Our knees have a lot to cope with. They carry our full weight, and are in use almost constantly, whether we’re out walking, or just climbing the stairs.
It’s not surprising that our knees sometimes hurt, but how can you tell whether it’s serious or not?
Understanding the probable cause of your knee pain can help you know whether you need to give your knees a rest, or see your GP.
How your knees work
Our knees are made up of three bones.
Your femur, or thighbone is attached to your hip at its top, and ends just under your patella.
The second bone is your tibia, or shinbone, which starts just under the lower part of your patella, and stops at your feet.
Your patella, or kneecap is the small triangular shaped bone that covers the ends of your femur and tibia.
Cartilage covers the back of your patella. This elastic material helps your knee bones move smoothly against each other when you bend or straighten your legs, and also works as a shock absorber.
Who gets painful knees?
Knee problems can affect anyone, but you are more likely to develop them as you grow older, and if you are overweight.
You can also be at risk if you are sporty, especially if you do (or have done), sports that put a lot of pressure on your knees, such as skiing, netball and football.
Common knee problems
Anterior knee pain (patellofemoral pain)
The symptom is a dull, aching pain at the front of one or both of your knees.
The cause of the pain isn’t always clear; although it may be the result of knee injuries you’ve had in the past, being overweight, or your knee cap(s) being slightly out of place.
If you have anterior knee pain resting and using ice packs can give your knee(s) a chance to recover.
You could also take non-steroidal anti-inflammatory drugs (NSAIDs), for instance ibuprofen. If you are on any other medications, check with your doctor that it’s safe for you to take these drugs.
If the pain doesn’t improve, or gets worse over a number of weeks, it’s worth seeing your GP. They may be able to suggest other ways of easing the pain, and may refer you to a physiotherapist, who can show you exercises that might help ease the pain.
It could also be caused by osteoarthritis (see below), especially if you’ve had a knee injury in the past, or have close relatives with osteoarthritis.
Bursitis (housemaid’s knee)
We all have bursa – fluid-filled sacs that act as a cushion between bones, tendons and muscles. Bursitis is when a bursa in the knee (or other joints) has become swollen and irritated.
Bursitis tends to happen when we have been kneeling for longer periods than usual, or have been bending our knees repeatedly. Other causes include sudden damage to your knee, gout or rheumatoid arthritis.
Symptoms of bursitis in the knee include swelling of your affected knee, tenderness, redness and pain. Your knee may also feel warm.
There are some simple steps you can take to ease the problem of bursitis – rest helps, as does putting an ice pack on your swollen knee.
You should be able to use your usual over-the-counter painkillers to help with any pain (if you are on other medications check with your doctor first).
If your bursitis becomes worse – it becomes more swollen, and hotter, you should see your GP.
They may suggest draining your bursitis, if it is very swollen and painful. This is done using a needle to draw the fluid out of the bursa.
Another way of dealing with a painful bursa is to give you a corticosteroid injection in the problem area, to reduce the inflammation.
Other possible treatments include antibiotics if your bursitis has become septic, and referral to an orthopaedic surgeon, or a rheumatologist, to see if you need further treatment.
Gout in the knees
Gout is a very painful type of inflammatory arthritis. It’s caused when urate (a chemical your body produces when breaking down certain foods) builds up and turns into crystals in your joints. This in turn can lead to inflammation.
The symptoms of gout include very painful, hot, red and swollen joints, and the skin over the affected joint can look shiny, and as if it’s peeling.
Our big toes are the most common part to suffer from gout, but it can also affect other joints, including our knees.
Gout tends to appear in people who have unusually high levels of urate in their bloodstream. If your kidneys can’t remove enough of the extra urate, its levels go up, and the urate can form into sodium urate crystals, most often in or near joint tissues. They tend to build up in the cartilage, particularly in finger and toe joints, as well as your knees.
Over time, some of the hard, needle-like crystals get into the space between your bones, known as the joint cavity.
When this happens they make contact with the soft lining of the joint, which becomes inflamed and painful. This usually lasts from a few days to a few weeks.
Your genetic background, being overweight, and having high levels of cholesterol and high blood pressure can make you more prone to gout.
If you know, or think you have gout, you need to see your GP for advice and prescribed drugs.
If you have attacks of gout only every now and then, with your GP’s agreement, you could try simple self-help treatments.
These include resting the painful knee, putting an ice pack or bag of frozen vegetables wrapped in a tea towel, on your knee, and taking drugs like ibuprofen and naproxen, as soon as the pain starts.
Colchicine is a prescription drug that is very useful for reducing the inflammation in your joints, but it won’t cure the problem.
Your doctor may suggest you have a steroid injection if non-steroidal anti-inflammatory drugs like ibuprofen don’t work during an acute attack.
