KNEE PAIN

Knee pain and knee injuries are common and affects people of all ages.

Knee joint problems are common. The joint is vulnerable to injury and pain because it takes the bodies full weight and extra force with running and jumping. Problems with the knee can affect all aspects of life from walking to driving a car and even working productively.

Many people experience some type of knee pain. These causes are usually minor like a strain or sprain. In these instances the knee pain is mild and is relieved within a few days. Sometimes, knee pain is caused by more serious injuries like from a fall, or from injuries through sports like football, netball and skiing. These might require a doctor or specialist medical care.

Knee pain can also be related to problems elsewhere in the body like the spine. Sometimes more than one cause for the pain may occur at the same time, which can then make assessing and managing knee pain more complex.


KNEE PAIN SYMPTOMS

Knee pain can occur suddenly or it can occur slowly. The pain might appear immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include a sharp or dull pain, sometimes radiating down or up the leg, stiffness, the knee swelling, and weakness and or inability to bend or straighten the leg fully. There may be popping or crunching noises, and there may be tingling, numbness, pins and needles. Sometimes people can be unwell if there is a more serious cause like an infection or fracture.


KNEE PAIN CAUSES

When knee experts make an assessment a few things need to be considered, because pain in the knee could be caused by a number of problems in or around the knee and sometimes even from more distant sites like the hip or spine.

There are many possible causes of knee pain:

  • The knee joint can become inflamed and swollen (arthritis), which can cause stiffness and pain. Sometimes the pain can be debilitating and long-lasting. Arthritis in the knee is usually from ‘wear and tear’, (osteoarthritis) but other types of arthritis can affect the knee joint, like rheumatoid arthritis and gout (uric acid crystal buildup), and pseudo-gout (calcium crystal buildup). More serious problems causing knee joint pain may include fractures and infection (septic arthritis).
  • Myofascial pain occurs because of problems with the surrounding muscles, ligaments and tendons of the knee. The muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause excruciating pain in and around the area.
  • Anterior cruciate ligament (ACL) injury: the ACL can tear with some sports like football, basketball and skiing.
  • Meniscus: the meniscus is the tough, soft cartilage that acts as the shock absorber of the knee. It is similar to the discs within the spine. The meniscus can tear in some circumstances like in a sudden knee twist.
  • Patellar tendonitis: pain in the patella tendon can occur when the tendon of the kneecap becomes swollen and inflamed. Sometimes the patella can dislocate.
  • Knee Bursitis: knee inflammation can occur in the small sacs of fluid that cushion the knee.
  • Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. Problems in the hips or feet can be felt as pain in the hip.  
  • Nerve pain: sometimes neurological problems can cause knee pain. Neurological causes might include shingles (zoster), post herpetic neuralgia, or meralgia paraesthetica.
  • Spinal problems like facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called lumbar foraminal stenosis and can cause radiating pain anywhere down into the leg, including the knee.
  • Sensitisation:
    • Sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain, seems to be spreading up into the body and or down into the leg, or even into the other side of the body. People with sensitisation can even have sensitive skin and even light touch using a brush can be intensely painful.
  • Post-surgical pain:
    • After an operation or knee surgery, pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, including knee replacement or arthroscopy. The pain can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, or muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons.
  • Serious causes of knee pain may include severe infections of the joint (septic arthritis).

Chronic knee pain treatment is recommended when the pain has been present for longer than 3 months and most treatments that have been tried have not helped. Treatment depends on what is causing the pain and should be delivered by pain specialists physicians and their team of experts.

Contact us to find out what's causing your pain.


WHO GETS KNEE PAIN?

Anyone can get knee pain and it can occur at any age, although some people are more likely to develop knee pain. There are a few risk factors that might make the development of knee pain more likely:

  • Older age
  • Lack of exercise and low fitness level
  • Being overweight
  • Certain jobs or activities that require bending, heavy lifting, repetitive twisting of the knee or certain sports like football, netball, skiing.

HOW DO I GET A KNEE PAIN DIAGNOSIS?

Knee pain is complex and should be assessed by a medical professional or pain specialist who will take the time to understand the pain story and perform a physical examination before setting forward a treatment plan.

In some circumstances imaging tests may be required. This could be an X-ray, CT scan, MRI scan, bone scan or ultrasound.

Once a knee pain diagnosis is made, the medical professional or pain specialist will determine the best treatment.  

Book an appointment to have a Pain Specialist make a knee pain diagnosis


WHAT KNEE PAIN TREATMENT IS AVAILABLE? 

