Knee Pain - Causes and Therapy

Knee pain: An overview of possible causes and therapies

The knee joint is the largest joint in the human body and allows walking, running, jumping, standing and sitting. The angle of rotation joint consists of bones, articular cartilage, tendons, ligaments, muscles and other joint structures, which can be affected or even destroyed by inflammation, injuries and signs of wear.

The knee is exposed to great stress. Especially people with malpositions such as legs or X-legs, overweight or people who kneel for work, such as tilers, often have pain in the knee area. Often these are noticeable in certain sports activities, while running, climbing stairs and / or downhill. The pain intensity ranges from mild, transient symptoms to severe, persistent pain that limits or even makes it impossible to walk.

contents

• Knee pain: An overview of possible causes and therapies
• definition
• symptoms
• Pain in the knee due to injuries
• Overload as a cause of knee pain
• Pain in the knee due to inflammation
• Cartilage bone damage as a cause
• Pain in the area of ​​the knee due to metabolic diseases
• Joint wear as a cause of knee pain
• Other causes
• risk factors
• diagnosis
• Treatment for knee pain
• Natural healing for pain in the knee

definition

Knee pain is mostly due to injury in young people, while older people are more likely to experience signs of deterioration (osteoarthritis). Light, short-term knee problems often disappear by themselves. In case of persistent complaints or injuries, for example after accidents, medical advice should be sought.

Knee pain is pain that occurs in the area of ​​the knee. They may be located above, below, on the side, on or behind the kneecap and in the popliteal fossae or deep in the joint. The causes are varied and range from a slight overload to a progressive degeneration of the knee joint. Both the articular cartilage and the surrounding structures such as ligaments and muscles can be affected.

Pain in the area of ​​the knee often occurs as a result of injury or joint wear. (Image: artstudio_pro / fotolia.com)

symptoms

The knee joint forms the connection between lower leg (tibia, tibia) and thigh (femur). The two crescent-shaped menisci (cartilage slices) in the knee joint act as a buffer between the two bones. At the front is the bony patella on the knee joint, which is held together by ligaments such as the inner, the lateral and the cruciate ligaments as well as by muscles.

If one or more of these articular structures become ill or damaged, pain and other discomforts such as restricted mobility may occur. Depending on the cause, the pain can be felt as oppressive, stinging or pulling. They may occur on, behind, below, above, or at the sides of the kneecap, in the popliteal fossa, or inside the knee joint.

Often, sufferers experience certain physical activity when walking, climbing stairs, and / or going downhill. In some cases, the pain radiates into the calf or thigh, and sometimes there are also buttocks pains. If swelling occurs due to inflammation, the affected area is often reddened and overheated.

The duration and intensity of the complaints can vary greatly from case to case. Some sufferers experience only mild, temporary knee problems, while others struggle with persistent, massive pain that can lead to or even impede walking.

Pain in the knee due to injuries

The most common causes include injuries. For example, impact injuries and falls can lead to fractures in the area of ​​the knee joint, such as fractures of the kneecap, the femoral rolls or the tibia plateau. Most such fractures must be surgically treated by osteosynthesis (surgical implantation of the fracture with implants). Affected bone parts are fixed with titanium or steel plates and so-called intramedullary nails or set screws. In addition, there is often a relining of the often depressed in accidents joint surface with the body's own bone or ceramic material.

Kneecap fractures are rare but heal well with simple fractures and appropriate care. In the case of transverse fractures, surgical intervention must be carried out, as otherwise the tremendous power of the quadriceps can lead to serious complications such as failure to heal the fracture (pseudarthrosis)..

Accidental dislocations (dislocation) of the knee joint often lead to the restriction of the ability to use, as it tears many ligaments. Also, a dislocation of the patella (patellar dislocation) or a Patellalateralisation, in which the patella laterally shifts due to instability, are possible.

