Have you recently suffered a knee injury and are now asking yourself the question, “what exactly just happened?” Maybe you have been running for a couple of weeks and are beginning to experience some nagging pain around your knee, or you felt a sudden wince of pain when taking a step. Regardless of the specific knee problem you are currently trying to manage, we are here to show you not only how to assess your knee pain, but also how to take control of those knee issues. Whether you are new to the [P]Rehab community, or you have been with us for some time, one of our biggest core values is putting the ball in your court with high-quality, educational content so you do not have to rely on anyone but yourself to maintain health and wellness!
What Can Be Causing My Knee Pain?
First things first, in general, when dealing with knee pain, or pain in any part of the body for that matter, some questions you can initially ask yourself are:
How long has my knee been hurting?
If the injury just happened (acute) versus if it has been going on for several weeks to months (chronic), that reference of time will help narrow down the root of your knee pain.
For example, a common overuse injury to the knee can be due to the knee cap joint (patellofemoral pain), versus a fall or blow to the knee during a sport may result in an anterior cruciate ligament (ACL) or meniscus tear.
What does the pain feel like?
A nagging, dull pain may be more related to soft tissue or joint-related issues, whereas some clicking/locking, or lack of stability in the knee may indicate cartilage or ligament issues. Numbness or tingling may indicate a nerve type of pain, as pain can also be referred from other areas of the body.
Where is the pain located?
Area of location can help to narrow down what potential structures may be involved in your knee pain.
For example, pain on the outside of the knee can be coming from the iliotibial band or lateral collateral ligament (LCL), whereas pain on the inside of the knee may be coming from medial collateral ligament (MCL) or inside portion of the joint space.
Take The Guesswork Out of Managing Your Own Knee Pain!
Are you tired of guessing what you should do after a knee injury? Rest? Try to push through? You should never have to guess how to rehab your knee appropriately after an injury. That is why we at Team [P]rehab have designed this program specifically for you! A program that takes you step-by-step on how to progress through knee rehab, right from your phone, and it can be done on your OWN time. This program is the best solution for you to recover from a knee injury. Click this link to get started with us today.
Simple Anatomy of The Knee
Not to dive deep into anatomy, but more so just to give yourself a brief reference and something you can go back to when you hear various terms for different structures of the knee. Ligaments connect bone to bone, with the more commonly injured ones being the anterior cruciate ligament (ACL) and medial collateral ligament (MCL). You have 2 menisci, one of the inside of the knee, and the other on the outside. These tissues are made up of a specific type of cartilage known as fibrocartilage, and sit between the shin bone and thigh bone, acting as shock absorbers and dissipaters. The patella is your knee cap, which sits on top of the knee joint.
What Should I Do First If My Knee Hurts?
Wondering what to do if your knee hurts? Don’t worry, we’ve got you covered on how to assess your knee pain. It is a difficult decision trying to decipher whether you should go to the emergency room, get imaging, rest your knee, or try to exercise through your issue. Fortunately, there are some indicators that have been developed by researchers and healthcare professionals to help you distinguish the first step to take when dealing with knee pain. More often, if an injury is acute, there is a higher likelihood that you may need to seek a medical consult first, whereas if the injury is chronic, it can often be managed with the right exercise program! This is not to say that all acute knee injuries need to have medical attention right away; however, when comparing acute versus chronic knee pain, it is more likely for acute knee injuries to require a medical consult.
Acute Knee Injuries: Fractures
If you have had an acute injury that just happened, and are concerned about the potential of a fracture, utilizing the Ottawa Knee Rules is a quick and easy way to help you with decision-making in regards to if you should seek further consultation, including imaging. To be clear, this is specific for if you have had a traumatic incident, such as a motor vehicle accident or fall. The rules are listed below:
Ottawa Knee Rules:
Age greater than or equal to 55 years old
Isolated knee cap (patella) tenderness
Tenderness at the head of the fibula (small bone on the outside of the knee)
Inability to bend the knee to 90 degrees
Inability to bear weight (4 steps) immediately after injury and in the ED
Acute Knee Injuries: Tears or Dislocations
Dislocations: Other situations in which you may need to immediately seek medical attention is if you have sustained a tear or dislocation to the knee. Dislocations are easy to observe and need to be treated as a medical emergency until proven otherwise. If your knee cap dislocates, you usually can straighten your knee out and it will relocate. A more serious knee dislocation involves the tibiofemoral joint, as dislocations to our main knee joint may compromise the nerves, arteries, and/or veins around the area. That is why it is of utmost importance to treat these injuries immediately.