Treatment of the knee depends on whether the pain is acute (meaning it only occurred recently, i.e., days or weeks ago), or chronic (meaning it has been present for more than 2-3 months).

ACUTE KNEE PAIN TREATMENT

  • Simple treatments like hot or cold packs, physical activity, exercise and physical therapy.
  • Pain medications like anti-inflammatories and anti-spasm medications to provide pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.

CHRONIC KNEE PAIN TREATMENT

Through years of experience, we’ve figured out that good and long-lasting chronic knee pain relief doesn’t work unless all bases are covered.

The best knee pain management combines pain-reducing treatments with selected therapies like physical and psychological rehabilitation treatment.

TYPES OF TREATMENT

  • Medications to reduce knee pain. These may be simple over the counter medications or can be medications prescribed by your pain specialist. Medications might include muscle relaxants or anti-neuropathic (nerve pain) medications. Sometimes analgesic compound creams are used to ease pain.
  • Pain interventions like injections for knee pain can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain. Interventional therapies include nerve blocks (genicular nerves, infrapatellar nerve, lumbar nerve roots) radiofrequency ablation (RFA), pulsed radiofrequency (PRF), epidural and nerve root steroid injections.
  • Some of these therapies can be focused on various structures that might be causing or making the pain worse like the knee joint, the infrapatellar bursae, the spinal nerve roots, the genicular nerves and other nerves around the knee. Sympathetic blocks can also be performed. Platelet-rich plasma (PRP Injections) can also be used in some locations around this area.
  • Nerve stimulation or neuromodulation techniques: advanced pain reduction strategies may include spinal cord stimulation for severe knee pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, burst DR stimulation and DRG stimulation.
  •  Surgery is generally recommended when tests show structural changes, which need corrective surgery. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. These are typically performed by an orthopaedic surgeon. Types of surgery might include reconstruction surgery and/or stabilisation surgery or joint replacement.
  • Rehabilitation: most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

HOW DO I GET KNEE PAIN RELIEF? 

Knee pain is best initially assessed by a general practitioner (GP). They will make an assessment and make sure there are no warning signs for something serious. If they suspect something more serious is causing knee pain, they may do some scans or blood tests and send you to see a pain specialist, neurosurgeon or spinal surgeon.

If the knee pain is mild or improving, GPs may:

  • Reassure that there is no serious cause for concern and advise that the knee pain should improve with physical activity and simple pain medications.

If the knee pain persists or returns GPs may:

  • Use stronger pain medications
  • Suggest management by an expert pain physiotherapist (LINK TO OUR PHYSIOS)
  • Refer to a pain specialist physician to provide more comprehensive knee pain management using options like joint and nerve blocks, sympathetic blocks and radiofrequency ablation (RFA), pulsed radiofrequency or nerve  stimulation and neuromodulation using spinal cord stimulation.
  • Refer to an orthopaedic surgeon for an opinion.

Contact us to book an appointment with a Pain Specialist.


WARNING SIGNS OF MORE SERIOUS KNEE PROBLEMS

In some instances, knee pain can indicate more serious problems. These problems might include, fractures, dislocations, infection, or severe nerve compression (pinched nerve).

  • Fractures of the knee can be caused by a direct hit, fall or accident but sometimes can occur with minimal or no trauma. Spontaneous fractures usually occur in elderly people with osteoporosis or those who may be taking steroid medications that weaken the bone.
  • A dislocated kneecap can occur when the triangular bone (patella) that covers the knee slips out of place, usually to the outside of the knee.
  • Infections of the knee (septic arthritis) tend to occur if patients have a weakened immune system from any cause or medical condition. Sometimes infections of the knee can occur if there is an infection elsewhere in the body. People with knee infections usually feel unwell and can have sweats and a fever.
  • Nerve compression: one type of compression condition is lumbar foraminal stenosis and can cause radiating pain anywhere down into the leg, which includes the knee. Another type of nerve compression is myelopathy, where there is a dangerous compression of the spinal cord in the neck. Myelopathy could cause symptoms that might include weakness or problems with coordination in the arms, hands, legs, or even feet.

Seek urgent and specialist medical advise if you:

  • Are experiencing sudden, unrelenting, disabling and severe knee pain
  • Were recently injured or fell.
  • Are unable to walk on the knee
  • Feel as if the knee is unstable or "gives out"
  • Are unable to fully bend or straighten the knee
  • See an obvious deformity in the knee