Regardless of whether knee pain occurs suddenly, slowly or only in certain situations: It is always extremely stressful and the trigger is often not immediately recognizable. What can be to blame for knee pain, how to help yourself, and what treatment options are available to the doctor.
Chronic or acute – every fifth German has problems with one or even both knee joints. With increasing age, this affects almost every second woman and every third man, as the Society for Arthroscopy and Joint Surgery reports.
Because our entire weight rests on our knees: when jumping, running or standing up there is even greater pressure. The muscles, ligaments and tendons of the knee joints act in their complex network like springs and shock absorbers. They are often under enormous pressure and tension. The knee joints are accordingly prone to injury, and the tissue can also wear out quickly.
Causes of knee pain: no sport, too much sport, obesity
With that, the two most important reasons for knee pain are already mentioned:
- Gonarthrosis (by no means a problem with age – more and more young people suffer from arthrosis of the joints ), so wear and tear. Overweight and a lack of exercise are high risk factors. Axial misalignments also have a negative effect on the knee joints, such as knock knees and bow legs, but also on the feet (sagging-kink-splay). The knees are constantly put under the wrong load and the joint degenerates prematurely.
- Injuries and constant improper stress, in everyday life or during sports
Sports that put a lot of strain on our knee joints are soccer, skiing, tennis and squash. This leads to falls, bruises, strains and dislocations of the kneecap (patellar dislocation). The most common injuries to the knee are cruciate ligament rupture and meniscus damage.
The menisci are crescent-shaped cartilages on the outside and inside of the knee joint. Tendon and bursitis (bursitis) are also possible. But even without injury (trauma), these types of sport overstrain the knee joints over the long term.
Runners’ knees, cruciate ligament tear, meniscus damage – typical problems for athletes
For example, knee pain in professional and amateur athletes is often triggered by the so-called runner’s knee (ilio-tibial ligament syndrome ITBS or tractus syndrome). The iliotibial band is a strip of fascia that runs from the outer thigh to the shin and is irritated during long-distance runs. The stabbing pain on the outside of the knee can make every step a torture.
Often one thing leads to the other: after a sports injury or after years of overload, fascia, cruciate ligaments or menisci, for example, are worn away or torn. As a result, the articular bones and their protective cartilage in the knee joint are incorrectly stressed and wear out prematurely, and osteoarthritis of the knee develops. This risk arises especially when cruciate ligament and meniscus damage has not been properly treated.
Inflammation in the knee as the cause of the pain
However, there are various other causes of knee pain, which are by far the most common:
- rheumatoid arthritis, whereby the immune system attacks the body’s own tissue in the structure of the knee
- Gout, this disorder of uric acid metabolism primarily leads to joint problems in the metatarsophalangeal joint of the big toe. But the joint most frequently affected after this is the knee.
- Psoriatic arthritis , which is inflammation of the joints associated with psoriasis. At least one in four patients with psoriasis also suffer from this form, one or both of the knee joints can be affected.
Type of knee pain gives clues as to the cause
The location and form of the pain provide information about the cause of the knee pain. Possible causes are for
- Front knee pain radiating from the patella: displacement of the kneecap, osteoarthritis of the patella, bursitis, incorrect loading, trauma
- back knee pain (back of the knee): cruciate ligament damage, osteoarthritis
- Inner knee pain (medial knee pain): Inner meniscus damage, tendon problems, bursitis
- Knee pain on the outside: damage to the external miniscus, arthrosis, runner’s knee
It also depends on the situations in which the knee pain occurs. For example, knee pain is particularly common when climbing stairs, especially when going down. Typically this is a sign of osteoarthritis. Likewise is the so-called
- Start-up pain (morning stiffness) is a symptom of osteoarthritis. This is pain that appears at the beginning of the movement and slowly subsides when the knee joint is still active.
- Pain in motion with injuries to the menisci and ligaments is possible. Then the knees hurt, especially during movement.
- Resting pain is the symptom of rheumatoid arthritis. Then the knee problems (also) occur at rest, for example at night.
First and foremost, what you can do yourself against knee pain
First aid against acute knee pain, such as after a strain, contusion or fall, is rest. A good recommendation is the PECH rule:
C ompression (sports napkin)
Quark compresses or pain relieving ointments such as ibuprofen can also provide relief. With these measures, harmless knee problems usually subside after a few days.
When to see a doctor
If this improvement does not occur, or if the pain occurs again and again under stress, you should have the knee joint examined by an orthopedic surgeon. Other symptoms related to knee pain, with or without a previous injury, that require a doctor’s visit:
- the knee pain is massive
- the knee is badly swollen
- the knee joint is red and hot
- in addition, a fever occurs
The doctor will examine the extent to which the knee joint can be bent actively and passively, as well as checking its stability. Imaging methods such as ultrasound and, if necessary, X-rays and magnetic resonance imaging (MRI) show the condition of the joint, ligaments and cartilage as well as menisci. If an inflammatory cause such as rheumatism is suspected, blood tests round off the diagnosis.