Tears: Tears may be a bit more challenging to diagnose on the spot. You usually will hear some type of ‘popping’ sensation, that is followed by pain and swelling of the knee. It tends to occur during quick, sudden movements, such as changing directions quickly, landing from a jump, trying to brace yourself if you suddenly lose your balance, and so forth. What you will feel besides the pain and swelling is a feeling of an ‘unstable’ knee, and you may even be apprehensive to place weight through your leg fully on your own. An orthopedic specialist will be the best person to see in this situation. Until you can have an appointment, keeping the knee relatively immobilized with some ice, protection, and compression will help manage your symptoms and prevent any further injury.
It Is Not Often That You Need An X-Ray After A Knee Injury
Now, just because you had an injury to your knee, this does not mean that you need an X-Ray. Essentially, if you have just some type of trauma to your knee, and you have ANY of the above signs or symptoms from the Ottawa Knee Rules, an X-Ray of the knee is indicated to rule out any significant injuries. These rules are helpful because you do not ALWAYS need an X-Ray after an injury, but knowing when you do is helpful. It has been found within research that knee X-Rays are one of the most frequently ordered images in U.S. emergency departments. What is interesting is that out of 60% to 80% of patients who have knee pain have a knee X-Ray, about 90% of them will not have a fracture.
ACL And Meniscus Acute Injuries
Generally speaking, ACL and meniscus acute injuries are non-contact, and involve some type of twisting motion (more often meniscus) and/or an over-straightened (hyperextended) knee motion (more often ACL). Moreover, these injuries can frequently occur in tandem with one another, along with an MCL tear, which is known as a terrible triad injury. If you happened to be playing a sport, running, or doing a jumping activity and felt any sensation of a pop, followed by immediate swelling and significant pain, that is an indication you may have suffered an ACL or meniscus injury. In that instance, it is indicated to see a physical therapist or orthopedic specialist near you as quickly as possible to assist in the confirmation of a diagnosis as well as offer treatment plans.
Specifically for the meniscus, if you feel that your knee sometimes will lock in place, particularly in a bent position, and you have a difficult time straightening your knee from this position, this is an indication that you should seek medical treatment. This may indicate you have a specific type of meniscus tear, known as a bucket handle tear, which often needs treatment from an orthopedic surgeon. More often, individuals will experience ‘pseudo-locking’ of their knee, which is when the knee may have a sensation of locking temporarily, but individuals can move the knee back and forth and it will eventually unlock.
If you want to learn more about the ACL and the meniscus, check out these other awesome articles we have:
There are cases in which individuals can cope with ACL or meniscus tears. This will be dependent on the extent of the tear, the life demands of an individual, the individual’s goals, tissue healing, and level of function. Both the meniscus (which is made up of articular cartilage), as well as the ACL has poor blood supply. Oftentimes, the torn part of the meniscus can be cut (meniscectomy), and an individual can walk out of surgery the same day, often times feeling “back to normal” within 2 months of focused rehab! Also, younger individuals tend to have tears to the red zone of the meniscus, where blood supply is more available, therefore surgical repair may be more successful. On the contrary, more elderly individuals with chronic, degenerative tears usually sustain them towards the white zone, where blood supply is sparse to none, and therefore less amenable to a repair. If an aforementioned bucket handle tear has occurred, a repair may be indicated, which has a much longer prognosis than a meniscectomy.
In regards to the ACL, there is a copers criteria which consist of a series of movement-related tests that an individual needs to “pass” in order to be deemed a coper. Sometimes athletes will attempt to do this during the season so they can finish playing before having surgery in the offseason. Another point is that if you are not involved in a lot of jumping, cutting, and twisting types of activities that place the most stress on the ACL, then you don’t necessarily need the ACL to be reconstructed. Maybe you want to continue jogging, taking walks, or doing light exercise. In that case, as long as you have a strong, foundational knee joint, core, and good mechanics from your entire movement system, surgery is not needed!
The video shown here demonstrates great exercises to perform before surgery. You may ask yourself, why would I want to exercise before surgery? Wouldn’t it make more sense to just rest and avoid further aggravation of the injury? NO! The BEST course of action to take is to engage in appropriate exercises your body can tolerate after surgery, which has been supported by numerous research studies to promote optimal recovery and give you the best chance of returning to 100 percent.
Regaining Range of Motion After Surgery
Specifically for the knee, straightening of the knee joint (knee extension) is the most important motion to restore after surgery. We always educate our followers that bending (flexion) will come with time, but staying consistent with your exercise routine will give you the best chance of restoring your range of motion after surgery.
