What does my knee pain mean?

The weather is warming up and after a long pandemic winter we are all chomping at the bit to get outside and exercise more. Unfortunately, that also means the possibility of more aches and pains as well. As a hip and knee replacement specialist, one of the most common complaints I see in the office this time of year is new onset knee pain and it presents in all shapes and sizes. Not all knee pain is alike and different issues require different treatment regimens.  Here we will discuss how to diagnose some of the most common types of knee pain as well as initial treatments.

1. Runner’s Knee is a term used to describe pain felt underneath the kneecap that worsens after running and occurs when going up or down the stairs.  This occurs when the kneecap is not tracking properly and the cartilage beneath becomes irritated and/or inflamed.  Initial treatments should include reducing your running mileage, foam rolling your quads, applying ice several times a day, taking anti-inflammatories, as well as cross-training with less impactful exercises (i.e., elliptical machine, biking/spinning, and swimming) that won’t aggravate your knees.  Runner’s knee can be prevented by strengthening your quads, foam rolling daily and shortening your running stride.
    
2. Iliotibial Band Syndrome presents as pain on the outside of the knee and usually starts to hurt within minutes of exercising.  The iliotibial band is a structure made of muscle and mostly tendon and fascia that runs from the hip down past the knee.  When the iliotibial band is tight, it squeezes a bursa on the outside of the femur near the knee and causes pain.  A bursa is a fluid-filled sac that acts as a cushion between muscle and bone and we have bursae all over our body.  Treatments include foam rolling the iliotibial band and reducing your exercise workload.  Also, pay attention to your shoes.  If most of the wear is on the inside sole near the ball of the foot and near the big toe, there's a good possibility that you overpronate.  If so, consider wearing motion-control shoes when exercising/running.  Iliotibial band syndrome can be prevented by concentrating on core and gluteal strengthening, foam rolling the iliotibial band, and by taking shorter and quicker strides if you are a runner.
    
3. Pes Anserine Bursitis presents as pain on the inside portion of the leg just below the knee that worsens with exercising and climbing the stairs.  Pes anserine bursitis is an inflammation of the bursa located between the shinbone (tibia) and three tendons of the hamstring muscle at the inside of the knee. It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee.  Several factors can cause this problem, including tight hamstring muscles, obesity, an out-turning of the knee or lower leg, and incorrect training techniques such as neglecting to stretch, doing excessive hill running and sudden increases in mileage.  Initial treatments include rest, ice, anti-inflammatories, stretching the hamstrings and weight loss.
    
4. Patellar Tendinitis causes pain just below the knee cap that sharpens as you exercise and worsens going up and down stairs.  It occurs when the force placed on the knee while exercising puts too much strain on the patellar tendon.  If you have these symptoms, stop whatever exercise is causing the pain, apply ice in 15-minute intervals five times a day, and buy an over-the-counter patellar tendon strap.  Patellar tendonitis can be prevented with strength training, quads and hamstring stretches and foam rolling.
    
5. Meniscus Tears can occur on either the inside or outside of the knee, as each knee has two.  A torn meniscus can cause pain (especially when twisting or rotating), swelling, stiffness and sometimes may block knee motion.  Other symptoms may include a popping sensation or a feeling of the knee giving way.  Each of your knees has two C-shaped pieces of cartilage that act like a cushion between your shinbone and your thighbone. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.  Conservative treatment — such as rest, ice and anti-inflammatories — is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own.
    
6. Osteoarthritis causes pain, swelling and stiffness in your knee during exercising or even day-to-day exercises and is caused by the wearing away of the cartilage lining the joint.  If severe enough, this can lead to the bone grinding on the bone.  Initial treatments include rest, anti-inflammatories, and ice.  Patients with osteoarthritis should also heavily consider modifying their exercise regimen to include more low-impact activities and/or exercising on softer surfaces.

If you have tried some of these initial conservative treatments and your knee pain is still affecting your ability to exercise and/or otherwise affecting your quality of life, please make an appointment with us at Rothman Orthopaedics.

Dr. Ari Seidenstein is a hip and knee replacement specialist with expertise in both primary and revision surgery, and sees patients in New Jersey (Montvale and Rutherford) and New York (Tarrytown).