We’ve all been there: that dull ache after a hefty football session, the unexpected twinge as you walk up a flight of stairs… Everyone experiences knee pain from time to time, and it comes in all shapes and sizes. But while most little tweaks and twinges disappear without further ado, the pain can sometimes be more persistent.
So what might be going on in these cases? Clearly there are many, many different possibilities. But, that said, some are an awful lot more common than others.
Based on my day-to-day experience at the clinic, these are the top five most likely causes of persistent knee pain.
A tear to the meniscus or cartilage
I’ve put this first for good reason. It’s perhaps the number one condition that we see in clinic. If you have torn the meniscus or cartilage in your knee, the first thing you’ll experience is a sharp, catching kind of pain. It will be localised, along the joint line. And it will probably feel quite unpredictable; the pain will come and go during the day. That’s essentially due to the mechanics of the problem. The piece of torn tissue can pop in and out – and when it does, you feel a sudden shoot of discomfort.
We tend to think of arthritis in terms of older people. But that isn’t always the case. Younger people can develop the condition, too. A bad injury might have damaged the cartilage lining, for example, or a malalignment of the joints might have worn that cartilage away more quickly. Either way, arthritic pain tends to be quite distinctive. You will usually feel a constant ache – a dull, background pain – which will still be there at rest. It’s often worse at night, too, after the exertions of the day.
A patellofemoral disorder
This is really a whole spectrum of conditions, but in essence it’s all about the kneecap. You’ll be feeling pain right at the front of your knee, and that pain will usually be worse on stairs. Stairs put great pressure on joints: about six times our bodyweight goes through the kneecap when we step up and down. Ordinarily, the load is spread evenly across the ‘V-shape’ at the back of our kneecaps. But if something causes that ‘V’ to misalign, the impact is channelled through a much smaller area. And in time that pressure wears away the cartilage.
A cruciate ligament rupture
The cruciate ligaments are the two tough tissue bands (the ACL and PCL) connecting the upper and lower parts of the knee. When some kind of trauma – perhaps a bad tackle, or a sudden deceleration on a squash court – causes them to rupture, the results are often quite dramatic. You may hear a ‘pop’ as the rupture happens. Then the whole knee swells up. The pain actually tends to settle over the coming days; the bigger issue is instability – and that will certainly need medical attention.
The patella is your kneecap. The patellar tendon is the powerful cord that connects it to your tibia (lower leg bone). Patellar tendinopathy? That’s when the tendon gets stressed through overuse. Again, it’s often associated with sporty people who are doing a lot of running, jumping and squatting. The pain is an attritional kind of pain; it will be fairly constant, and will get worse soon after starting any knee activity. It may seem to improve after a day or two, only to return once you resume activity. Again, it will definitely need to be checked out.
Whatever is going on with your knee – and these are just some of the most common issues – recurrent pain is a warning sign that shouldn’t be ignored. If you’re experiencing these or any other kinds of pains, do get in touch with me direct. I’d be very happy to help you find out what’s going on, and to find a solution for it.
PS – If you’re being troubled by pain in the shoulders rather than the knee, don’t feel left out! I’ll be focusing on the top 5 likely causes of shoulder-related pains in my next blog. Look out for that over the next couple of weeks.