My Knee Hurts Worse Than My Doctor Believes It Should
Sometimes we will see a patient who is reluctant to seek medical treatment for their chronic knee pain. The reason? I have tried everything, nothing has helped. My MRI is not bad enough for me to get surgery and my doctor is recommending I get counseling. My doctor says my tests, my MRI, my examination, nothing warrants the amount of knee pain I am having.
It is clear to see how a sense of hopelessness and depression can impact this patients ability not only to heal but to even understand if they can ever heal their knee pain. In our clinic, we see a lot of difficult knee cases. The first thing that we want to convey to patients is that for most people, we can help a lot. The first step towards healing is to help people understand their pain, what is causing it, and how we can help.
Chronic Degenerative Meniscal Tear
If you’ve experienced swelling, joint pain, and a sensation that your knee is sticking or locking, the problem could be a chronic degenerative meniscal tear.
A meniscus is a rubbery cartilage cushion in your knee that helps to pad the joint. Each of your knees has two of them. “Sometimes these structures are torn during an injury, but in degenerative cases, the cartilage just becomes frayed and worn over time, resulting in a breakdown or tearing of the tissue,” says Dr. Breslow. When a meniscus is frayed, ragged edges or loose pieces may get stuck in the joint when it’s moving, causing a sensation that your knee is locking up. If this is happening, be sure to see your doctor.
How to treat it: Surgery is no longer the first-line treatment for this condition, says Dr. Breslow. “It used to be that most people got referred for an arthroscopic procedure to remove the torn meniscus or repair it,” she says. “But now research is showing that, in many cases, the condition can be treated non-operatively just as effectively.”
Clinicians are now more likely to recommend treating the condition with physical therapy. As is the case with patellofemoral pain syndrome, building up the muscles around the joint and in other parts of the body can ease pain, without the risk of complications. However, you may need surgery if a piece of the meniscus is interfering with the motion of the joint.
Sprains And Torn Cartilage
Ligament sprains of the knee are usually caused by a blow to the knee or a sudden twist of the knee, according to Johns Hopkins Medicine. Common symptoms include feeling a pop, pain, swelling, instability , or difficulty walking, says Gotlin.
Torn cartilage, which can occur with injuries of the knee or with arthritis, is another common cause of knee pain, adds Gotlin. Trauma to the knee can tear the menisci, which are cushioning pads of connective tissue that also absorb shock located within the knee joint. Knee buckling, swelling, and pain during specific motions may indicate torn cartilage.
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Keeping Track Of Knee Pain
Here are some additional prep steps you can take before and during your office visit to make the most of it:
- Keep a pain diary. For a week before your doctors appointment, keep track of your knee pain on paper or the computer. Log the time of day when your pain is at its worst and what you are doing when it hurts. You may see a pattern that will make it easier for you to describe your symptoms.
- Rate your pain. Your doctor may ask: On a scale of one to 10, one being slight and 10 being unbearable, how would you rate your pain? Note your ratings in your pain diary and bring it with you to your doctors appointment.
- Talk about limitations. Tell your doctor if your pain prohibits you from doing specific activities or tasks, such as climbing stairs or going grocery shopping. Talking about how the pain is affecting your daily activities gives him or her clues to work with.
- Prioritize your concerns. Write down your most pressing concerns and order them from most important to least important. That way youre sure to at least discuss your most important concerns during the limited time you have at your visit.
Where Is Your Pain
The hunt for the cause of knee pain is like the search for a home:Location matters.
For example, pain below your kneecap might be a sign of patellar tendinitis, or inflammation in the tendon that connects the kneecap to the shinbone, says rheumatologist Scott Burg, DO. Pain above the kneecap often means quadriceps tendinitis.
Pain on the inside or outside of your knee could be a sign of a torn ligament , Dr. Burg says. But it also could indicate a torn or degenerative meniscus, which is the cartilage that lines and cushions your knee joint.
Those are just a couple of causes, not including various types of arthritis. Location is important, but we also ask other questions, Dr. Burg explains.
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Anterior Knee Pain Causes In Young Athletes:
Before you read this, it is worth repeating the majority of you will not have the issues that I outline below. The majority of you will have pain due to a gait abnormality or muscle imbalance. We all feel the need to have a specific label for why our knee hurts. Anterior knee pain due to muscle imbalance just doesnt cut if for some of you you want something more specific. I understand that.
