Knee Pain

The causes of knee pain are many and varied, ranging from injuries, overuse and rheumatoid arthritis to structural problems such as meniscus tears or cruciate ligament injuries. One of the most common causes of pain is osteoarthritis, the chronic wear of the joint cartilage, which is the protective layer between the bones. Osteoarthritis of the knee is also known as gonarthrosis or knee arthrosis. This can be accompanied by inflammatory changes in the joint mucosa and is particularly common in the second half of life. Sports, previous injuries and a genetic predisposition have a major influence on the development of osteoarthritis.

Poor posture, obesity and muscular imbalances can also cause or worsen knee pain.

A common, often overlooked factor that can play a role in knee pain is the presence of dysfunction in the masticatory system. In this case, knee pain is an expression of a transmitted structural problem and part of TMJ (temporomandibular joint dysfunction).

In order to treat the problem adequately, an accurate diagnosis must first be made. The first step is a thorough anamnesis with a manual examination. This enables the practitioner to obtain a valuable orientation about the knee condition.

For more detailed information about knee pain, it may be necessary to perform additional imaging. Imaging techniques for knee pain include X-rays, MRI and, rarely, CT.

The localisation of the symptoms can provide the treating physician with important clues as to the cause.

Various structures on the inside of the knee can cause pain. Often, the medial meniscus is damaged and causes pain. But cartilage wear in the medial compartment is also a typical cause of pain with increasing age. Overuse and injuries in the area of the inner ligament and the pes anserinus, a collection of several tendons with a common insertion, can also occur, especially in athletes. Malpositions of the leg in the sense of bowlegs can also trigger pain on the inside of the knee; the root cause can be found in the hip, knee or foot.

On the outside of the knee, the meniscus is less often the cause of complaints. Cartilage wear is a trigger for complaints, especially in the case of X-defects. Runners in particular suffer from inflammation of the tendon on the side of the thigh, which then manifests itself as pain on the outside of the knee, known as ‘runner’s knee’.

On the back of the knee, the so-called Baker cyst is often a possibility. This is a bulging of the joint capsule into the hollow of the knee and is filled with synovial fluid. The cause is usually an irritation in the joint, which leads to increased formation of synovial fluid. Due to the pressure, a cyst is formed. Overloading of the calf muscles or torn muscle fibres in this area can also trigger pain in the popliteal fossa.

But diseases that have nothing to do with the knee should not be forgotten either; vascular diseases such as an aneurysm or thrombosis are also worth considering.

The front of the knee often shows signs of wear and tear of the kneecap. Secondly, overuse of the kneecap ligament (patella tip syndrome) can also lead to pain here. Sometimes the causes of discomfort are as trivial as new shoes. Another problem is inflammation of the bursae, the pouch between the tendon and the bone, which is called bursitis. Bursitis can occur especially in front of and above the kneecap, e.g. due to overuse when kneeling for long periods.

In children, Osgood-Schlatter disease should be considered when there is pain in the kneecap area, as it can occur particularly in children who are very active in sports.

Knee pain is often caused by overuse, particularly in patients in the first half of life. But even at an early age, wear-related problems diseases can occur as a result of sporting activities.

Typical knee pain that moves when bending or strongly angling can be an indication of meniscus damage. Pain can also occur in the hollow of the knee when bending due to problems behind the kneecap, typically with cartilage damage on the back of the kneecap, inflammation of the Hoffa’s fat pad or the plica syndrome.

Pathological changes in the area of the extensor apparatus, which is the tendon of the anterior thigh muscle and the patellar ligament, become particularly noticeable in the stretching. The patella tip syndrome is an example.

Pain when climbing stairs can give a good indication of the location of the cause. Often, discomfort and pain when climbing stairs is localised behind the kneecap in the meniscus area. However, when going down stairs, there is a typical ‘slipping away’ of the knee as the internal support is missing, which indicates a cruciate ligament rupture.

This is called a runner’s knee, which is an inflammation of the lateral tendon strand of the thigh. This inflammation becomes painful in the area of the knee, especially after exertion. The cause is usually to be found in the muscle that runs into this tendon, which is located in the hip area and not at the knee.

