Knee pain

The main cause of knee pain in adults over 45 is Osteoarthritis, while in those under 45 it is injury. In both cases it is most commonly mild and self-limiting. In these case self-management will often be all that is necessary. Below are listed some self –management strategies.

If it is a more severe pain or injury with swelling, inability to weight bear or loss of function an opinion should be sought from your doctor, physiotherapist or health practitioner.

What can I do myself to get better – now and in the future

There are some simple strategies you can use to manage your symptoms

  • Exercise – Regular aerobic exercise such as walking or jogging, and muscle-strengthening can help. Click here for exercises which are particularly useful for knee pain. For more information on staying active, click here.
  • Painkillers – taking regular doses of painkillers like ibuprofen, paracetamol, or a combination, are often helpful. Alternatively, you may prefer to use ‘rub on’ (topical) versions instead. Speak to your pharmacist for further information
  • Ice – This can be very useful to reduce pain and swelling. Take care not to sustain an ice burn by wrapping the ice in a damp cloth and only using for short periods
  • Weight management – If you are overweight, aiming to get yourself down to a healthy weight can help your condition.
  • Appliances – You can reduce the stress on the affected joint by using a walking stick, wearing supportive footwear or a supportive strapping
When should I see my doctor?

You should see your GP if you have:

  • A significant injury causing difficulty with weight bearing on the knee.
  • If there is joint swelling, redness or heat or the pain coincides with a fever or rash.
  • If the pain is in both knees or affecting other joints as well.
  • If your condition flares up or you have any pain or new symptoms that you do not recognise as being “normal” for your condition
  • If your pain does not improve with self-management advice above.
Common causes of knee pain

For additional information on the conditions below click on the link

  • Knee Osteoarthritis (Knee OA) This is an extremely common cause of knee pain and is caused by erosion or damage to the cartilage shock absorber of the knee with consequent pain. Pain is usually on weight bearing and gets gradual worse. It affects approximately eight million people in the UK. The knee is the joint most commonly affected by osteoarthritis.
  • Cartilage (meniscus) injury
    • Commonest in younger people ( <40). They are usually caused by sudden twisting movements on a weight bearing of the knee, resulting in pain, swelling and sometimes locking of the knee.
    • The cartilage shock absorbers, can become worn with general wear-and-tear and commonly cause pain in older individuals. Surgery is now only considered if there is a clear history of ‘locking’ of the knee. Evidence shows that surgery is NOT effective for uncomplicated knee pain in these cases.
    • In younger people they are usually caused by sudden twisting movements on a weight bearing of the knee, resulting in pain, swelling and sometimes locking of the knee.
  • Anterior knee pain ( Patellofemoral pain)
    • If pain occurs at the front of the knee( behind the knee cap) and is generally worse on sitting for long periods of time, or on climbing stairs this is the likely diagnosis.
    • Usually settles with rest, anti-inflammatories and ice packs. Exercises which strengthen the large muscles in the thigh are often helpful (e.g. lunges and squats)
  • Collateral Ligament Injury 
    • The Collateral Ligaments (medial – inside of the knee and lateral- outside) connect the bones across the knee joint. These are usually injured during sudden twisting or changes of direction, often in contact sports such as football or rugby.
    • Urgent medical advice is needed if there is a significant injury with difficulty weight bearing and/or swelling.
    • In mild or moderate cases self-management may be effective –see above.
  • Cruciate Ligament injury ( anterior and posterior)
    • The cruciate ligaments, anterior and posterior, prevent forward and backward movement of the femur on the tibia respectively. Similar to collateral ligaments, they are injured during sudden trauma, usually in high velocity injuries such as rugby, skiing etc. It is a significant injury that requires clinical assessment. A joint swelling within 6 hours suggests bleeding in the joint and an urgent assessment via A&E is appropriate. Swelling arising over a longer period can be assessed more routinely. Difficulty with weight bearing also demands more urgent assessment.
  • Patellar Tendinopathy
    • This is generally a result of overuse, particularly from jumping-type or lunging activities, such as basketball or netball. It cause pain, at the front of the knee, in the patellar tendon which runs from the knee cap ( patellar) to the upper tibia.
Other causes of knee pain
  • Simple strain
    • Usually comes about after a minor injury, over activity or unusual activity, involving the knee. This should settle with self-management.
    • Can usually be prevented by warming up carefully before exercise, stretching to cool down afterwards, increasing activity levels slowly over time and ensuring you have supportive footwear.
    • Self-management options are often effective. Resuming activity with lower impact activities such as swimming and cycling will help strengthen muscles while avoiding recurrence.
  • Patellar dislocation or instability – Patella dislocation is usually obvious as the knee cap will become stuck to the side of knee. Pain will be severe and require an assessment at accident and emergency. Instability is however more common. In this situation the patellar feels as though it might dislocate but doesn’t and resumes its normal position. This is commoner in individuals who are female and hyperflexible. This condition is best managed by exercise advice from a physiotherapist.
  • Bursitis, or “housemaid’s knee”
    • This is caused by repetitive friction of the knee, from activities such as kneeling, resulting in a build-up of fluid over the knee, leading to pain and swelling at the front of the knee.
    • Usually responds well to self-management advice. Pain usually improves before the swelling, which can take longer to completely disappear.
    • If it becomes red or hot ,more painful or you feel unwell, clinician advice should be sought in case of potential infection