Knee pain is a common condition practitioners encounter. The functional capability of the knee, not to mention its fluidity, and agility is truly amazing. Unfortunately, intrinsic in its design, it has the potential to increase the risk of knee injuries.
Dr. Kevin Wait, PT, DPT, SCS, CSCS - Clinic Director of Capitol Physical Therapy in Sun Prairie, Wisconsin deals with complaints of knee pain frequently. As a Board Certified Sports Clinical Specialist and Certified Strength & Conditioning Specialist, Dr. Wait has an impressive working knowledge of knee injury and diagnosis. In his article below, Dr. Wait goes over a list of possible knee pain signs and symptoms.
MY KNEE HURTS…IS SOMETHING WRONG WITH IT?
Knee pain is one of the most common complaints we see here at Capitol Physical Therapy. These injuries can come suddenly or with overuse, and people of all ages can experience knee pain. People consistently report certain things aggravate them, and that is often enough for us to know what’s going on. We will then examine their trunk and lower extremity to confirm our suspicion. This post will describe what many patients tell us and what the problem might be for the most common knee injuries. Knowing some things about your condition and what to actively do about it is a much better response than ‘I’m sure it will go away eventually.’
Knee Pain Symptoms
What you tell us: The pain is located around the kneecap.
The pain is located around the kneecap. Pain is worse with sitting too long (like sitting in church or watching a movie), you have pain with stairs, during squatting, and with loading the knee during prolonged activity. Your pain is mostly achy and doesn’t bother you all the time. You might be a young athlete who does lots of running or jumping, typically affects young females the most. You get relief from sitting down or resting.
WHAT IS IT:
More than likely, you’re just having general front of the knee pain, possibly from some overuse of the kneecap and overload during an activity. Maybe you ran longer than normal or started using the stair climber for exercise. Something usually causes this from a training volume or activity perspective. The pain can be treated easily with exercises, heat/ice, stretching, and activity modification. Your Physical Therapist can help you with this so it actually gets better…and faster.
What you tell us: You feel noises or ”Rice Krispies” in your knee when you bend/straighten your knee.
You feel noises or ”Rice Krispies” in your knee when you bend/straighten your knee. You seem to feel the noises when you squat or use stairs as well. You may have some of the symptoms in #1.
WHAT IS IT:
You likely have some irritation or arthritic changes under your kneecap. You may hear it called “chondromalacia” or softening of the bone. Think of smooth, healthy cartilage as a slick surface, like a freshly cleaned ice rink. When cartilage gets irritated it loses its normal hard surface and becomes slightly softer and less smooth. The noises you hear are from the used cartilage that isn’t quite as smooth anymore. The noises can sometimes be relieved with an arthroscopic surgery, but the best outcomes according to the research comes from weight loss, exercises, heat/ice, stretching, and activity modification to help relieve this. Again…call us for details.
What you tell us: You may or may not have had an incident where you were squatting or twisted on one knee.
You may or may not have had an incident where you were squatting or twisted on one knee, like getting out of the car, or planting and twisting in a basketball game. You may or may not have felt a sharp pain. Stairs are difficult. Your knee may buckle or give way randomly. You may not be able to straighten your knee completely or bend it. There is usually some swelling built up around the knee. Walking is likely painful for you.
WHAT IS IT:
You may have tweaked a meniscus. Depending on your age and activity level, an orthopedic surgeon may need to look at your knee and investigate an MRI for evaluation. Usually younger, more active patients fit into this group. FIRST, get to PT! You need to be walking without pain and have improved mobility in the knee which we can help with. Depending on the severity of the injury, you will normally be referred to PT first anyway. Some people need a repair or get the knee cleaned up by a knee scope procedure. Sometimes these knee injuries will not heal on their own because the blood supply is bad. Let us check you out first and give you some information to make the best and least expensive decision possible.
What you tell us: You planted or landed from a jump or possibly got hit from the outside of the knee.
You planted or landed from a jump or possibly got hit from the outside of the knee. You felt a pop and collapsed to the ground. You immediately clutched your knee. Your knee had immediate swelling. Your knee feels a little ‘weird’ walking. Almost like it’s going to give out at any moment. This is more than likely something that happens when you are active or playing a sport.