This is a complaint which can have countless possible causes. For example, knee arthrosis often manifests itself with discomfort when walking. We would advise you to make an appointment with your physician for a correct diagnosis.

Particularly at a younger age, knee pain is less often caused by wear and tear than by acute injuries or overuse. Common causes are mentioned below.

The knee is stabilised by several ligaments. Inside, there are two cruciate ligaments running crosswise. The anterior cruciate ligament runs from the back outside to the front inside, while the posterior cruciate ligament runs from the back inside to the front outside, thus connecting the thigh bone and the lower leg. If the lower leg is fixed in place while the knee is rotated, one or both ligaments can tear. This often happens when playing sports such as football or during skiing. As a rule, a cruciate ligament rupture must be operated on.

Similar to the cruciate ligament, twisting movements in the knee, can lead to meniscus injuries. This can occur for example during sports. These injuries are then differentiated according to the medial or lateral meniscus, localisation and tear shape. The therapy differs according to the type of tear and age. This latter one is because the meniscus of young people is still well supplied with blood, but this blood flow decreases with age. Some meniscus tears can be sutured, in some the damaged part is removed and sometimes surgery is not necessary at all. Because of the increasingly reduced blood flow, meniscus tears occur more and more in old age, even without having an accident.

Knee contusions are probably the most common knee injuries and almost everyone experiences them at least once in their life. Such a knee trauma can result in pain, swelling, and bruising. Fortunately, they are usually harmless and heal on their own. Cooling and rest can be helpful. However, if symptoms persist, other injuries should be ruled out.

In contrast to a torn ligament, a sprained ligament does not result in an interruption of the ligament tissues. Therefore, this injury is milder and does not require intervention. In principle, any ligament can be affected, but the collateral ligaments are relatively often affected. Therapy may include the “Rest, Ice, Compression and Elevation” (RICE) method and bandaging at first, then later functional physical therapy to strengthen the muscles and ligaments. As a rule, this injury heals without consequences; permanent instability is unlikely.

Knee capsule injuries can occur particularly during sports. The joint capsule completely envelops the joint and is filled with a thin layer of synovial fluid. A capsule injury is often found when the ligament is torn. This is characterised by swelling, pain and usually a haematoma. There may also be bleeding into the joint. Unfortunately, capsular injuries take a relatively long time to heal and require a lot of rest. Surgery is rarely necessary for isolated capsular injuries.

Overuse or bruises can lead to bursitis. Here, too, cooling and rest are usually successful and surgery can be avoided.

The treatment options for knee pain vary depending on the cause.
In the event of an acute injury, the “Rest, Ice, Compression and Elevation” (RICE) method is often the first step to relieve pain.

This is followed by physiotherapy and cryotherapy, or orthopaedic aids such as bandages, to restore functionality.

If the functionality is not completely restored, the next stage of therapy can be injections of various kinds. For example, PRP and hyaluronic acid injections have proven effective for knee pain.

Supportive measures to relieve the immune system and optimise metabolic processes can effectively support the treatment of knee pain. Methods such as infusion therapy, INUSpheresis, ozone therapy or neural therapy have been shown to be helpful.

If the knee pain is caused by inflammation, for example arthritis in the knee, it is important to adjust the diet accordingly, to correct possible imbalances in the intestines and to balance the immune system. Moreover, it is important to identify and eliminate the hidden inflammations in the body, known as silent inflammations. Hidden inflammations in the intestines or jaw inflammations can intensify arthritis and block healing. Intestinal cleansing and INUSpheresis are helpful therapies to reduce the inflammation and balance the body.

For osteoarthritis, holistic therapy aims to support the joint cartilage. Dietary supplements and infusion therapies can help balance essential nutrients in the body by providing a tailored supply of micronutrients, as individually measured and recommended by a holistic doctor. Acupuncture and leech therapy have also proven effective for osteoarthritis of the knee.

We will now answer a few questions on knee pain. You should always consult an orthopaedic specialist, who can differentiate between the various injuries and initiate the best therapy.

The information listed contains relevant topics and serves to improve understanding.