain
  • Take pain relief such as paracetamol and ibuprofen
  • Use an ice pack on your knee for up to 20 minutes every couple of hours
  • Keep your leg elevated to try to bring down the swelling
  • Sleep with a pillow under your leg

For chronic conditions like osteoarthritis, getting the right kinds of exercise is important. Your consultant or physiotherapist will suggest activities that can help keep your knee fit and strong.

Prevention for knee pain

Prevention has an essential role in knee care. Although it’s not always possible to avoid knee injuries and chronic conditions, there are some preventative measures you can take:

  • Maintain a healthy weight to avoid additional strain on your knees
  • Do simple exercises to keep your quadriceps and hamstrings strong
  • Stretch before exercising and try to incorporate flexibility training into your routine
  • Focus on core strength and balance to avoid ligament damage
  • Wear proper footwear and use arch support if necessary

Physiotherapy

Your physiotherapist at The London Independent Hospital will work with you to build a tailored programme of movements and exercises to help reduce pain and stiffness, increase mobility and strengthen your knee joint and muscles.

Mr Gulati explains how physiotherapy can help relieve knee pain. “Imagine the knee joint. If you put more load through an injured knee or a knee with a problem, it gets more painful. But if you have lots of muscles around it, it's almost like a blanket around the knee that can absorb that load for you. So less load goes through the knee joints, and more is absorbed by the neighbouring muscle. So the role of the physiotherapist is to get that muscular envelope activated and working and strong. But also to encourage your knee to undergo its full range of motion.”

The London Independent Hospital has five private treatment rooms and a gym. All our physiotherapists are registered with the Chartered Society of Physiotherapists. They work closely in multi-disciplinary teams with our orthopaedic knee consultants, radiologists and surgeons to ensure you get the best possible care.

You can learn more about our private physiotherapy treatment options on our dedicated physiotherapy page.

Injections for knee pain

Your knee consultant might suggest injection therapy to treat pain and swelling in the knee.

There are several different types of injection therapies that we offer at The London Independent Hospital:

  • Corticosteroid (steroid) injections for bursitis or tendonitis
  • Hyaluronic acid injections for osteoarthritis
  • Platelet-rich plasma (PRP) injections for sports injuries

You can learn more about the benefits of injection therapy on our injection therapy page.

Surgery for knee pain

Although it’s not always appropriate, in some cases, knee surgery might be the right treatment for your knee problem. For major injuries and severe osteoarthritis, you might benefit from knee surgery. Your consultant will discuss whether or not this is the best choice for you.

Potential surgical treatments at The London Independent Hospital include:

  • Arthroscopic surgery – more commonly called keyhole surgery, this is a surgical procedure that allows orthopaedic surgeons to diagnose and treat knee problems of the soft tissue through small incisions in the skin by using an arthroscope (a thin tube with a camera and a monitor).
  • Knee replacement surgery – If osteoarthritis has reached a stage where it is interfering with your life and you cannot cope with the pain, your doctor might suggest knee replacement surgery.
  • ACL reconstructive surgery – for younger, active adults, ACL surgery is the best option for stabilising the knee and ensuring a return to sports after an ACL tear. This keyhole surgery is often done simultaneously with other ligament repairs, including meniscus repair.

Your Circle Health Group orthopaedic consultant will be able to talk you through the type of surgery needed in more detail, should you need it.

Knee pain can significantly impact your quality of life and ability to do the activities you love.

If you are concerned about knee pain or other symptoms, it can be helpful to book an appointment with one of our orthopaedic knee specialists to get the right diagnosis, expert advice on home care and a tailored treatment plan that is bespoke to you.

When you choose The London Independent Hospital for your knee pain, you will benefit from:

  • Bespoke treatment plans from an experienced consultant
  • Prompt treatment that can be booked around your schedule
  • State-of-the-art imaging, such as X-rays and MRI scans
  • Time with your consultant to discuss your questions and concerns
  • Comprehensive physiotherapy support
  • Quicker treatment for acute problems
  • Friendly, accessible staff

Mr Gulati emphasises the importance of prompt treatment. He explains how this was made clear by the COVID-19 pandemic, which caused delays in face-to-face diagnosis and treatment.

According to Mr Gulati, patient outcomes have suffered as a result:

“During COVID, sometimes physiotherapy pathways, especially face-to-face ones, fell through. And we’ve seen now the results from surgeries have been worse as a result of that. People have had delayed knee diagnosis and treatment, because of COVID, whether that’s young people with ACL ruptures or older patients with arthritis.”

He goes on to explain, “As a result, their surgeries have become a lot more complicated. So they’ve taken longer time, they’ve needed more special kinds of special equipment, more complicated knee replacements, which are more difficult to rehabilitate with. COVID has taught us the consequences of delaying diagnosis, and it’s not good.”

Fast knee pain relief in East London

Your knee joints are highly complex, and although knee pain is common, finding the right cause and treatment is best left to medical professionals.

When you book a consultation at The London Independent Hospital, you’ll be seen promptly by a specialist knee consultant who will take time with you to carefully diagnose your condition and create a bespoke treatment plan for you.

The London Independent Hospital can be found at 1 Beaumont Square, Stepney Green, London, E1 4NL. It is accessible by bus, tube (Stepney Green) and a car park with 30 spaces.

Book an appointment online today or call us at 020 7780 2400.

Specialists offering Knee pain

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Mr Kostas Tsitskaris

Trauma and Orthopaedic Surgeon (Hip and Knee)

MD, MSc, FRCS(Tr&Orth)

The London Independent Hospital

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Mr Chatenya Chauhan

Consultant Surgeon. Trauma & Orthopaedic

MbChB, FRCSEd, FRCSEd (Orth & Trauma)

The London Independent Hospital 1 more Southend Private Hospital

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Mr Ahsan Sheeraz

Consultant Trauma & Orthopaedic Surgeon

MBBS, MRCS, PGDip, FRCS

The Saxon Clinic 1 more The London Independent Hospital

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Mr Amer Khan

Consultant Orthopaedic Surgeon

BSc(Hons) MB BS FRCSEd FRCS(Tr&Orth)

The London Independent Hospital

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Mr Ziali Sivardeen

Consultant Orthopaedic Surgeon

BMEDSCI, BMBS, AFRCS, FRCS (TR AND ORTH)

The London Independent Hospital

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Mr Deepu Sethi

Consultant Orthopaedic & Knee Surgeon

MBBS MRCS FRCS (T&O)

The London Independent Hospital

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