Single Leg Balance Progressions
This is where the fun begins! The knee joint feeds off of proprioception, which is understanding where the body is in space as you interact with different parts of your environment. Training proprioception is a crucial step in knee rehab. If you have ever wondered what contributes to your balance, and how you can improve it, check this article out.
Try These Other Knee Rehab Hacks At Home!
We always harp to our followers that exercise can be an activity that can be incorporated into your activities of daily living. We understand that our lives are busy, and making time for exercise each day can be a challenge. However, there are definitely ways you can still move and exercise intentionally if you are willing to make a conscious effort to do so.
Think about how many times you do the following activities each day:
Get up from a chair
Go up and down a flight of steps
Walk throughout your home, workspace, or community
For the knee specifically, you can take each of these actions that you perform many times a day, and make your movements intentional. For example, rather than ‘plopping’ down in your chair at work, sit down slowly with control, which will work your muscles against gravity (eccentrically). Each time you go up and down the stairs, try to avoid using the railing, and think about using your legs more for propulsion. These are ways you can ‘hack your rehab’ and expedite your healing process!
Chronic Knee Injuries
Not all knee injuries will happen due to an acute, specific incident. Oftentimes, pain can begin to develop gradually over time, which can be due to overuse, lack of an appropriate exercise program, and many other factors. Some of the more chronic conditions that are related to knee pain include:
Knee Cap Pain (Patellofemoral pain)
Knee Cap (Patellofemoral pain)
Patellofemoral Pain Syndrome (PFPS) is one of the most common knee injuries that affects many individuals. In order for the patella to move properly within the groove on the femur, it is important for the soft tissues that attach to this joint to have optimal flexibility. In addition, it is important for the muscles that are responsible for moving the knee cap to have adequate strength! You can think of an analogy of a group of people on a canoe. If one side of the canoe is paddling harder than the other side, the canoe is going to move more in a certain direction, and vice versa. The same analogy applies to the patellofemoral joint. If certain soft tissues are tighter, they may pull the patella more in a certain direction, or if certain muscles are not strong enough, the patella may not move the way it is supposed to! This concept of the patella moving incorrectly within the joint is known as patellar maltracking.
Sometimes, one can inherently be at risk for developing knee cap pain if they have a more shallow groove for the knee cap to sit in, have genetically more laxity in their body, or a larger Q angle (which is an angle from the pelvis, down the thigh, to the knee). In other situations, modifiable risk factors can lead to the development of knee pain as discussed above, including strength and/or mobility issues.
Pain due to the knee cap is often non-specific and localized around the front of the knee, usually worse with prolonged sitting (movie theater sign), as well as with activities that increase stress to the knee cap, such as squatting, stairs, and other weight-bearing activities.
If you are dealing with patellofemoral pain, here are some exercises to help combat it!
Regaining adequate quad strength by performing this active straight leg raise can help with patellar tracking, prior to performing more weight-bearing exercises that place more stress on the patella.
Lateral Step Down
This is a great way to work on eccentric control, to help improve the strength of not only the quadriceps but the hips, which also play an important role in knee health.
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One of the most common causes of knee pain as individuals age is knee osteoarthritis, which is a degenerative disease within the knee joint. Common symptoms individuals complain of is a gradual onset of knee pain that is worse with activity, especially weight-bearing activities, stiffness that is especially apparent after prolonged sitting or standing, and pain that worsens over time. How quickly one develops symptoms will differ from one person to another. What is also important to note is that not everyone who has evidence of knee osteoarthritis on X-Ray will be symptomatic! In fact, in a study by Magnusson et. al in 2019, the authors concluded that only 15% of the patients with radiographic findings of knee OA were symptomatic.
Bone on Bone Does Not Happen!
Have you ever been told that you have bone-on-bone arthritis? Watch this video below to learn the truth behind this term.
Exercises and Self-Management For Knee Osteoarthritis
The good news is that there are great ways you can manage your knee pain if you are dealing with knee osteoarthritis! The knee joint responds very well to exercise, as exercise will promote movement of synovial fluid within the knee joint, which helps nourish the joint. Initially, if your pain is significant with weight-bearing activity, it would be better to start with some non-weight-bearing exercises that can still accomplish similar goals of providing mobility and strength to the knee. Once the knee begins to feel better, you can begin to re-expose the knee to progressive weight-bearing exercises in an appropriate manner. Here are some exercises you can work on to bulletproof your knee.
Although this condition is termed ‘runner’s knee’, it is a condition that is not exclusive to runners. It is a common knee injury that is used to describe a plethora of conditions that lead to pain around the front of the knee, which can be due to running as well as walking, cycling, endurance sports, or jumping activities. Two of the common reasons runner’s knee can develop may be due to knee cap issues (previously discussed), as well as iliotibial band friction syndrome (ITBFS).