Therapies for knee pain – strengthen muscles, reduce excess weight
In many cases, the doctor will recommend conservative measures, including painkillers in the initial phase, including acetylsalicylic acid (ASA), ibuprofen, diclofenac or naproxen, i.e. the common non-steroidal anti-inflammatory drugs (NSAIDs). In the case of osteoarthritis of the knee, the current guidelines also discuss the administration of glucosamines, a natural amino sugar contained in cartilage and synovial fluid, and chondroitin sulfate, a macromolecule that is supposed to build up cartilage. However, further studies are needed here.
But there is no question that physical therapy is extremely important, where exercises are learned specifically to strengthen the muscles that support and protect the knee joint. In addition, heat and cold therapies can be helpful. Other measures against knee pain:
If there are malpositions of the feet , medical insoles are important, including so-called sensorimotor or proprioceptive insoles that activate the foot. Chronic knee pain often goes away this way.
Medical bandages and orthoses (important if the knee joint has to be immobilized for a while) relieve and stabilize the knee joints.
Treatment with iontophoresis or Stangerbad, i.e. hydroelectric procedures, are intended to activate the metabolism locally and thus reduce inflammation.
And last but not least, obesity should be reduced: every kilogram less relieves stressed knee joints.
For ligament and meniscus damage: injections with cortisone and hyaluron
If these measures are not sufficient or do not work quickly enough, injections into the joint space of the knee can relieve pain and improve mobility. Doctors use hyaluronic acid as a natural lubricant and / or anti-inflammatory agents such as cortisone. However, these are only in exceptional cases health insurance benefits, usually IgeL (individual health benefits), which amount to around 30 euros plus the cost of the product used.
Arthroscopy as a minimally invasive operation
Many doctors also use arthroscopy as a particularly gentle and elegant solution. The doctor inserts instruments into the knee joint through tiny incisions in the skin under image control. He can not only check the internal condition of the joint, but also flush out broken cartilage particles, implant cartilage cells and stem cells, mend ligaments or replace damaged ligaments with a replacement tendon.
However, not all measures in the context of knee examinations have now received unreserved approval from experts. Various studies indicate that the long-term effect is controversial, for example with cortisone injections , hyaluronic acid injections and stem cell transplants .
Not least because of this, since 2011 the knee endoscopy as a treatment for osteoarthritis of the knee is no longer part of the health insurance benefits.
Last solution knee implant (knee endoprosthesis)
That is why the number of knee examinations has fallen sharply in recent years, but the number of knee prostheses used has increased significantly, to 213 per 100,000 inhabitants.
Doctors do not recommend implanting a knee prosthesis until all other measures have been exhausted. The implants are getting smaller and smaller and the operation is less of a burden for the patient.
Depending on how badly the knee joint is damaged, there are two different solutions for the knee prosthesis or endoprosthesis:
1. Partial endoprosthesis (hemislide): Often only the destroyed cartilage and an affected joint surface of the thigh bone and the opposite joint surface of the end of the tibia are replaced. Plastic materials or metals are used for this. In principle, the technology can be compared with a dental crown.
2. Total endoprosthesis (knee replacement): With the full prosthesis, both articular surfaces on the femur and the tibia head are replaced. The joint replacement can be implanted with a special adhesive (bone cement). But a cement-free solution is also possible, for example through a rough coating of the prosthesis parts, which gradually connect to the bone and, so to speak, grow together with it.
The techniques are constantly being improved and individually tailored to the joint. After the operation, most patients can walk normally six weeks later. The success rates of knee joint implantation are therefore high; only three to five percent of patients have a complication in the first year. Modern knee prostheses have a lifespan of 20 to even 30 years.
The best that you can do for your knees: lose weight and exercise, be careful with yoga
But even if the surgical techniques continue to improve: It is even better to bypass an operation and not let it get to the point where osteoarthritis and injuries damage the knee. The most important thing:
Keep moving and stay (get) slim. In this way, you avoid the two most important risk factors for knee pain, as described above: lack of exercise and being overweight. From a BMI of 30, the risk of knee problems increases rapidly. Knee-friendly sports such as walking, cycling and water aerobics strengthen the leg muscles and also burn a lot of calories.
- Avoid postures that overload the knee joint, such as cross-legged positions, but also heel or lotus positions (yoga). Excessive bending (over 90 degrees) and turning of the knee joints is also harmful.
- Do not carry heavy loads, this not only affects the intervertebral discs, but also the knee joints.
- Another tip for women: wear high-heeled shoes only for a short time and never all the time. The high heels change the body statics negatively, the center of gravity moves forward. This not only has to balance and balance the spine, but also the knees – which puts a lot of strain on them.