However, if you are having attacks more often, and you have high levels of urate in your blood, your doctor may recommend that you take a drug to reduce the amount of urate in your blood stream. Commonly prescribed drugs include Allopurinol and Febuxostat.
Knee osteoarthritis
The most common form of arthritis in the UK, osteoarthritis is most common in our knees, as well as our hips and the knuckle and other small joints in our hands.
Pain and stiffness are the major symptoms, and these can make it difficult to carry our normal activities.
Osteoarthritis in your knees can make them feel tender, stiff and painful if you’ve been sitting still for a while.
Osteoarthritis in the knees can make it more difficult to walk, and get up from a chair, and can reduce the movement in your joints, making it harder to climb stairs.
Osteoarthritis damages the surfaces of your joints, so they don’t work as smoothly as they should. Severe arthritis can actually deform joints, making them more painful.
There are a number of reasons why you may develop osteoarthritis – it tends to develop as you grow older, and it is more common, and worse in women, especially in the knees and hands.
Damaging your knee joint, or having an operation on it can lead to osteoarthritis, as can being overweight, being born with joint abnormalities, and to a small extent, having this condition in your family.
There are steps you can take to help yourself if you have osteoarthritis. These include
- Losing weight if you are overweight
- Doing exercises that will strengthen the muscles around your affected joint
- Doing aerobic exercises that will make you fitter and reduce your pain. Swimming and t’ai chi are known to be good for osteoarthritis, and helping with pain reduction
If you think you have osteoarthritis, see your GP. They will be able to advise you on the help available to you. For instance, you can buy painkillers over the counter, that may help, but your doctor may be able to prescribe stronger, prescription-only painkillers for osteoarthritis.
They may also suggest steroid injections if your osteoarthritis is very painful. Capsaicin cream, which is made from pepper plants (capsicum), works well as a painkiller, and is especially useful for osteoarthritis in the knee.
If you are in a lot of pain, and have trouble walking, your doctor may suggest considering a knee replacement.
Ways to relieve knee pain
Practice tai chi
The ancient art of tai chi will make you feel calmer, improve your balance and also ease achy knees. Researchers believe the benefit may be a result of the slow, deliberate movements that may help strengthen muscles surrounding the joints, albeit in a gentle way. This may help to improve posture and relieving pressure on your joints.
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Build more muscle
Knee pain is exacerbated when the muscles surrounding your joints are weak, so by carefully targeting those muscles with exercise you’ll experience better alignment in your muscles and bones. Making these muscles stronger helps to support your knee joints, and may mean that you can get out more, and be more active.
However, you must be careful not to injure yourself – avoid any exercises where your knee goes beyond your toes, such as deep lunges, for example, as it puts pressure on the kneecap. Partial squats (where you only lower yourself halfway) are good, as are step-ups.
Prevent muscle loss
Lose weight
You might not think that extra pound or kilo makes much difference to your knees but it does. Researchers have theorised that losing a pound (0.5kg) is the equivalent of taking 5 pounds (2.5kg) of pressure off your knees. When you walk, the pressure in your knee is around five times your body weight - so even carrying a few extra pounds can make a big difference.
Drink milk
Or you can eat cheese or yogurt. Research published in the medical journal Arthritis Care & Research found that drinking a glass of milk daily helped female patients with osteoarthritis slow any further development of the disease.
Osteoarthritis - the foods to avoid
Ditch the high heels
Walking in heels puts the knees under extra strain, which increases wear and tear and may lead to osteoarthritis over time.
A study from Stanford University Medical Center in the US found that wearing high heels changes the walking gait, especially around the knee joint.
The higher the heel, the more likely it is that your knee will still be bent when your shoe makes contact with the ground – increasing pressure on the joint.
Glucosamine combined with chondroitin
Researchers haven’t been able to show glucosamine and chondroitin improve symptoms in all patients but they have shown that some patients do respond very well to it. Why do some patients feel the benefit and others don’t? They don’t know yet. In the meantime, it’s worth giving it a go.
Use ice
If you do suffer a knee injury put ice on it for about 20 minutes every two or three hours (less if keeping it on your injury for that long is too cold or uncomfortable). This will help reduce inflammation. For the same reason, taking a non-steroidal anti-inflammatory such as ibuprofen will also be beneficial.
Get a good night's sleep
Poor sleep can increase sensitivity to pain among people with knee osteoarthritis, according to a recent study published in the journal Arthritis Care & Research. Or to put it another way: lying awake worrying about your knee pain will only make it worse.
Can't get to sleep? Placing a pillow between or behind your knees may help you find a comfortable position. It's also a good idea to speak to your GP or physiotherapist about bedtime relaxation techniques.
Corticosteroids
These injections are very effective but the pain may well return. There is concern that overuse of corticosteroids causes cartilage to deteriorate so this is something to try only when you really need to. (According to www.nhs.uk , usually you are only able to have two or three corticosteroid injections each year.
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