ITBFS is a common knee injury that is due to inflammation of the distal portion of the iliotibial band, which results in pain that occurs around the outside portion of the knee (2). The repetitive bending and straightening of the knee with daily activities such as walking or running can lead to potential irritation of certain portions of the IT band that eventually can lead to injury.
A combination of risk factors and training errors is usually the underlying the issue for runner’s knee. Just because someone runs with a flat foot or has weaker hip muscles does not mean that is the sole reason he or she has developed runner’s knee. Many times, if you can reorganize your training schedule to avoid overtraining, as well as incorporate a healthy dose of strength training into your routine, runner’s knee can be avoided entirely! Don’t believe us? Check out this infographic below on why runners, as well as endurance athletes, need to lift weights.
Importance of Resistance Training For Endurance Athletes
We hope that you were able to learn how to dictate your own outcomes if you are dealing with knee pain by reading this article. Our team here at [P]Rehab diligently invests our time and energy into showing our followers what they can do on their own in order to maintain health and wellness. If you are still having questions as to what may be contributing to your knee pain, or you want a more specific program to manage your knee pain, you can click HERE to get started.
Also, if you have any questions about how to manage your knee pain, please leave a comment on this post or email us at email@example.com, as we would love to help guide you in the right direction.
Take The Guesswork Out of Managing Your Own Knee Pain!
Knee discomfort is one of the reasons why people end up sitting out but that’s about to change through the tag team champs of the world: education and movement. The knee must be strong enough to create its own muscular forces and be the traffic director for force passing through. Therefore, to have a successful outcome your program must include not just the knee but the core, hip, and ankle. Teamwork makes the dream work, ready to be part of the team?
Stiel I, Wells G, Hoag R, Sivilotti M, Cacciotti T, Verbeek R, Greenway K, McDowell I, Cwinn A, Greenberg G, Nichol G, Michael J. Implementation of the Ottawa knee rule for the use of radiography in acute knee injuries. JAMA; 1997; 278: 2075 – 2079
Magnusson K, Turkiewicz A, Englund M. Nature vs nurture in knee osteoarthritis – the importance of age, sex and body mass index. Osteoarthritis and Cartilage. 2019;27(4):586-592. doi:10.1016/j.joca.2018.12.018
MESSIER, S., LEGAULT, C., SCHOENLANK, C., NEWMAN, J., MARTIN, D. and DEVITA, P., 2008. Risk Factors and Mechanisms of Knee Injury in Runners. Medicine & Science in Sports & Exercise, 40(11), pp.1873-1879Loudon, J., 2016.
Biomechanics And Pathomechanics of The Patellofemoral Joint. International Journal of Sports Physical Therapy, 11(6), pp.820-830.
Grindem, Hege PT, PhD1; Eitzen, Ingrid PT, PhD2; Engebretsen, Lars MD, PhD3; Snyder-Mackler, Lynn PT, ScD, SCS, ATC, FAPTA4; Risberg, May Arna PT, PhD1 Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury, The Journal of Bone and Joint Surgery: August 6, 2014 – Volume 96 – Issue 15 – p 1233-1241 doi: 10.2106/JBJS.M.01054
Topp et al. 2009, “The Effect of Prehabilitation Exercise on Strength and Functioning After Total Knee Arthroplasty”. American Academy of Physical Medicine and Rehabilitation, Vol. 1, 729-735, August 2009
Swank et al. 2011, “Prehabilitation Before Total Knee Arthroplasty Increases Strength and Function in Older Adults With Severe Osteoarthritis”. Journal of Strength and Conditioning Research, Vol. 25, No. 2, (December 2011)
About The Author
Sherif Elnaggar, PT, DPT, OCS, SCS
[P]rehab Head of Content
Sherif graduated from Temple University with a Bachelor’s of Science Degree and a concentration in Kinesiology. He then received his Doctorate of Physical Therapy Degree from DeSales University, graduating with honors of the professional excellence award and research excellence award. After his graduate studies, he served as Chief Resident of the St. Luke’s Orthopedic Physical Therapy Residency Program. Sherif is a Board Certified Orthopedic Clinical Specialist. Sherif focuses on understanding how movement impairments are affecting function while also promoting lifestyle changes in order to prevent recurrences of injury. His early treatment interests include running related injuries, adolescent sports rehab, and ACL rehab in lower extremity athletes. He also has been involved in performance training for youth soccer players. Outside of working as a physical therapist, he enjoys traveling, running and cycling, following Philadelphia sports teams, and spending time with his family.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.