Common Causes Of Knee Pain

Your knee joint is formed by the union of your Femur (thigh bone), your Tibia (shin bone) and a couple of other much smaller bones (patella & fibula). Your knee joint is classed as a hinge joint as its primary movements are basic bending and straightening. The knee joint is very enlarged in humans because we stand upright on 2 legs and bear a lot of weight through our knees. In many ways your knees are examples of  miraculous natural engineering as each can bear your weight dynamically millions of times per year. 

Any of the main structures of the knee are capable of generating pain depending on what they are going through. Bone – cartilage –  fascia – muscle – ligament – tendon – nerve are all susceptible to disease and injury, which can lead to severe knee pain.
If you are struggling to make sense of and manage your knee pain this page aims to help by breaking down the common causes of knee pain into 6 categories – movement issues – scar tissue – muscle wasting – trauma – infection – metabolic disorders – degenerative disorders – connective tissue disorders.

Knee Pain Caused By Movement Issues

The truth behind most knee pain is that it is not caused by diseases, infections or even arthritis. The majority of knee pains are the tissues of the knee trying to tell you that they are suffering with some ongoing movement based issue. This is why it often makes  more sense to manage knee pain in the long term with exercises than with pills. Mechanical stress that comes from stubborn movement issues is the biggest challenge faced by most knees and the reason behind most knee pain

Examples of the types of movement issues that are common causes of knee pain include… 

  • Very high arches affecting knee motion. 
  • Flat feet or low arches affecting knee motion. 
  • Muscle imbalances affecting knee motion.
  • Shortened muscle eg. hamstring.
  • Glutes not firing properly affecting knee motion. 
  • Problems with running technique.
  • ‘Quirky habits like always standing with most of  your weight one one side 
  • Overuse is a movement issue for the knee.
  • Underuse is a movement issue for the knee.

Our amazing modern medical system saves countless lives, lives of people in desperate and life threatening situations and it does so by being very good at identifying and treating disease and illness. Nothing in this world is complete or perfect however and medicine is terrible at identifying and managing movement issues. In fact broadly speaking  medicine ‘acts’ if they are not even a thing. It’s important to know this if you have been struggling for a long time with knee pain. If you have been through all the medical tests and you have been cleared then you probably don’t have an undiagnosed disease process. Once medicine has shrugged its shoulders in regard to your pain or told you that it’s all

in your head it may be time to work with someone who understands movement. 

Knee Pain Caused By Scar Tissue

One of the most common oversights in modern pain management is that of scar tissue. The most obvious and well known type of scar tissue is that which comes on after a significant injury. 

The lesser known kind of scar tissue is the kind that builds up slowly and gradually in the bodies tissues as the result of repetitive strain. 

Areas of persistent mechanical strain in the body tend to become tight and can eventually undergo a ‘fibrous’ change, this includes joints, muscles and connective tissue. This issue is a major part of what eventually starts to make us feel old. These changes occurs most often and most quickly in body parts that have old injuries in them, or areas under persistent strain. Microscopic scar tissue that  builds up between the layers of tissue can cause them to stick or adhere to one another which is usually felt as stiffness, tightness and pain. 

Conditions like plantar fasciitis, arch pain, heel pain, ankle pain, knee pain, knee osteoarthritis, IT Band syndrome and hip pain have a significant scar tissue component. The great news is that in many cases scar tissue can be broken up very effectively with non invasive stretching and deep tissue release. 

Knee Pain Caused By Connective Tissue Trauma 

It takes a lot to damage a healthy strong knee, but knee injuries do happen. The majority of knee injuries are either major events or smaller incidents that occur in areas of pre-existing weakness within the knee. The knee is one of the most injury-prone joints in the body. The extreme weight bearing function of the knee places it at risk for certain types of injury. Some injuries are significant tears to connective tissues structures which are usually associated with dramatic pain, stiffness and swelling. Other knee injuries are more along the lines of microtears which often have less swelling but might he felt as stubborn pain and catching or clicking after an injury. 

Some of the most common severe knee injuries like tears within connective tissue structures and displacement of knee structures include… 

  • Collateral ligament
  • Cruciate ligament tears 
  • Meniscus tears
  • Tendon tears 
  • Joint cartilage tears  
  • Dislocations

Injuries of this nature are relatively common in athletes
and obviously some will require the full spectrum of surgery through to extensive rehabilitation processes in order to heal fully. It is tempting to want to self diagnose in the Google age, it should go without saying that if you suspect any of the above knee injuries you should seek professionally assistance. 

If you have a significant injury you will more often than not have had quite a severe twisting, bending or ‘giving way’ incident. If you have a serious knee injury you will than likely have a lot of pain, a lot of stiffness and a lot of swelling that aren’t improving quickly.

