Knee Pain

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Your knees take a lot of stress from regular movements like walking, squatting, and going up and down stairs. The muscles surrounding the knee are also used for motion in joints like the hip or ankle. Because of this, lower-extremity muscle balance is key.

Knee problems can be caused by overuse, traumatic injury, and/or naturally occurring changes. Suffering from knee pain? Contact us to learn about treatment options.

How Your Knee Works

The knee consists of four bones – the kneecap (patella), the upper leg thigh bone (femur), the shin bone (tibia), and an outer lower-leg bone (fibula) – the joints between them, the ligaments that keep it stable, and the muscles that generate strength and motion.

The thigh bone stacks on top of the shin bone, creating the true knee joint. The outer bone runs parallel with the shin bone of the lower leg; together they form the tibiofibular joint. The kneecap comes in contact with the thigh bone in the front of the knee to form the patellofemoral joint.

A flexible rim of soft tissue called the meniscus fills the space between the thigh bone and shin bone. The meniscus is comprised of two C-shaped pieces, which help increase the knee’s stability and provide shock absorption.

The four main ligaments in the knee that help provide stability are commonly injured in sports or by trauma. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) wrap around each other deep within the knee, attaching the thigh bone to the shin bone. This helps prevent excessive pivoting of the knee and keeps the shin bone from moving forward or backward under the thigh bone.

The medial collateral ligament (MCL) and the lateral collateral ligament (LCL) help keep the knee stable side-to-side. The MCL runs vertically along the inside of the knee, while the LCL runs vertically on the outside of the knee.

Three main muscle groups surround the knee joint and help power the knee for walking. The quadriceps muscles on the front of the thigh bone cross the knee over the kneecap, attaching to the shin bone via the patellar tendon. On the backside of the thigh the hamstring muscles cross the knee. Hamstring tendons attach on the fibula and on various places on the shin bone.

In the back of the shin bone, the calf muscles (gastrocnemius) attach to the heel and run up the back of the lower leg, connecting again behind the knee on the backside of the thigh bone.

Many other muscles play a role in the knee’s function and assist with tracking of the kneecap, including the IT band and gluteal muscles. In order for the knee to function properly, the bones, joints, ligaments, and muscles must work in unison.

Evaluating Knee Pain

Knee-pain evaluation starts with you telling us when and how your knee pain started, how it currently feels, and which treatments you have tried. We also ask about other medical conditions that may contribute to your knee pain. We do a physical exam to test the structures of your knee, check your knee’s range of motion and strength, and do special tests that can uncover specific problems. Sometimes we check hip strength and range of motion, as these can play a role in knee pain.

Based on the findings of your physical, we may use a cortisone injection as a clinical test and pain treatment. The numbing medicine in the injection helps us determine the source of your pain, while the cortisone relieves pain. Sometimes we order X-rays or MRIs to visualize your bones and soft tissues. X-rays can show fractures, spurs, and changes from arthritis. MRIs can show more bone detail, as well as soft-tissue damage like tears of the ligaments or the meniscus.

Causes of Knee Pain

  • Arthritis
  • Fractures
  • Instability
  • Weakness
  • Inflammation
  • Less common causes– infection, tumors, or nerve problems

Treating Knee Pain

Treatment of knee pain is very specific to the diagnosis and severity of your symptoms.

Viscosupplementation Injections lubricate the knee, assisting with arthritis pain in the knee.
Physical therapy focuses on getting your muscles and joints to work together properly to move your leg. Even if you are very strong and active, muscle imbalances may be causing knee pain.
Medications ccan help with some knee conditions. Non-steroidal medications (NSAIDs) such as ibuprofen or naproxen can relieve inflammation. For severe inflammation, a short burst of a steroid medication may be an option. Acetaminophen (Tylenol) can also help control pain.
A variety of braces can help with arthritis pain (unloader braces), increase the stability of the knee (hinged braces), and keep the kneecap’s proper alignment (patellar stabilizing braces).
Cortisone injections target a specific location in your knee using a powerful anti-inflammatory medication. Numbing medications in the injection help us know if the injected spot is the pain source.
Surgery may be the next option for certain knee conditions if all other treatment options have been exhausted. Although many surgeries can be done through small incisions using a special camera to see inside the body (arthroscopy), some may still require a traditional open surgery.

More About Knee Surgery

Lifestyle modifications include: resting your knee, changing your daily activities to avoid painful situations, riding an exercise bike with no resistance to smooth and polish the knee, and doing exercises to strengthen weak muscles.

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