Knee pain treatment in Birmingham

Fast track your tailored knee treatment at The Priory Hospital

A wide range of health problems can cause knee pain. The cause may depend on a person’s age and symptoms.

Knee pain can often be treated at home, and should start to feel better in a few days. But, if your knee is very painful, or does not improve within a few weeks, you may need to see a doctor to find out what is causing your knee pain and to treat it.

To diagnose the cause of your knee pain, your healthcare provider will ask you a series of questions about your medical history, type of pain, the location of your knee pain, and how the pain started.

Knee pain treatments can largely be divided into conservative, or simpler treatments, and operative treatments that involve surgery.

How to relieve knee pain at home

Some of the conservative treatments are home remedies that you can try before seeing a physician.

These include:

Taking painkillers like ibuprofen or paracetamol
Resting the knee for short periods of time
Applying ice to the knee, particularly after injuries
Trying to keep as active as possible — maintaining muscle bulk always improves the outcomes for knee problems, explains Dr. Green
Losing weight if you are overweight or obese

Injections or physiotherapy exercise for knee pain

Furthermore, many knee pain causes can be easily fixed in primary care, Dr. Green explains.

Family physicians can prescribe physiotherapy or injections to the knee that can easily solve the cause of the pain.

Injections may contain:

Steroids
Hyaluronic acid – a compound that ‘plumps up’ and reinforces the cartilage
Platelet-rich plasma (PRP) – a blood product protein that can be squirted into the joint to help articular cartilage and to help relieve pain

Surgical treatments for knee pain

Surgical treatments depend on the cause of knee pain and include:

Knee realignment surgery (osteotomy) – recommended for arthritis
Knee replacement surgery
Reconstructing or rebuilding the damaged ligaments – if the cause is ACL or PCL
Repair or excision of fragments of the meniscus – if the cause is a meniscal tear

Knee pain can be common among children and adolescents. This may be due to a knee injury or knee conditions.

Runner’s knee

Patellofemoral pain syndrome, also called ‘runner’s knee’, occurs where your kneecap (patella) meets your thigh-bone (femur).

Usually, the pain is dull and located at the front of the knee. The pain is triggered by activities such as running, jumping, bending your legs, and stair climbing.

Patellofemoral pain syndrome may be caused by a wide variety of issues, from structural problems such as a kneecap that is too high in the knee joint, to poor footwear, weak thigh muscles, a certain way of walking or running or overuse.

Osgood-Schlatter disease

This condition primarily affects children and adolescents between the ages of 12 and 18 — most commonly between 12–14 — and occurs in boys more often than in girls.

The pain will be triggered by the same activities as in runner’s knee, but the pain tends to be located more on the bumpy region at the top of the thigh-bone (the tibial tuberosity).

Knee swelling may also occur in addition to knee pain.

Sprains and ligament injuries

Traumatic injuries such as sprains and tears of the ligaments can also cause knee pain.

These include sprain of the medial collateral ligament (MCL), injury to the anterior cruciate ligament (ACL), or injury to the meniscus.

Damage to the articular cartilage may also cause knee pain, as well as fractures to any of the bones of the knee joint: the bottom of the thigh-bone, the top of the shin-bone, or the kneecap. The kneecap can also be dislocated.

In adults, knee pain may be caused by a few different health problems. In particular, osteoarthritis and rheumatoid arthritis — the two most common types of arthritis — can be responsible for knee pain with no obvious injury.

Osteoarthritis (OA)

Osteoarthritis (OA) is also known as degenerative joint disease of the knee. OA is usually the result of wear and tear and the gradual loss of articular cartilage. It commonly affects people over 50 and 60 years of age.

Knee pain caused by OA is gradual in onset, gets worse with physical activity, and gets worse over time. The knee is stiff and swollen and the pain may occur after prolonged sitting or resting.

OA can be primary, which has no known underlying cause, or secondary, which can be caused by a traumatic injury or by rheumatoid arthritis.