WHAT IS IT:
Possibly an injured ACL. It could be completely injured or just partially. Don’t freak out though…the human body is amazing. Some patients are able to get along without their ACL and some need to have it repaired. Whether or not you can do this without surgery is often based on your activity level and age and some other factors. Most people need these fixed if they desire any level of continued physical activity, particularly in people that play sports that involve cutting and jumping.
What you tell us: Activity sometimes makes your knee feel better.
You are likely an athlete of some sort at any age. Activity sometimes makes your knee feel better, but you usually hurt at first when you start and then after. If this progresses, it may hurt during daily activities. If you are a young athlete who’s had a growth spurt recently and plays sports that involve lots of running and jumping, this could be you. You’re tender over the soft tendon below the kneecap.
WHAT IS IT:
Probably patellar tendinitis, or if it’s been going on for a few months, tendinosis. Patellar tendinitis is also known as “Jumper’s Knee.” Both should be treated differently. Come see one of our physical therapists and we’ll show you the best exercises for this. Muscle mobilizations, dry needling, counterforce straps, stretching, and strengthening really help this, along with activity modification.
What you tell us: The knee popped, but you were able to walk.
You are likely a younger athlete and cut weird or collapsed after a jump. The knee popped, but you were able to walk. Your knee likely swelled the next day. Walking may be pain free and then all of a sudden feel a sharp pain that literally drops you to the floor. Dynamic activities like running and jumping or squatting usually hurt.
WHAT IS IT:
You may have irritated the articular cartilage. This can create a small divot at the end of your bone. You may need a knee scope for this to heal and should probably see an orthopedic surgeon. We can help you find a surgeon who will listen to your problem and has outstanding communication skills to work with us on the rehabilitation side for an improved outcome following the procedure.
What you tell us: You fell directly on the front of your knee.
You fell directly on the front of your knee. Maybe you were in a car accident and your knee hit the dashboard. Maybe you’re an athlete and somebody “slid” into the front of your tibia (“shin bone”). It hurts to bend the knee and it hurts behind the knee.
WHAT IS IT:
You may have a posterior cruciate ligament (PCL) tear. This is a less common injury and rarely needs surgery. However, you should have structured physical therapy.
What you tell us: You ache in the morning and first few steps are painful but feel better after moving around.
You ache in the morning and first few steps are painful but feel better after moving around or during the middle of the day. Activities on your feet for more than a few minutes can cause some pain that gets worse the longer you spend. Pain typically aches over the entire knee and feels better after resting. You are probably in your 40’s or had a previous knee injury. Heat typically feels good.
WHAT IS IT:
You likely have arthritis which in many ways is completely normal. All of us get arthritis on some level. There are actually many things you can do for arthritis. Stretching, exercise, joint mobilizations, weight loss and activity modification are all things a physical therapist can help you with. In some cases, steroid injections or lubricating injections can help or allow you to get back to certain exercises and activities.
Again, this is just a small list of possible signs and symptoms we will use to guide our treatment. Hopefully it’s helpful for you. If some of these sound like you, please let us know so we can give you some guidance. Perhaps a knee brace will work well for you to help alleviate the symptoms. We can help you find the right answers without wasting a lot of time and money. Remember that often with your insurance you often don’t have to see a physician prior to seeing us for therapy and to get an evaluation done. We have multiple locations around the Madison community to serve you.
Kevin Wait, PT, DPT, SCS, CSCS
Clinic Director of Capitol Physical Therapy in Sun Prairie, Wisconsin
Dr. Wait is a board certified Sports Rehab Specialist. He is also an instructor for national Trigger-point Dry Needling and Instrument Assisted Soft Tissue Mobilization courses.
He is a graduate of the Mayo Clinic College of Medicine Doctoral Program in Physical Therapy. He completed his residency training at Gundersen Health Sports Medicine in La Crosse, WI and was previously the Clinical Education Coordinator at Keesler Air Force Base in Biloxi, MS.
To read more from Dr. Wait about sports injuries and physical therapy, please visit the Capitol Physical Therapy website here.