The cause of a cruciate ligament rupture are usually sports accidents. (Image: Syda Productions / fotolia.com)

The most common ligament tears in the area of ​​the knee joint include cruciate ligament tears as well as internal or external torn ligaments. A cruciate ligament rupture is often the result of sports accidents, such as football, skiing or handball. Due to the so-called flexion-valgus external rotation position, the cruciate ligament rupture occurs, in which the knee is unintentionally bent, rotated in the X-leg position and outwards, while the lower leg remains firmly in place.

Cruciate ligament ruptures are accompanied by vascular tears that lead to bleeding in the knee joint. In the event of accidents, the tendon of the patellar tendon or the tendon of the thigh extensor may also rupture.

Injuries to the meniscus also often cause discomfort in the knee. Meniscus rupture (meniscal tear), meniscal crushing, anomalies such as the disk meniscus or degenerative changes of the meniscus may occur.

Overload as a cause of knee pain

Overloading can irritate the bones, cartilage, muscles, tendons and ligaments, which can result in inflammation. Patellar spike syndrome, for example, causes a chronic overload disorder of the patellar extensor at the bone-tendon transition of the patellar tip.

Also known as "jumper's knee", the syndrome has similar symptoms to that of the "tennis elbow" and is often felt to be very painful. The overstress of the patellar tendon causes hardening and lime deposits in the tendon insertion at the kneecap. Athletes who practice athletics or ball sports often suffer from patellar tendon syndrome.

In the so-called Chondromalacia patellae sufferers also have some severe knee pain. The disease, also known as "runner's knee" in the English-speaking world, causes softening and degeneration of the cartilage on the underside of the kneecap. Especially young and physically active people are affected. The symptoms often occur at the front of the knee or in the form of patella pain.

Mostly overuse, particularly high forces acting on the cartilage, dysfunction of the thigh muscles, trauma, chronic wear and inflammation of the knee joint, the X-leg position, a patellar high or ligament weakness to Chondromalacia patellae.

The pain syndrome, referred to as the "runner's knee" in German-speaking countries, is a malady and overload disease, the so-called iliotibial ligament syndrome, which also causes knee problems. They arise because the iliotibial tract (tendon plate, which runs from the outer thigh to the tibia) rubs over the bones of the knee joint. The irritation causes inflammation of the tissue.

The so-called Plica syndrome can arise from chronic overload of the knee and often affects cyclists. (Image: nokturnal / fotolia.com)

Also, the so-called Plica syndrome often leads to knee pain, swell in the enlargements and thickening or wrinkles (plica) of the joint skin due to inflammation and painful entrapment in the joint. The wrinkles can occur above and below the kneecap, laterally and towards the center of the joint, causing pain behind the kneecap and swelling to cartilage damage. Often riders and cyclists are affected. In addition, however, a previous injury may lead to Plica syndrome.

Pain in the knee due to inflammation

Inflammations of the knee joint often lead to discomfort. An arthritis (joint inflammation) can be based on different causes. The most common forms of arthritis include rheumatoid arthritis. The cause of the disease is a malfunction of the immune system, so that one's own joints and tissues are attacked and destroyed. Therefore, rheumatoid arthritis is counted among the autoimmune diseases. Mostly it shows symmetrical swelling of both knee joints, typical are still morning stiffness of the joints and movement-related pain.

Other causes of inflammation may be, for example, irritation (for example, runner's knee). In addition, infections by viruses or bacteria can lead to inflammation in the knee area. These include the infectious diseases of rubella, ringworm, hepatitis B, hepatitis C, HIV and mumps. Bacteria that can cause inflammation in the knee joint are, for example, staphylococci, streptococci, salmonella, campylobacter and borrelia. Also fungi, such as the genus Candida, can cause inflammation.

Pain in the knee is often due to a so-called bursitis, a bursitis. In the knee, for example, are located laterally, on or below the kneecap or as a connection with the joint interior bursa. The internal bursae are primarily injured in fractures. The bursae lying in front of and below the patella are often inflamed due to the high pressure load they are subjected to. For example, tilers are more often affected by chronic bursitis. But falls and impact accidents or an inflamed wound can cause bursitis.

