Knee pain comes in many forms, and often there’s an obvious culprit.
A nasty fall.
A mistimed tackle.
That enthusiastic twisting pirouette at exercise class that was just a little too enthusiastic.
It would be nice if medical problems were always so clear-cut. But of course they aren’t. If you google the phrase “knee pain”, the second most common question that pops up is:
What can cause knee pain without injury?
Sometimes, in other words, joint pain takes us by surprise. It seems to emerge out of nowhere.
So what might be going on? Let’s explore the possibilities with four diagnostic questions.
Are you getting any other symptoms with the pain?
The first thing we need to do is to exclude the ‘red flags’. Two potential causes of unexplained pain are infections and tumours. Emphasis on the word potential: these causes are unlikely, so we don’t want to be alarmist. But a consultant will want to eliminate them. If your pain is severe, if it occurs particularly at night, if there’s increased heat, redness or swelling in the knee – these are good reasons to seek prompt medical advice.
Where is the exact source of the pain?
Any diagnosis of a knee complaint also needs to explore the location of the pain. Whereabouts in your knee did you first notice tenderness? The focal point of the soreness is an important guide. Pain at the front of the knee, for example, could indicate a problem like tendinitis (see below). Pain on the outer sides of the knee, by contrast, might indicate Iliotibial band syndrome (where the fibres in this firm band of tissue become inflamed). Osteoarthritis pain (see also below) will be focused on the part of the knee where your cartilage has worn away.
Have you had a change of activity?
Your recent history is another key tool for diagnosis. Is it possible you’ve been doing something to aggravate an underlying problem? Repetitive, new, unfamiliar movements are the things to zero in on here. A weekend painting the skirting boards. A weeding session in the flowerbed. A new class or programme at the gym. Repetitive strain or overuse can cause a range of degenerative problems where the tissues in the knee become torn or inflamed. Common examples include tendinitis or a tendinopathy (where the tendon – often the patellar tendon – becomes inflamed as a result of overuse) and bursitis (where one or several fluid-filled pockets in your knee joint swell up and restrict movement).
How old are you?
Your age is also an important factor in determining why you’ve developed knee pain without any obvious injury. If you’re over 50, osteoarthritis is a higher possibility (though the condition can affect younger people, too). This is a very common wear-and-tear condition, where time and rubbing slowly reduce the protective layer of cartilage on your bones. This often leads to a constant aching pain after activity, or at night. But adolescents also seem to be particularly susceptible to unexplained knee pain. One of the most common issues is Osgood Schlatters, where tightened thigh muscle pulls on the knobbly bone below the knee (the tibial tubercle), resulting in pain and swelling. Another is Plica pain; the Plica is a congenital remnant of the shelf-like tissue on the inside of the knee. This normally disintegrates as we reach maturity. But in some young people it can persist, which results in painful friction in the knee.
This is of course just a starting point for unexplained knee pain. What happens next? In the first instance you may want to treat your knee with rest, icing and painkillers (paracetamol or an anti-inflammatory, if you can take it) to see whether the issue disappears naturally.
But if it persists or becomes severe, you’ll want to see a medic as soon as possible. This might be your GP. But you can also do it directly with us here at Chris Bailey Orthopaedics – we can often scan, diagnose and get you started on treatment within one or two appointments. Getting to the roots of any problem, after all, is the first step to overcoming it.