KNEE PAIN?

WHAT IS KNEE PAIN?

Knee pain is the most common and challenging pain that affects the performance and activities of daily living. Apart from the bones, the surrounding neuromuscular structures are also integral parts of the knee joint. Knee pain is a common clinical symptom in the adult population that affects half of the population aged over 50, with various causes ranging from degenerative conditions to structural imbalances and injuries.

Prevalence:

Christopher W. Bunt et al (2018) reported that Knee pain affects approximately 25% of adults, and its prevalence has increased by almost 65% over the past 20 years, accounting for nearly 4 million primary care visits annually.

WHAT IS THE CAUSE OF KNEE PAIN?

Soft tissue injury: Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial collateral and Lateral Collateral Ligament, Meniscus, Tendinitis, Bursa, Baker’s cyst.

 

Arthritis: Osteoarthritis, Rheumatoid arthritis, Gout arthritis

 

Infection: Osteomyelitis, septic arthritis

 

Dislocation & Fracture: Patella, Femur and Tibia

 

Congenital causes: Juvenile Idiopathic Arthritis, Osteochondritis dissecans.

 

Non-Specific causes: Mobility restriction of Hip, knee, and ankle joint, Hip and knee muscle weakness.

 

Overuse causes: patellofemoral pain, chondromalacia patella, Osgood Schlatter’s disease, Sinding-Larsen-Johansson

 

Post-surgical: Total Knee Replacement, Ligament Reconstruction

WHAT ARE THE RISK FACTORS OF KNEE PAIN?

Obesity and Overweight: Silverwood et al. (2015) indicated that in patients with a new onset of knee pain 24.6% related to being overweight or obese. Obesity is a significant risk factor for the development of knee pain and Osteoarthritis, with overweight individuals having a higher likelihood of experiencing knee pain.

 

Gender: Oleksandr Buhaiov et al. (2024) convey that Women are at a higher risk for chronic knee pain, potentially due to hormonal and anatomical differences.

 

Previous Injuries: A history of knee injuries, such as ligament tears or fractures, increases the risk of developing knee pain later in life. V. Silverwood et al. (2015) indicated that in patients with a new onset of knee pain, 5.1% of cases were due to previous knee injury. These injuries can lead to joint instability and degenerative changes over time.

 

Deformity: Erkoçak et al. (2016) suggest that Lower extremity rotational deformities may increase the risk of anterior knee pain

Valgus/varus Deformity of the knee is often caused due to osteoarthritis, leading to chronic pain and functional limitations.

 

Genetics: Ting Zou et al. (2016) reported that genetic factors may be involved in the pathogenesis of knee pain, as offspring of those with severe knee osteoarthritis had an increased risk of worsening knee pain over 8 years.

 

Chronic knee pain: Oleksandr Buhaiov et al (2024) suggest Chronic knee pain can persist even in the absence of active joint damage, often due to neuropathic pain mechanisms. This type of pain involves changes in nerve processing and can be influenced by factors such as genetics and age.

 

Depression: P. Phyomaung et al (2014) concluded Depression plays a significant role in knee pain, and a biopsychosocial approach is integral to optimizing outcomes for knee pain.

WHAT ARE THE SYMPTOMS OF KNEE PAIN?

Based on the causes and the severity of the knee pain the symptoms will vary from person to person. But the common symptoms of knee pain are,

  1. Knee pain in loading (load-induced pain)
  2. Knee Joint swelling
  3. Joint stiffness
  4. Limited range of motion
  5. Difficulty in daily life activities 
  6. Redness & warmth to touch
  7. Popping sound/ crepitus
  8. Muscle weakness & wasting
  9. Knee buckling/instability

HOW IS KNEE PAIN TREATED?

The treatment of knee pain varies according to the severity of the pain/condition.

NON-SURGICAL TREATMENT

Medical management

Nonsteroidal anti-inflammatory drugs (NSAID):   These are effective for short-term pain relief in knee osteoarthritis, but long-term benefits are not supported due to potential adverse effects.

Opioids:   B. R. D. Costa et al. (2009) suggest that Opioids show small to moderate benefits for pain relief and function improvement in osteoarthritis patients, but their increased risk of adverse events makes them unsuitable for routine use.

Intra-articular corticosteroids: Alessandro Bensa et al. (2024) reported short-term pain relief and functional improvement for knee osteoarthritis, but their benefits diminish after a few weeks and are not sustained in the long term.

Physiotherapy management

Exercise therapy

Exercise significantly reduces pain and improves function, performance, and quality of life in people with knee pain.

S. Goh et al. (2019) reported that Aerobic and mind-body exercises are most beneficial for pain and function improvements in knee and hip osteoarthritis.

D. Beckwée et al. (2013) concluded Exercise reduces pain and improves functioning in osteoarthritis of the knee through neuromuscular, peri-articular, intra-articular, psychosocial components, and general fitness and health.   

 Weight loss

I. J. H. Chu et al. (2018) concluded that 5% to 10% weight loss significantly improved pain, self-reported disability, and quality of life in adults with knee osteoarthritis and obesity.

