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Health & Fitness

Knees creaking? You have a problem

knee pain
The most common reason for knee pain to recur is failure to treat the underlying cause of a problem. FILE PHOTO | NMG 

If it is not the stairs that are creaking but your knees, you could be in trouble.

One of the most common musculoskeletal issues is back pain, however in any medical camp or wellness drive we participate in we never miss a number of people suffering from knee pain. It has become a ubiquitous condition.

Accurate knee pain diagnosis is the first step in recovering from a knee problem so you can beat your pain and stop it from coming back again. It is important to work out what is causing your pain so you treat it effectively and make a quick recovery.

The most common reason for knee pain to recur is failure to treat the underlying cause of a problem. For example, let us say your knee is swollen. You can treat the swelling with ice, compression bandages, elevation and exercises and the swelling will most likely start to improve. But chances are, it will come back again unless you have identified what caused the swelling in the first place and also treated that.

So how do we make an accurate knee pain diagnosis? Well, there are a few ways to you can approach it: You can think about:

1) The location of the pain: where exactly your knee pain is e.g. front, side or back

2) How the pain started: the mechanism of injury e.g. sudden twisting or gradual onset

3) Your specific symptoms: what are the main symptoms associated with your pain e.g. popping noises, locking

We shall start by looking at using the location of the pain and how it started to help you work out what your problem might be and what you can do to treat it.

Pain Location

The pain can be in one of the following areas:

•Front knee pain

•Inner side knee pain

•Pain behind knee

•Outer knee pain

•Calf pain

•Knee cap pain

Front knee pain

Let us look at the causes and symptoms as well as treatments for pain at the front of the knee.

1. Runner’s knee

Classic symptoms: General ache around the front of the knee and patella/knee cap pain,grinding sensation with knee movement, mild swelling. Gets worse with repetitive activities e.g. running or jumping, stairs and prolonged inactivity

What Is It: Runners knee is the most common cause of front knee pain caused by a problem with how the kneecap moves up and down in the trochlear groove. It does not only affect runners, it is just as common in office workers too!

Onset: Builds up gradually over time. No specific injury

Also Known As: Patellofemoral Pain Syndrome/Anterior Knee Pain

Treatment: Exercises, brace, orthotics, occasionally surgery.

2 Chondromalacia Patella

Classic Symptoms: Achy pain in front of knee, swelling, clicking sounds and grindingsensation with knee movement. Worse when you first stand up, play sports, comedownstairs and apply pressure through the kneecap. Typically affects young, healthypeople.

What Is It: Damage to the cartilage on the back of the kneecap

Onset? Gradual onset.More common in women.

Treatment: Exercises, knee straps, orthotics, gel pads, occasionally surgery.

3. Housemaid’s knee

Classic Symptoms: Pain and swelling at the front of the knee - like a squashy orange. Symptoms aggravated by kneeling, walking and bending the knee

What Is It? Inflammation/swelling of the prepatellar bursa (fluid filled sac) at the front of the knee

Onset: Gradual onset in people who spend a lot of time kneeling e.g. carpet layers, plumbers, housewives, gardeners. Occasionally develops after a blow to the front of the knee

Treatment: PRICE (Protection, Rest, Ice, Compression, and Elevation), stretches, gel pads, injections, occasionally surgery

4. Osgoodschlatters

Classic Symptoms: Tender, bony lump just below the kneecap, causing front knee pain. Typically affectsadolescents. It gets worse with sports activities such as kicking, jumping and running.

What Is It? Irritation of the bone just below the kneecap. It is the most common cause of front knee pain in teenagers

Onset: Most common in boys aged 9-16. Often follows a growth spurt

Treatment: PRICE (Protection, Rest, Ice, Compression, and Elevation), knee straps, exercises, plaster cast, gel pads.

5. Patellartendonitis (Jumper’s knee)

Classic Symptoms: Front knee pain just below the patella, aching and stiffness after activity, thickening of the patella tendon. Worse with repetitive activities such as jumping and kicking

What Is It? Damage to the patellar tendon just below the kneecap

Onset: Gradual onset. Usually gets progressively worse

Treatment: Rest, ice, knee straps, exercises, surgery.

6.Cartilage/meniscustear

Classic Symptoms: Knee swelling, locking (where the knee gets stuck), instability, difficulty straightening the knee, catching pain with knee movements. It gets worse when weight-bearing e.g. walking, running, on stairs and when squatting.

What Is It? Tear in the cartilage lining the joint

Onset: Can occur suddenly with a force through or sudden twisting of the knee, or gradually through wear and tear

Treatment: PRICE (Protection, Rest, Ice, Compression, and Elevation), exercises, brace, tubigrip, sometimes requires surgery. Can take a long time to heal.

7.Knee sprain

Classic Symptoms: Instability - knee gives way, knee swelling, bruising at time of injury, generalised pain and stiffness i.e. reduced knee movement.

What Is It: Overstretching or tearing one of the ligaments in the knee. There are three grades of sprain depending on the severity of the injury

Aggravating Activities: Depends on the severity but likely to be any weight-bearing activity

Onset: Sudden twisting movements or a force through the knee

Treatment: PRICE (Protection, Rest, Ice, Compression, and Elevation.), exercises, braces.

8.Arthritis

Classic Symptoms: Morning stiffness in the knee,generalised swelling,clicking/grinding noises and sensations and knee stiffness with loss of end range movements. Symptoms tend to be worse after rest which gradually improves with gentle movement, in cold weather and after activities. Most common cause of front knee pain in people over 50 years.

What Is I? Changes in the bone caused by wear and tear, known as osteoarthritis or inflammation, known as rheumatoid arthritis

Onset: Symptoms gradually come on over time and may fluctuate

Treatment: Exercises, brace, walking aids, injections, surgery.

9.OSTEOCHONDRITIS DISSECANS

Classic Symptoms: Occasional sharp pain with general background ache, clunking sensation with leg movements, locking, weakness, decreased leg movement andswelling. It gets worse with sports, twisting of the knee and on stairs. Typically affects teenagers.

What is it? Decreased blood supply to the bone causes fragments of bone and cartilage to detach

Onset: Occurs at any age but most prevalent 10-20 year olds. Three times more common in men. Fairly rare cause of front knee pain

Treatment: Rest, exercises, brace, surgery.

10.PATELLA INJURIES

Classic Symptoms: Usually caused by a fairly major injury resulting in severe pain, knee swelling, restricted movement. Knee may appear deformed. All knee movements will be painful and restricted.

What is it? Damage to the kneecap such as a dislocation (where it shifts out of place) or a fracture

Onset: Sudden onset from a fall or awkward twisting. It takes a great deal of force to dislocate or break the patella

Treatment: Rest, knee brace, exercises, taping and in some cases surgery.

Front knee pain is extremely common, but is usually fairly simple to overcome. If you would like some help working out what is causing your problem and what you can do about it, visit our health centre.

Nellie Nthiga, BDM, C&P Health Centre

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