People who are affected by so-called chronic knee diseases also often suffer from the Baker cyst, a liquid-filled throat in the popliteal fossa. The causes include rheumatoid arthritis and chronic meniscal damage. If it comes to an injury or damage to the knee, increased inflammation processes joint fluid is formed. As a result, the internal joint pressure increases, causing the surrounding connective tissue to relax. A fluid-filled cyst is created, the Baker's cyst.

Rheumatoid arthritis is characterized by inflammatory processes that cause massive pain in the affected joint. (Image: designua / fotolia.com)

Cartilage bone damage as a cause

Another disease that affects mainly boys between the ages of 10 and 14 but also athletes is Osgood-Schlatter disease. In the case of growth disturbance, bone fragments detach due to irritation of the patellar tendon (patellar tendon) on the anterior tibial bone and can die off, resulting in so-called aseptic osteonecrosis. This is a dead bone area at the base of the patellar ligament (patellar tendon) below the kneecap.

The causes are considered to be training-related micro injuries or overloads, reduced tibial load capacity during pubertal hormonal changes, obesity and local circulatory disorders.

The Sinding-Larsen-Johansson disease occurs primarily in male adolescents and athletes. The painful inflammatory reaction at the root of the patellar tendon at the tip of the patella can cause a piece of bone to detach from the patella and die. The cause of Sinding-Larsen-Johansson's disease is an overload.

Knee pain in children and adolescents may also be due to Panner's disease (Osteochondrosis dissecans). Bone necrosis mainly affects boys between the ages of six and ten years. This leads to the formation of a so-called joint mouse, a free cartilage bone part whose cause is due to circulatory disorders, overload or an unknown trigger. The free joint body can settle into the joint and cause severe entrapment, damage to the cartilage and later in the course of arthritis.

Another cause in infants (and infrequent adolescents) is Blount's disease. Affected suffer from a deformation of the lower leg bone due to a growth disturbance of the medial growth fugue.

Chondropathia patellae is a cartilaginous disease on the back of the kneecap. The typical symptoms include pain when climbing stairs, getting up after sitting for a long time and squatting. The articular cartilage on the back of the kneecap is subject to degenerative changes, which become painful only when the degeneration has progressed so far that the underlying patellar bone is also affected. When the femur is involved, it is referred to as patellofemoral pain syndrome. See also knee joint pain.

Metabolic disorders can lead to deformation and damage to the knee joints. (Image: artstudio_pro / fotolia.com)

Pain in the area of ​​the knee due to metabolic diseases

Cause can be an acute gout attack. In the process, uric acid crystals that have not been broken down, inter alia, deposit in the joints and internal organs and can cause severe pain. Uric acid is also a metabolite in healthy people. However, it is normally broken down sufficiently by the metabolism.

Disruptions in the metabolism can lead to the formation of uric acid accumulations, which can lead to deformation and damage to the joints. As so-called pseudogout the formation and deposition of pyrophosphate crystals is called, which can also lead to severe joint pain.

People who suffer from haemophilia have knee pain due to bleeding in the joint. The first bleeding in a joint (initial bleeding) is often caused by an accident. It comes to the release of enzymes through the synovial membrane (synovial membrane), through which the blood contained in the joint is broken down. This is why the Synovia (synovial fluid), which is more heavily pervaded with blood vessels, increases in large effusions. As a result, there is a cycle of bleeding and inflammation.

Other metabolic disorders that can lead to knee pain include hemochromatosis (iron storage disease) and hypercholesterolemia.

Joint wear as a cause of knee pain

Wear and tear in the knee joint (gonarthrosis) can lead to severe knee problems. The cartilage in the joint can be completely destroyed. Often previous injuries such as cruciate ligament rupture or meniscal damage are triggers. With progressive wear, the patient can no longer move his joint without suffering pain.

In the worst case, the knee joint stiffens. Therefore, gonarthrosis therapies not only aim to relieve the sufferer of the discomfort, but also to maintain joint mobility. This may require surgery and even an artificial knee joint. With early treatment, the wear can be stopped in most cases.

