Q&A My knee hurts. When should I see a doctor?
The knee is a hinge joint made of the thigh bone, the shin bone, and the knee cap. The bones are covered with cartilage to absorb shock and protect the knee. The knee joint is held together with ligaments, the Anterior Cruciate Ligament (ACL), the Posterior Cruciate Ligament (PCL), and the medial and lateral collateral ligaments. Additionally, the knee bones are held together by muscles and tendons. The two groups of muscles that allow a wide range of knee movement are the quadriceps and the hamstrings that are attached to the bone by tendons. If any one or more of these structures are damaged, knee pain can result. Knee pain can be caused by normal daily wear and tear, repetitive use, aging and injury.
Dr. Jorge Chahla is a renowned orthopedic surgeon and sports medicine expert in Chicago whose focus is on complex injuries of the knee, hip and shoulder. Below, he answers your questions about knee pain and when to see a doctor.
What are the most common causes of knee pain?
One of the most common causes of knee pain is osteoarthritis of the knee. Osteoarthritis is a degenerative and inflammatory process where the cartilage in the joint progressively wears away. It can happen with aging but also after an injury to the knee. Meniscus tears (pads of connective tissue that act as shock absorbers and also enhance stability) are also really common, although most of the times are not symptomatic (you might have one but you do not feel pain).
Additionally, sprained or strained knee ligaments and/or muscles are a common knee injury. A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee, although they can also occur with direct trauma such as a tackle or a car accident. Finally, inflammation of the tendons may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper’s knee. This often occurs with sports, such as basketball, where the force of hitting the ground after a jump strains the tendon.
I’ve had minor knee pain for some time, but it is beginning to interfere with my sleep. Should I see an orthopedic surgeon?
If pain is not resolving after a couple of weeks of avoiding activities that elicit you pain, then you should have your knee checked out by a professional. Sometimes, small changes to the way you walk, jump, or exercise can improve the pain significantly. Additionally, if inflammation persists, injections or specific anti-inflammatories can help ease the pain.
I’m a runner and have occasional knee pain. Should I stop running? When should I see a doctor?
We are sports medicine specialists, and therefore, we want to keep you active. Our goal is to keep you doing the activities that you love. Runners are used to tolerating high amounts of pain, and sometimes it is difficult to differentiate what is actually a “bad” pain from a training pain. If pain seems different than what you are used to feeling, if pain is more severe, lasts longer, or is present every time when you run, then you should contact a doctor.
My knee hurts when I bend it, should I see a doctor?
Pain that is worse when the knee is bent has several potential explanations. The most common are patellofemoral pain (between the kneecap and the thighbone) and meniscus or cartilage problems. When the knee is bent, there is significant more pressure in the kneecap as well as in the meniscus. This is the reason why going up or down stairs, squatting, or sitting for a long period of time can increase the symptoms.
My knee swells up sometimes and hurts. It used to go away but now it is swollen all the time. What could be wrong? When should I see a doctor?
Knee swelling is a sign that something might be wrong within the knee. A swollen knee may be the result of trauma, overuse injuries, or an underlying disease or condition. To determine the cause of the swelling, your doctor might need to obtain a sample of the fluid to test for infection, disease, or injury. Removing some of the fluid with a small needle also helps reduce the pain and stiffness associated with the swelling. Once your doctor determines the underlying cause of your swollen knee, appropriate treatment can begin.
When I move my knee, I can hear a popping sound. Is this serious? Should I see my doctor?
Noises within the knee joint are common. Crackling, clicking, or popping can occur, and it is important to differentiate the cause of its occurrence as they might mean different things. It may be from simple soft tissue catching or more serious damage to the bearing surface of the joint, the articular cartilage. Usually if it does not cause pain or swelling then it might not be as concerning.
One common cause for painless popping in the knee is something called a plica. Plicas are soft tissue connections within the knee that go over a bony lump (thigh bone) and pop when they snap back into place. When the popping sounds are accompanied by swelling and pain, or they produce a catching sensation or the knee gives way, then those are times when you should contact a doctor sooner rather than later. Popping in these situations could be due to meniscus injuries, small pieces of broken cartilage or loose bodies within the knee. Painful popping could also be because of osteoarthritis, where the smooth cartilage has worn down and the bones cause friction when they rub against one another. This painful popping would be more persistent. If you felt a pop and your knee swelled while playing a sport it is unquestionably a cause for concern. This might represent torn ligaments — anterior cruciate ligament, posterior cruciate ligament or medial collateral ligament — or the meniscus or articular cartilage.
I twisted my knee, it swelled up and I tried RICE. It helped but now my knee hurts all the time. Should I see an orthopedic surgeon?
Yes, if pain is persistent, you should always see a doctor. An xray or an MRI along with a comprehensive physical examination can help determine the cause of your pain. The menisci, the articulations cartilage, or a ligament can be injured and thus it is important to determine the cause of pain.
What is the best way to treat knee pain?
If your pain is tolerable, there are numerous ways to try to improve it. First and foremost, time can improve your pain on its own. Rest, ice, compression, and elevation (RICE) is the best first approach for knee pain caused by a minor injury or an arthritis flare. Give your knee some rest, apply ice to reduce swelling, wear a compressive bandage, and keep your knee elevated. Anti-inflammatories can also help alleviate pain at first. If you’re not sure which motions are safe or how much you can do, talk with your doctor.
How will I know if my knee pain is serious?
If your pain is associated with swelling, is too severe, lasts for a prolonged period of time, or does not improve with time, it might mean that is related to something that should be looked at by your doctor. Sometimes delaying a consult can worsen your condition.
I fell on my knee and it hurts. When should I see an orthopedic surgeon?
If you have significant swelling, pain that is severe, or feel that your knee gives way, the answer is now. If pain is tolerable, you can rest and ice it to see if it will improve. If it does not improve over the course of a couple of days, it is reasonable to seek help.