M. Hall et al. (2019) suggested that A combination of diet and exercise treatments can provide moderate pain relief for knee osteoarthritis patients, but not for diet-only treatments.

 Patient Education

A. Goff et al. (2021) concluded that Patient education improves short-term pain and function in people with knee osteoarthritis, but it is more effective when combined with exercise therapy.

Electrotherapy modalities

The addition of interferential current therapy (ICT), shortwave diathermy therapy (SDT), and photobiomodulation (PHOTO) to an exercise program for individuals with knee osteoarthritis is not superior to exercise performed in isolation in terms of clinical benefit.

 

Duong et al. (2023) reported Knee Osteoarthritis Treatment Guidelines from Major Professional Societies.

Surgical treatment

Surgical Treatment is often the last and definitive resort for patients with severe knee pain after failure to achieve symptomatic relief with conservative treatment.

  • Total knee replacement,
  •  Arthroscopic surgery
  •  Ligament reconstruction,
  •  Patellar surgery.

Studies suggest that exercise, particularly preoperative and postoperative rehabilitation, can improve early postoperative outcomes such as pain, function, and muscle strength, and reduce hospital stay after knee surgeries.

HOW DO YOU GET RID OF KNEE PAIN?

Maintain a Healthy Weight:

  • Obesity significantly increases the risk of knee pain and osteoarthritis. Regular exercise and a balanced diet can help maintain a healthy weight, reducing joint stress.

Incorporate Gender-Specific Interventions

  • Women may benefit from targeted exercises to strengthen knee-supporting muscles and address hormonal or anatomical differences that contribute to knee pain.

Prevent and Address Injuries Promptly

  • If injuries occur, seek timely treatment to minimize long-term damage.

Correct Lower Limb Deformities

  • Address deformities, such as valgus alignment or rotational abnormalities, through physiotherapy, orthotic devices, or corrective surgery when needed, to improve knee stability and function.

Understand Genetic Predispositions

  • If there’s a family history of knee osteoarthritis, focus on proactive joint care, including regular low-impact exercises (e.g., swimming, cycling), and monitoring for early signs of joint pain.

Address Mental Health

  • Since depression can exacerbate knee pain, adopting a biopsychosocial approach, including counseling and stress management, may help alleviate symptoms and improve overall well-being.

Manage Chronic Knee Pain Effectively

  • Chronic pain should be approached holistically, combining physical therapies (EXERCISES), neuropathic pain management, and psychological support, such as cognitive behavioral therapy (CBT), to improve outcomes.

EXERCISES FOR KNEE PAIN

Mobility exercise for knee pain

  1. ATG- ankle knee focused
  2. Couch stretch
  3. Downward-facing dog calf stretch
  4. Prone quadriceps extension
  5. Tibial rotation
  6. Hamstring stretch

Strengthening exercise for knee pain

  1. Squat
  2. Lunges
  3. Single-leg RDL
  4. Single leg squat
  5. Hamstring bridging
  6. Eccentric forward touch-down squat

To overcome and prevent knee pain we should also improve the mobility and strength of the hip joint and ankle joint.

To learn the mobility and strengthening exercises of the hip joint click here – Exercise for ankle pain

WHAT NOT TO DO WITH KNEE PAIN?

With knee pain, avoid self-medicating with painkillers, heat/cold packs, or exercises without professional guidance. Because it may worsen the condition. So  Focus on identifying the root cause of the pain first. Then proceed with the treatment accordingly.

IS WALKING OK FOR KNEE PAIN? 

Walking is absolutely safe while having knee pain. You can do all the activities you wish, there is no need to stop anything but, before doing those activities Build muscle strength, capacity, confidence, and self-efficacy under the supervision of a qualified physiotherapist.

WHICH FOOD IS NOT GOOD FOR KNEE PAIN?

To manage knee pain, avoid foods that can increase inflammation, such as processed meats, sugary snacks, and fried foods. High-fat items can worsen joint stiffness. Refined carbohydrates, like white bread and pasta, also contribute to inflammation. Excessive alcohol and sugary drinks can interfere with your body’s healing processes. Instead, focus on a balanced diet with lean proteins, whole grains, and plenty of fruits and vegetables.

HOW WE APPROACH KNEE INJURY & PAIN?

The best treatment approach starts with a proper assessment of a patient.

OUR ASSESSMENT

1) History collection

2) Accurately Diagnose the condition with clinical correlation

3) Assessment for fear of movement

4) Psycho-social factor assessment

5) Identify the root cause/risk factors for having knee pain

6)    Physical examination

Every individual is different so based on the assessment, needs, and goals we create a tailor-made treatment program.

CONCLUSION:

Knee pain is always not a serious problem with proper treatment and care most individuals recover fully. However, it is important to identify the root cause and treat it accordingly. So, it is essential to consult a qualified physiotherapist before beginning any new exercise routine.

At Exercise Prescriptor Clinic, we provide professional assessments that will help to determine the root cause of your pain and ensure that the given exercises are appropriate and tailored to your specific needs, reducing the risk of further injury or complications.

Schedule a consultation today to take the first step toward a healthy and pain-free life.