For Ed, it started with a pain he hadn’t felt before. “Out riding a couple of times, I noticed a slight twinge in my right knee,” says the cycling enthusiast, an engineer in his 50s from Dorset.
“It felt like something was ‘catching’. It was almost as if something was wandering about in the joint. Then I’d catch it wrong, and there would be a shooting pain. And over the weeks, it got steadily worse.”
Ed’s problem turned out to be osteoarthritis, which had spread across his right knee joint. Though for a while – at least until he went for a scan and had it diagnosed here at the clinic – he did his best to dismiss the discomfort. “I’d tried ignoring the pain, but it was becoming more frequent.”
Ed’s story (which you can follow in this case study) is far from rare. Arthritis Research UK calculates that approximately 1 in 5 adults over the age of 45 in England have osteoarthritis of the knee. That’s a lot of people with potential knee pain.
But what does arthritis actually feel like when it first affects a knee joint? How would you know if you had it? Here are some pointers.
What’s happening to a knee with osteoarthritis?
Knee joints, like all the joints in our bodies, are covered in a thin layer of cartilage. This layer is there to help the two bone endings move smoothly against each other, a kind of anti-friction coating. With osteoarthritis, the layer becomes depleted. This might be because of a major impact, like an accident. More commonly, it’s due to long-term wear-and-tear. Either way, the bone endings no longer have that smooth protection. They begin to grind against each other – often painfully.
How would you first notice it?
Although Ed’s onset was slightly different here, most people first experience osteoarthritis as a dull ache that wasn’t there before. To begin with, it’s just in the background; usually, though not always, in one part of the knee (the inner (medial) side is the most common). But over time the ache becomes more noticeable. Our patients often describe it as a nagging, toothache-style discomfort that won’t go away. Activity may make it worse, but generally it’s just there all the time – even at night. One of the most frustrating aspects of osteoarthritis pain is the feeling you can’t escape it.
What else might you notice?
A persistent ache isn’t necessarily the first or only sign of early arthritis. Like Ed, it could involve sudden, sharp pains too. Some people describe this as like having a stone stuck in your shoe, only one that’s inside the knee. Others sometimes mention that their knee has begun to “lock” during movement, or that the pain makes it impossible to put weight on their foot. A sharp knee pain could be due to something like an associated meniscal tear. Or it may be that the cartilage surface has become irregular, causing frayed tissue to catch in the joint when you move in a particular way.
Is osteoarthritis pain always relentless?
Not necessarily. Some patients find the pain or dull ache comes and goes. It may be bad for a week, before settling down again. Others say it becomes more noticeable during colder weather (though there may be other factors at play: see Why does my arthritis get worse in the winter? for more here). It can be difficult to know exactly why arthritis pain ebbs and flows in this way.
What should you do next?
The first thing to say is that knee pains are very common. We all experience them from time to time, particularly if we’re very active or play a lot of sport. Most of them will settle down. Most aren’t related to a serious underlying condition. So, unless you’re in the rare situation of facing something like a knee infection, it’s best to rest first, manage your symptoms, and see how things develop. If the pain began with a specific activity, avoid the activity for a while to see how your knee fares. Try substituting gentler forms of exercise, such as swimming or easy walks. Think about footwear too: could you try shoes that are more supportive, or that spread the weight more evenly across your knee joint? You could also manage the discomfort with simple painkillers – though you should only do this temporarily, and certainly not beyond two or three weeks without seeking further advice.
If this new pain you’re experiencing does persist beyond several weeks, it may be time to get yourself checked out. There are some basic physical tests we can do here in the clinic, and we may ask you to follow up with scans – MRI scans are particularly effective at detecting osteoarthritis in the knee, since the images pick up subtle changes in the lining cartilage which are not apparent on x-ray. But even if your symptoms do turn out to be osteoarthritis, there’s no need to panic. There are plenty of things we can do to manage and reduce the discomfort you’re feeling as we work on a treatment programme. Whatever happens, we’re here to help and support you as you plan the next steps.