The point I am trying to make is, if you assign the cause of your pain to a specific structural finding or something that your MRI report mentioned, then you may have difficulty getting past that and buying into the PT or exercise strategies that have been shown to work.
- Chondromalacia: Chondromalacia is likely a very early sign of arthritis. It involves the softening of the cartilage under your patella . As the cartilage softens, it is thought that it irritates other tissue in the knee with certain activities. Im not convinced that this is a common cause of anterior knee pain. Chondromalacia is very common, even in people with no pain.
We find chondromalacia in so many people at the time of surgery for other things, such as an ACL tear. And those people rarely have pain in the front of their knee. So it is not entirely clear why some people might have pain due to chondromalacia, and others do not. Surgery is rarely needed.
Pain Is A Subjective Experience And Varies Widely
Pain is a personal experience for each individual. What may be mild back pain to one person can feel severe and overwhelming to another. Subsequently, the same condition can require completely different kinds and levels of treatment for different people.3 For example, over-the-counter medication and/or exercise may be sufficient to treat the pain from a common back condition for most people. But your subjective experience may dictate that you need a more robust treatment plan to handle your intense pain, such as an epidural steroid injection.
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When To See A Doctor
Most knee pain is the result of aging or continual wear and tear on the joint. Other knee problems are often the result of injury or a sudden change in movement.
Mayo Clinic recommends the following treatment options for knee pain:
- Seek immediate medical attention: If your knee injury is accompanied by a deformed joint, a popping noise, the inability to bear weight, intense pain or sudden swelling, you should seek immediate medical attention.
- Schedule an office visit: If your knee injury results from a forceful impact, or if you experience significant swelling, redness, tenderness and warmth around the joint, significant pain or fever, you should make an appointment with your doctor.
- Self-care: Not all knee pain requires medical treatment. If your knee pain comes on slowly, results from a minor injury or results from a more strenuous activity, it can sometimes be managed at home. You can try over-the-counter pain relievers and should follow the RICE model of self-care.
Common Causes Of Knee Pain Without Injury
Of all the joints, our knees are arguably the ones most likely to feel pain. Lots of injuries can cause knee pain. Car accidents, falls and sports accidents are some of the most common causes of knee injuries, like fractures, torn ligaments and sprains. Even though its never fun to experience knee pain, when it follows an injury, at least you have a pretty good idea whats causing your discomfort. And that can make it a little easier to seek and receive proper treatment.
Sometimes though, knee pain occurs without a preceding injury. In those cases, it can be tempting to ignore the pain at first to see if it subsides on its own. The problem is, even though you might not have had an accident, the issue causing your pain can still be serious. And delaying care can wind up prolonging your symptoms and even making them worse.
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Why Do I Have Pain In The Front Of The Knee
The most common cause of anterior knee pain is often felt to come from a muscular imbalance or a particular pattern of weakness. This will be the case for the majority of you reading this. At least thats what we think is the most common cause. We have come a long way in evaluating runners and other people who present with pain in the front of their knees. They often show the same findings when we use high-speed cameras to videotape them while running or walking. Now, this might be a chicken vs. the egg thing. Right? Which came first, the weakness pattern or the pain? We like to think it was the weakness that came first. We are still working on proving that.
If you are a runner or cyclist, etc then your training may influence your anterior knee pain. If you train too hard, too fast, and too often then you are at a higher risk of developing anterior knee pain. Most amateur runners run too fast on their easy days and too slow on their hard days. Proper base building, for strength, endurance and conditioning our joints to adapt to distance is of paramount importance. Zone 2 running programs are extremely important even for elite runners. Try to keep your training at a continuously progressive pace. You should be slowly increasing the load, distance, or speed over time. Try not to increase your load, eg. distance, speed, etc more than 10% per week. Most runners overuse injuries are training errors.
Professional Help For Knee Injuries
- Aspiration if the knee joint is grossly swollen, the doctor may release the pressure by drawing off some of the fluid with a fine needle.
- Physiotherapy including techniques to reduce pain, kneecap taping, exercises for increased mobility and strength, and associated rehabilitation techniques.
- Arthroscopic surgery or keyhole surgery, where the knee operation is performed by inserting slender instruments through small incisions . Cartilage tears are often treated with arthroscopic surgery.
- Open surgery required when the injuries are more severe and the entire joint needs to be laid open for repair.
