Knee pain can strike in many different ways. Sometimes the discomfort feels sharp and sudden – a needle-like pain. Sometimes it’s the complete opposite – a dull but persistent aching feeling, like toothache.
The way your knee pain starts is, of course, an important clue to what might be happening inside the joint. So what if the pain is more like a burning sensation? People sometimes describe burning knee pain as a fiery, acute feeling of heat – as if the joint were “on fire” – or alternatively as a more subtle but persistent warmth or tingling. What might be causing these types of pains?
Where is the burning pain?
If you came to see us at the clinic with burning knee pain, there are a few things we would want to determine first:
History – When did your pain begin, how long has it been happening, and do you have any other conditions we should know about?
Location – Whereabouts is the pain: the front, back, inside or outside of the knee, or all over?
Symptoms – Has anything else accompanied the pain – for instance swelling, warmth, stiffness, clicking, locking, instability?
Pattern – Is your pain constant or does it come and go? Do you find it’s worse at night or after specific activities?
Nature of the pain – How would you describe the burning feeling itself – and does that pain feel like it’s on the skin or deeper down?
That last point can often help us narrow down the likely cause of your burning knee pain. Here’s why…
Burning pain on the skin surface
Burning pain that feels like it’s coming from the surface of the knee, or that doesn’t have any other obvious signs of joint damage, often indicates a nerve problem. We call this neuropathic pain. Typically, you’ll feel the discomfort in a defined part of your skin; you might even be able to map the area with your finger. It’s likely very sensitive to touch (known as “allodynia”), meaning the burning sensation can be triggered by even gentle everyday actions, such as clothes rubbing against your leg or the bedsheets brushing against you at night.
What might have caused it? Neuropathic pain is a very complex area, but some potential causes include:
Injury – you damaged or irritated one of your nerves in a fall or sporting accident
Surgery – a recent operation has cut or damaged the nerves near your knee
Entrapment – one of your nerves has been squeezed or compressed (for example a trapped nerve in the spine, causing sciatica)
Another condition – certain medical issues, such as diabetes, can trigger neuropathic pain
Sometimes neuropathic pain is idiopathic, meaning we can’t identify a clear reason why it’s happening.
Burning pain that’s deeper down
If the burning sensation goes below the skin surface – and especially if you’re getting other symptoms with it – the problem is more likely to involve joint damage. What kind of damage? Again, there are lots of potential causes here. But some of the main culprits include:
Gout is an inflammatory condition that’s caused by urate crystals accumulating on the surfaces of joint tissues. When these tiny crystals spread into the protective synovium between bones, they can rub against surrounding tissues, causing inflammation, skin that feels hot, red or swollen, and joint pain. Gout pain is often particularly pronounced at night.
There are many different types of arthritis. The most common one is osteoarthritis. That’s when the joint cartilage wears away, leaving the bone endings exposed. Osteoarthritis pain is usually focused on a specific part of the knee and often feels worse in the mornings (before easing off with activity). The second most common type is rheumatoid arthritis, which can flare up in different locations, but often makes the skin hot and red.
Bursitis is what happens when one of the fluid-filled sacs in your knee becomes irritated and swollen, usually because of an injury or through repetitive damage (such as kneeling on a hard surface for an extended period). When the bursa swells, it can feel warm and sensitive to the touch.
The knee is a complex network of bone and soft tissues. Tissue tears commonly involve the meniscus (a large cartilage pad in the middle of your knee) or the supportive ligaments that cross the joint (including the ACL, PCL, MCL and LCL). Tearing one of these tissues can also result in nerve damage, causing a burning sensation in the joint.
Note: Because warmth and redness can also be triggered by an infection in the knee, it’s important to rule this out if you do experience these symptoms. For more information, see this article: Understanding knee infections.
How do we treat burning knee pain?
Once we’ve discussed your knee pain in detail and done a physical examination, we’ll have a clearer idea of what to do next. The answer really depends on which of those two pathways is the most likely cause.
Nerve-related pain
Neuropathic treatment is a wide (and growing) area of medicine, so there’s a broad range of potential treatments and solutions here. If we suspect your problem is related to nerve damage rather than a condition or injury in the joint, we’ll likely refer you to a pain specialist, or a neurologist, for further investigation. Broadly speaking, the treatments fall into three key areas:
Medicines – like gabapentin, pregabalin and certain antidepressants to stabilise the nerve signals, or topical treatments like capsaicin cream
Therapies – like physiotherapy, to help manage stiffness and reduce pressure on the nerves, a TENS machine to target the nerve pain with electrical currents, or anaesthetic injections to provide short-term relief
Management – addressing the lifestyle factors that might be involved in the pain, such as diet, smoking and alcohol, or modifying the activities that might have provoked it.
Deeper joint problem
If the burning pain is linked to a problem deeper into the joint, we may send you for some scans to narrow down the cause and get a full diagnosis. From that point on, we’ll be able to steer you down the right pathway to solving the issue. Many knee problems, even persistent or very painful ones, can be managed very effectively without surgery – with things like physical therapy to strengthen supportive muscles, pain-relief management to target the burning sensation itself, and a careful programme of rest and rehabilitation over the coming weeks.
And if you’re wondering whether your pain is related to one of the conditions we mentioned above, you may also find these articles helpful:
- How do you know if you have gout in your knee?
- What does knee osteoarthritis feel like?
- What on earth is knee bursitis? (and how to get rid of it)
- What is an ACL tear? What is a meniscus tear?
Need more support and advice? We’re here to help. Just call or email the team to set up an appointment with Mr Bailey – or use our booking form to submit a quick message.