Other causes

In addition, knee pain and leg pain can occur with growth pains, hyperplastic joint, chronic fatigue syndrome, fibromyalgia and tumors. Due to the multitude of possible causes, these statements represent only a selection of the more frequently occurring triggers. In principle, a doctor should be consulted for ongoing or recurring complaints.

Those who work a lot on their knees are at an increased risk for knee problems. (Image: Ingo Bartussek / fotolia.com)

risk factors

Risk factors include kneeling or squatting, such as tiling or parquet flooring, and sports that can affect the knee, such as running or skiing. However, the main risk factor for knee pain is obesity due to increased joint strain and lack of exercise.

diagnosis

Since the causes range from a short-term overload to accidents and metabolic diseases, a differentiated diagnosis is important. The doctor will first ask questions about possible accidents and previous illnesses. Also, the exact location of the pain is important to get to the cause of the problem. The doctor will perform various movement tests so that a restriction of movement, if any, can be detected.

The external examination of the knee can provide information about swelling and redness. Depending on the case, further examinations such as X-rays, blood tests, for example on inflammatory values, ultrasound examinations (sonographies), magnetic resonance imaging (MRI), joint punctures in joint effusions and arthroscopy (knee joint mirroring) are necessary.

Treatment for knee pain

The treatment depends on the cause of the problem. While short-term, acute complaints often go back by themselves, ongoing and / or recurrent knee pain require therapy. Frequently, anti-inflammatory analgesics are prescribed. In addition, if necessary, joint injections and joint irrigation with cortisone-containing agents are used. Local analgesics can also be administered in the joint.

Whether exercise or protection makes sense depends on the diagnosis. Often good results are achieved with physiotherapy. In addition, special muscle training for strengthening and stretching, certain sports such as swimming or cycling, heat or cold therapy, water and bath therapy, ultrasound therapy or orthopedic bandages, shoe heels or crutches can help.

Knee problems can often be dealt with well by individually coordinated physiotherapy. (Image: contrastwerkstatt / fotolia.com)

If these therapies provide no relief, surgery may be necessary. In most cases, surgery is performed by means of arthroscopy (knee joint mirroring). If the degeneration of the knee joint is already very advanced, an artificial joint can be used.

Preventive is in addition to adequate, adequate exercise and a balanced diet advisable. In this way, bones and cartilage are supplied with all the important nutrients. At the same time the composition and amount of synovial fluid is positively influenced, which ensures a reduced friction of the joint partners. If the knee is moved, it mixes the synovial fluid and "lubricates" it at the same time, so that the cartilage is nourished.

Natural healing for pain in the knee

From the point of view of naturopathy, knee pain is always considered in the context of other body structures. For example, the nerve (femoral nerve), which is responsible for the care of the knee, runs from the lumbar spine between two muscle parts of the hip flexor (M.Iliopsoas). However, this muscle is often shortened by prolonged sitting in office work and lack of exercise. If pain occurs after getting up or without mechanical stress and there is no conventional medical explanation, the complaints in osteopathy are often considered as a consequence of a jamming of this nerve.

To relieve discomfort, acupuncture as part of traditional Chinese medicine (TCM) has long been used in Europe. In the process, thin needles are placed at certain points along meridians (paths in which the life energy "Qi" flows).

The process by which these points are heated is called moxibustion, the massage of acupressure. Acupuncture can provide relief, especially with knee joint arthrosis. This is proven by scientific studies.

Leeches give off their saliva while they suckle anti-inflammatory
Enzymes off. (Image: 2707195204 / fotolia.com)

A therapy with leeches that are put on the skin can be promising. The leeches give off with their saliva (Salvia) many health-promoting substances. For example, the enzymes cause a widening of the blood vessels, inhibit blood clotting and have anti-inflammatory and analgesic.

Other techniques used in natural healing include cupping, pulling cupping glasses along the muscle pathways, and Ayurvedic therapy, which consists of a combination of massage, external uses of herbal oils and sacs, a special diet, and yoga exercises.

Phytotherapy, which uses various medicinal plants, is also often part of the natural treatment for knee pain. (ag, last updated on 19.01.2018)