Rheumatoid arthritis (RA)

This is a chronic, autoimmune disorder that affects several joints throughout the body, including the knees.

In RA, the synovial membrane — that is, the connective tissue that covers the knee joint and helps secrete the lubricating synovial fluid — is inflamed and starts to swell. This causes pain and stiffness in the knee.

Traumatic injuries

Traumatic injuries to the ligaments, tendons, or cartilage may be the cause of knee pain.

These include damage to the ACL, which is the anterior cruciate ligament (ACL), or the PCL, which is the posterior cruciate ligament. ACL injuries are usually caused by a sudden twisting or pivoting motion. PCL injuries are usually the result of a direct impact, like a car accident or during sports activities.

Meniscal tears may occur suddenly or gradually and can result in pain that gets worse when extending the leg. Swelling, tightness, or stiffness in the knee can also occur when your meniscus is injured. Tendon injuries may result from sports activities or from a fall.

Other trauma to the cartilage or kneecap from a blow or a fall may tear off bits of the cartilage or break or dislocate the kneecap.

If you’re not sure what is responsible for your knee pain, considering any other symptoms or the area of your knee that is affected can help to establish the cause.

Here are some questions you may have about your knee pain and the possible reasons that may be causing it, according to Dr. Marcus Adrian Green, a Consultant Orthopaedic Surgeon at the Priory Hospital in Birmingham.

What can cause knee pain and swelling?

Dr. Green explains that most swollen knees are very painful. “If they're very swollen, [knees] will be painful and the swelling can be due to all sorts of different causes.”

It can be due to any of the injuries to the joint mentioned above. “Things like damage to the meniscus, [damage to] the big ligaments like the ACL, pure arthritis and [...] inflammatory arthritis, rheumatoid arthritis,” can all cause knee pain and swelling.

“Osteoarthritis, which is the wear and tear arthritis, can give you swelling as well.” Gout, which is a form of arthritis, can also cause knee pain and swelling.

What may cause pain in the back of the knee?

Back of knee pain, also called posterior knee pain, may be caused by a variety of reasons. The most common are soft-tissue injuries to the muscles or tendons. Less common causes include neurologic causes and problems with blood vessels in the area.

“The most common cause of pain at the back of the knee,” says Dr. Green, is “a Baker's cyst, which is a benign cyst that is usually associated with degenerative disease in the knee.”

Back of the knee pain may also be a form of ‘referred’ pain, he explains — that is, pain that originates in one part of the body but is felt in another part of the body. In the case of back of knee pain, this can be referred pain from the patella, or the kneecap, and from the little groove that the patella goes up and down on.

There are many other structures at the back of the knee that, when injured or damaged, may cause pain behind the knee. These include:

The meniscus
The hamstring
The calf muscle, also called the gastrocnemius muscle
The popliteus muscle, which is a small triangular muscle that helps stabilise the knee joint

The hamstring and the calf muscle may often be damaged in sports activities. The popliteus muscle may be damaged through a direct stretch or overuse.

Tears in the meniscus tend to cause back of knee pain more rarely.

Inside knee pain: what causes pain inside the knee?

Inner knee pain, or pain inside the knee, can be caused by a wide range of factors, which are usually age-dependent, explains Dr. Green.

He goes on to note three main causes of inside knee pain:

Meniscus tear – “Inner knee pain from damage to the meniscus [is] quite common,” he says.
MCL – “If you have had some mild or severe trauma, you can damage a structure called the medial collateral ligaments, which is a ligament that keeps stability on the inner aspects of the knee.”
Arthritis – “If you've got arthritis, you can get medial sided pain from pure arthritis on the medial side.”

“So, it is a little bit age-dependent,” Dr. Green concludes. Pain inside the knee is “more likely to be [caused by] meniscus or medial collateral ligament in the younger person and in the older person, it is more likely to be osteoarthritic change.”

What may cause knee pain when running?

