Most people will experience some sort of knee pain in their lifetime. Barring a specific injury, knee pain usually subsides after several days of rest, ice, elevation and over-the-counter anti-inflammatory medication. A specific injury to the knee or pain that does not resolve should seek professional medical attention.
Following are questions I am frequently asked by patients regarding knee pain.
Q. Should I use ice or heat?
A. A general rule is to use ice for 20 minutes out of the hour for the first 48-72 hours following an injury. The idea is to decrease blood flow, which in turn reduces pain and swelling. Heat increases blood flow and aids in healing. But, you should not use heat during the initial phases of an injury. Heat is recommended for chronic injuries or those that have no inflammation or swelling.
Q. What type of over-the-counter medications work best?
A. Everyone responds differently to medication. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, Ibuprofen (Advil) and Naproxen (Aleve) are the most common over-the-counter medications used to treat pain associated with muscular skeletal injuries. Some control inflammation, others are best for pain. Acetaminophen (Tylenol) is not an NSAID because it has no anti-inflammatory properties, it only helps with pain. All of these drugs have potential side effects and can interact with other medications. NSAIDs and Tylenol can be of great benefit when used appropriately, but their dangers should not be underestimated. Always consult a physician before taking any medication.
Q. Do glucosamine and chondroitin supplements work?
A. There is no scientific evidence to support that these supplements can rebuild/regenerate cartilage and they are not regulated by the FDA. According to the American Academy of Orthopaedic Surgeons, a study by ConsumerLab.com showed almost half of all glucosamine/chondroitin supplements tested did not contain the labeled amount of ingredients. However, these supplements are believed to have some anti-inflammatory effects that may relieve pain and have few reported side effects. Ask your doctor before taking any medication.
Q. How does cortisone work? How often can I get a shot of cortisone?
A. Cortisone (steroid) injections work by helping to decrease inflammation and pain. Although they can be beneficial for some orthopedic issues, they do not change the course of arthritis or cure the condition. The general recommendation is no more than one cortisone injection per area every three to four months.
Q. Sometimes my leg gets stuck in a certain position and I can’t bend it, what could be the cause?
A. Locking of the knee or the inability to completely straighten the joint is a red flag for a meniscal tear. The meniscus is a sponge-like structure between the femur (thighbone) and the tibia (shinbone). If the meniscus is torn, it can flip into the joint and block the knee from bending or straightening. There is usually a twisting injury associated with a torn meniscus.
Q. With activity, my knee gives out. Why does this happen?
A. Instability or “giving out” is most commonly caused by two conditions: 1. Kneecap (patella) instability. Meaning, the kneecap moves too freely and does not track properly. When this occurs, a person experiences pain and the sensation of the knee giving way. 2. A ligament injury. Most commonly, an Anterior Cruciate Ligament (ACL) tear, which is usually associated with a traumatic event (many times involving an audible “popping” sound), followed by knee swelling and pain.
Q. I have a lump on the back of my leg, right behind my knee. What could this be?
A. Most commonly, a lump behind the knee is a Baker’s cyst and should be evaluated. These cysts are the result of underlying problems inside the knee such as arthritis or a cartilage (meniscal) tear. Conditions of this type cause the knee to produce more fluid, which gets pushed out the back of the knee causing the Baker’s cyst. Treating the underlying problem can improve the symptoms, which are normally knee pain and stiffness, and decrease the size of the cyst.
Q. Why does my knee swell up when I’m active?
A. The knee produces a lubricant called synovial fluid. It helps reduce friction as your knee moves with activity. When the knee is irritated or injured, it produces more lubricant to protect the knee joint. The overproduction of synovial fluid leads to swelling and pain.
Q. Why does my knee hurt when going up and down stairs or sitting in my car?
A. Many times, this is related to the cartilage under the kneecap. It is called “patellofemoral pain” which means pain in the knee joint. It can be related to arthritis (wearing down of the smooth bone surface) or softening of the surface (chondromalacia). It can also be caused by the kneecap being pulled to one side of the knee, therefore stressing and wearing down the cartilage faster.
Q. Why does my knee makes sounds when I bend it?
A. Everyone’s joints can make noises with motion. It can be related to the unevenness of the joint surface (arthritis) or excess swelling (fluid) in the joint. When these noises are associated with pain it is advisable to seek medical attention.
The above is a generalization of common questions and should not serve as a way to self-diagnose a possibly serious condition. Only a medical professional can properly diagnose your condition.
James R. Seeds, MD holds a double board certification in both Orthopeodic Surgery and Sports Medicine. He was fellowship trained in Sports Medicine at the American Sports Medicine Institute (Birmingham, AL) in the company of internationally renowned surgeons Dr. Lawrence Lemak and Dr. James Andrews. Dr. Seeds is a partner at the Midwest Bone & Joint Institute (Algonquin, Barrington, Elgin and Geneva, IL).