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What Is One To Make Of This Research Optimism Works
- Patients with osteoarthritis and depression need strong family support, if not available, the patient needs to be optimistic in his/her own ability to have successful treatment. This can be a difficult chore for some.
- Patients who are told of the severity of his/her knee or hip osteoarthritis based on their MRI should more believe what their own body is telling them. In most cases, the MRI is saying they are worse than they feel.
- If treatment is begun with optimism, and optimistic thoughts outweigh pessimistic thoughts, the greater the chance for the alleviation of symptoms.
How Do I Explain Knee Pain To The Doctor
If you are experiencing knee pain, it is important to consult with a doctor to receive a proper diagnosis. When explaining your knee pain to the doctor, be sure to provide detailed information about the location, intensity, and duration of the pain. Additionally, it is helpful to mention any other symptoms that you are experiencing, such as swelling or stiffness. Providing this information will help the doctor to determine the cause of your knee pain and recommend the most appropriate treatment.
You can determine what is causing your knee pain by performing a physical exam, X-ray, MRI, CT scan, or other tests. Your answers to this question may assist your doctor in determining the cause of your pain. If you are experiencing a popping or snapping sensation, it is possible that you have tore a ligaments. If you have arthritis and your pain is worse when you rest or wake up, your knee may be stiff. When the outer thigh muscles are stronger than the inner thigh muscles, there is a greater likelihood of knee pain. If your doctor wishes, he or she may advise you to have one or more of these tests performed on your knee. X-rays can help diagnose joint disease by providing a two-dimensional image of your bones. X-rays taken from a variety of angles are combined in an attempt to provide a three-dimensional view of the knee during a CT scan.
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How Are Knee Problems Diagnosed
In addition to a complete medical history and physical exam, other tests for knee problems may include:
X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
Magnetic resonance imaging . This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body can often determine damage or disease in a surrounding ligament or muscle.
Computed tomography scan . This test uses X-rays and computer technology to make horizontal, or axial, images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube , which is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen used to evaluate any degenerative or arthritic changes in the joint to detect bone diseases and tumors to determine the cause of bone pain and inflammation.
Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
Why Does My Knee Hurt
If you are experiencing knee pain when walking, knee pain when bending, knee pain when resting, or are hearing popping/clicking in your knee, etc., it may be a minor concern or indicator of a serious issue.
Knee pain is usually caused by traumatic injuries, repetitive motion injuries, long-term wear & tear, or tissue disorders. Below are injuries that are common causes for knee pain, but it is best to enter your symptoms into our Knee Pain Diagnosis Symptom Checker to gain a better understanding of your injury.
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There Is No Easy Surgical Solution For Anterior Knee Pain
The mere fact that there are likely to be ten or more described surgical techniques to try and treat pain in the front of your knee should give you pause. That usually means that none have been very successful, so we keep trying new ones. Surgery for anterior knee pain has not been proven to be more effective than a proper exercise program.
Some procedures have drilled holes into the patella, thinking that excess pressure may have been the cause of pain. Did it work for some people? Maybe but with that pesky placebo thing, we always hear about, we dont know because this procedure was never tested against control or sham. Besides having holes drilled through your patella might cause it to break if you fall on it or if you are hit in front of your knee.
One prolific Spanish author wrote about burning the tissues around the patella. We call that a denervation procedure. Thats because when you heat the tissues, you will fry the nerves to that region. The thought behind this procedure was that the patella is fed by nerves that could easily be burned using an arthroscopic approach. This procedure was also never evaluated against a control group or a sham group- so we just dont know if it works.
When To See The Doctor
Sure, its tempting to use an online knee pain symptom checker to try to figure out whats causing your pain. The problem is, because joints are complex, knee pain self-diagnosis is very difficult. Like all your joints, your knees are designed to function without pain or stiffness. No amount of pain or stiffness is normal.If you notice any type of discomfort in or around your knee joint, its always a good idea to schedule an office visit with Dr. Van Thiel.
As a leading orthopedic surgeon in Rockford and Crystal Lake, Dr. Van Thiel uses advanced diagnostic methods to make sure you receive the best, most appropriate care for meaningful pain relief. To find out whats causing your knee pain, call OrthoIllinois at or schedule an appointment online today.
Dr. Van Thiel treats patients from all over Wisconsin and Illinois including Rockford, Elgin, Huntley, Dekalb, Crystal Lake, Barrington, McHenry, and Beloit.
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