Running is an “incredibly complex” process, says Dr. Green. Knee pain when running may be caused by:

Patellar tendonitis, also known as patellar tendinopathy or ‘Jumper’s knee’. This is a condition in which your patellar tendon is inflamed. The patellar tendon connects the patella, or your kneecap, to your shinbone. This condition may cause pain at the front of your knee from running.
Meniscal tears. The meniscus is a key part of your knee structure that acts as a shock absorber. It is a C-shaped cartilage that is attached to your shinbone and helps stabilize the knee. The human body has two menisci for each knee. Tears in the menisci may also cause pain when running, among other forms of pain.
Arthritis of the knee
Specific runners’ conditions such as iliotibial band syndrome or damage to the articular cartilage. Iliotibial band syndrome may cause knee pain down on the outside of the knee, explains Dr. Green. Keen runners may develop little holes in their cartilage called ‘chrondal defects’ — this is loss of articular cartilage over a small area, which can be painful and lead to swelling in the joint.

What may cause knee pain when bending?

Bending is quite important when diagnosing knee pain, explains Dr. Green.

The following group of symptoms accompany knee pain when bending:

Pain when getting out of a low chair
Pain when getting out of a low car
Pain when going up and down steps and stairs
Creaking sound or grinding sensation

Knee pain when bending the joint is “often related to damage to the kneecap or the grooves that the kneecap goes in — we call this patellofemoral damage.”

Patellofemoral damage and pain may be caused by wear and tear in arthritis, or it can be a result of overloading the joint, explains Dr. Green. If the alignment of the joints is not right, a bit of the joint can get overstressed and may cause pain.

Osteoarthritis: symptoms & types of knee pain in OA

There are different types of knee pain in OA that come with different symptoms, depending on the location of the pain, explains Dr. Green:

If you have inner knee pain, this is called medial OA
Pain on the outer, lateral side is called lateral side OA
Patellofemoral arthritis describes OA of the kneecap joints

“If you've got patella femoral arthritis, you will have problems getting out of low chairs, going up and down steps and stairs,” Dr. Green says.

“If you've got pain on the inner aspect, medial pain, you can get pain that radiates down the shin.”

“The level of pain can [range from] a little bit of discomfort after a long day of work or in the gym, to pain that is so bad it disturbs your sleep, it makes you limp, and is described by lots of people as the worst toothache pain they've experienced.”

There are many lifestyle changes, such as maintaining a healthy weight and doing exercise, that can help knee pain go away on its own, Dr. Green says.

However, “If you’ve had an injury, and you can’t weight bear, then you definitely need to see a doctor urgently,” he advises.

“If you've got knee pain that doesn't settle over a six-week period, and is getting worse or causing you to limp for weeks, then you should probably see someone about it,” he says.

If the pain starts to interfere with your life or stops you from doing your physical activity, then you should get your knee pain checked.

Firstly, Dr. Green explains, physicians are conscious that knee pain can be referred from somewhere else. “We don't assume that every person with knee pain has got pain that is coming from the knee.”

“Some people who have back pain or back disease can present with knee pain if the back disease is damaging or injuring the nerves that go down to the knee,” he explains. There are also “patients who have problems with their hips [...] but they will present with knee pain.”

Your consultant will consider your age and the mechanism by which you acquired the knee pain in order to determine its cause — for example, did you acquire the pain suddenly from an injury, while playing sports, or was the pain slower and more gradual?

Your physician or consultant will also ask you about the location of your pain. Whether the pain is at the back of the knee, in front of the knee, or inside the knee can all point to different causes.

Another key thing to consider is whether the pain wakes you up at night. “It's very unusual for some of the traumatic causes to wake you at night,” Dr. Green says, “but some of the degenerative diseases can wake you at night.”

Dr. Green adds that waking at night from knee pain can also be a ‘red flag’ signalling things like infection in the joints or, very rarely, cancer in the bone. He stresses the fact that there are “many, many different causes of knee pain.”

X-rays, MRIs, or other diagnostic tests can help discern what causes knee pain.

When you choose to go private with Circle Health Group, you can expect: