Understanding knee pain and knee injuries

Knee pain and knee injuries are a common complaint, usually caused by the aging process and continual wear and stress on the knee joint from everyday activities like walking, bending, lifting and standing.

Unfortunately, athletes are much more likely to experience knee injuries and knee pain, especially if their sport involves a lot of jumping, turning or risk of collision. Mr Neil Jain, Consultant Orthopaedic Surgeon at The Wilmslow Hospital, part of HCA Healthcare UK, answers some questions about common knee complaints, how they are caused, ways to protect your knees and how to treat injuries.

What would you say are the most common knee injuries, and what causes them?

The knee joint is one of the most important joints in the body, it plays a pivotal role in supporting the body’s weight and facilitating movement.

Being active is one of the best things you can do for your joints and the rest of your body but the knee joint is large and complex, it is susceptible to multiple injuries, either as a result of overuse or an acute injury from sudden impact or collision.

Acute injuries include sprains and strains, and sometimes even torn ligaments or fractures. Overuse injuries may include early arthritis, patellofemoral pain syndrome and tendonitis.

Can you tell us more about these injuries?

A sprained knee ligament or muscle is most commonly caused by either by a blow to the knee or a sudden explosive manoeuvre. Symptoms often include pain, swelling, and difficulty in walking.

Torn ligaments and cartilage injuries are usually caused by a significant twist or a sudden impact or collision. We see a lot of torn ligaments in football. The most common ligament injury is a tear to the anterior cruciate ligament (ACL) or medial collateral ligament (MCL). While injuries to the ACL often require surgery, an injury to the MCL can usually be treated non-operatively with an initial period of rest in a brace, strengthening and rehabilitation.

Knee fractures are usually caused either by a powerful impact or if you fall heavily onto your knee joint. Typical signs that you may have fractured your knee include pain, bruising, or swelling that happens soon after an injury. It may be painful to move the knee, either by bending it or simply by putting weight on the affected leg. You may find it difficult to straighten the leg fully or to walk without pain. 

Early osteoarthritis is seen commonly. The wear and tear process of the knee joint is a normal occurrence with ageing and is more rapid the more activity that we do. It is therefore a good idea to consider joint preservation techniques as early as possible. This is worth a discussion with a specialist. 

Patellofemoral pain syndrome is also sometimes called ‘runner’s knee’ and is a common cause of knee pain. If you have consistent pain in the front of your knee, you may be suffering from ‘runners knee’, which is often caused by overuse.

Tendinopathy is a process that we used to term as tendonitis which would be inflammation of the tendons. We now know that it is not an inflammation but a pathological process which may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendinopathy of the patellar tendon is called ‘jumper's knee’ which is common with sports like basketball, where the repetitive force of hitting the ground following a jump strains the tendon.

Are there certain sports that tend to cause more knee injuries?

Knee injuries are common in many sports but are particularly prevalent in sports where there’s a lot of twisting, high impact or collision like football or basketball. Also sports that involve landing from a high area like gymnastics may also be more likely to injure the knee. And then there is running which puts consistent stress on the knee and can cause injury. 

How are knee injuries diagnosed and treated?

Fortunately, most mild to moderate knee injuries will get better on their own with rest and time away from intense activity. If your pain persists beyond a few days, if your knee becomes warm, swollen or you have a sensation of locking or instability, you will need to see an orthopaedic specialist for evaluation and diagnosis.

Diagnosing a knee injury will usually include a physical examination and an X-ray and MRI. In some cases a CT scan, arthroscopy or radionuclide bone scan may also be required to aid the diagnosis.

Your treatment plan will then depend on your specific injury. Non-operative treatment options may include physical therapy and/or rehabilitation, stretching exercises and a functional knee brace. And if you have a torn ligament or certain knee injuries, you may need surgery.

Knee pain and knee injuries. How are they treated and diagnosed. Patient with radiographer CT scanner 1443435492.jpg

If you have injured your knee, when is it safe to return to activity?

This depends on the type of injury and treatment that you have had. Usually a good principle is to take things slowly and make sure your knee doctor or physiotherapist signs off any return to activity. Don’t try to return to your previous level of physical activity until your injured knee is fully recovered.

In some cases, it may be possible to do some sport in the healing phase and an alternative sport may be possible so that you can stay active until you return to your primary sport. It may be an idea to avoid high impact sports initially and look for an alternative that won’t aggravate your knee. If you’re a runner you could try swimming or cycling whilst your knee heals. Ease your way back into sport and do not overdo it. Please check with your doctor before going back to sport.

What’s the best way to avoid knee injuries?

If you play sport, particularly intense sport, you can’t guarantee that you won’t get injured. But there are steps you can take to reduce the risk:

  • Injury prevention strategies now exist and these can be incorporated into warm up and warm down exercises
  • Get the right footwear, making sure they offer enough support. For runners there are lots of trainers with shock absorption 
  • Focus on thigh (quads and hamstrings) and gluteal strength as that will help ease the burden on your knees 
  • If you want to make your workouts more intense, do it gradually 
  • Being overweight can add stress to your joints, so make sure you are in the healthy weight range for your height 
  • If you are a runner, consider the environment. Run on a synthetic track or soft surface like grass
  • If you feel pain, stop immediately to minimise the damage. Pain is the body’s way of telling you something isn’t right 

Whether your knee injury and knee pain is a result of everyday use or sport related, it can be a nuisance and even debilitating in some circumstances, so please do see a doctor.

To see myself or one of the team about a knee or other injury please call The Wilmslow Hospital on 01625 545 000.

Book an appointment with Mr Neil Jain