Stubborn knee pains often come subsequent to significant connective tissue type knee injuries that have not been fully rehabilitated. Persistent knee pain can also be a warning sign of potential injuries in your future. Through managing thousands of cases of knee pain over the years we have come to realise that life’s persistent niggly knee pains, major knee injuries and the stiff ‘old’ knee’s are often all caused by a single underlying weakness that the person carries with them throughout their life.

Knee Pain Caused By Bursitis

Bursae are small, fluid-filled sacs that provide cushioning for knee joint structures and make it possible for tendons and ligaments to glide smoothly over the joints.

Bursae can become inflamed and swollen as a result of persistent strain and faulty movement patterns. A hard blow to the front of the knee can injure the bursae. In certain cases damage can occur if people spend a lot of time on their knees without protection. Bursitis can lead to swelling, warmth, pain, and stiffness in the knee.
Some cases of bursitis have a major visible swelling and others are more subtle and the primary symptom is pain. 

Bursitis is more often than not quite an easy complaint to manage. A combination of ice, pain killers and hands on treatments to take tension out of the structures around the bursae and increase blood flow usually brings a lot of relief. In severe cases it also often necessary to assess the underlying causes of the irritation to the bursae and address them with rehabilitation. 

Knee Pain Caused By Fractures

 Bone fractures in the knee are not a common cause of persistent knee pains, if you break a bone in your leg or knee you usually know about it and head straight for hospital!!! Trauma from major falls and impacts can cause fractures in the bones that make up the knee joint.
The knee contains several bones that can break, including the kneecap (patella), the tibia (shin bone) and the thigh bone (femur). 

People with osteoporosis and other degenerative diseases that weaken bones are at significantly increased risk of fractures in the bones of the knee. Suspected fractures are always a reason to head straight to hospital, continuing to bear weight on a fractured bone is no joke and can lead to long term  complications. 

Knee Pain Caused By Dislocations 

Under certain circumstances the kneecap can become displaced out of its bony groove at the front of the knee joint. If this happens to you you’ll know all

about it, in the form of extremely sharp stabbing pain at the front and usually outer side of the knee.Usually the kneecap will either relocate itself or practitioner can replace the kneecap without issue. An X-ray can identify any accompanying fractures in the area. There can be a significant period of treatment and rehabilitation after a bad kneecap dislocation. If it is a more minor displacement known as a ‘subluxation’ recovery can be quite fast. 

The kneecap can definitely displace (patellofemoral dislocation)  in an extreme moment of poor fortune like a severe rugby tackle. More commonly chronic tension in the IT band at the outside of the thigh and/or weakness at th end of their quad muscles is the true cause. Addressing these underlying imbalances can be the key to attempts at prevention of kneecap (patellofemoral) dislocation. 

Knee Pain Caused By Osteoarthritis / Wear & Tear

Degenerative tissue disorders like osteoarthritis or ‘arthritis’ are a common finding in older people with stubborn knee pain. Osteoarthritis is the medical term for degeneration of the cartilage within the knee. Osteoarthritis when it is symptomatic can produce pain, stiffness, clicking, weakness and joint dysfunctions like ‘giving way’ under weight bearing. 

There is potentially so much more to the successful management of arthritic knee pain than just drugs and surgery. The provision of healthcare for conditions like osteoarthritis is generally quite poor compared with many other conditions. In the U.S. research has shown that the average length of specific ‘pain consultations’ at GP’s offices for older people is a little over 2 ½ minutes. At our clinic for example, when older patients come to us with a specific pain complaint the average initial consult is over 40 minutes. If you have stubborn knee arthritis related pain seek professional advice from multiple trained sources. 

Osteoarthritis is a complex condition. For most it takes multiple underlying factors that come into play in the generation of osteoarthritis and associated pain in a given joint include..

  • Dietary factors like collagen deficiency leading to osteoarthritis. 
  • Genetic factors like weak cartilage leading to osteoarthritis 
  • Lifestyle factors like overuse leading to osteoarthritis.
  • Environmental factors like concrete floors leading to osteoarthritis. 
  • Wellness factors like lack of appropriate exercise leading to osteoarthritis.

Perhaps the most significant truth of all about osteoarthritis is the fact that over 90% of knee replacement surgeries are single replacements. This means that the knee being replaced has a neighboring knee suffering significantly less or sometimes even no osteoarthritic change. Both of the those knees are the same age, both have the same mileage in every sense and yet one wore out in that amount of time and the other didn’t ! The reasons for this are often movement and repetitive strain based, they are also often deeper understanding and more comprehensive pain management for knee arthritis. 

Knee Pain Autoimmune Arthritis / Inflammatory Arthritis

Rheumatoid arthritis is an example of inflammatory arthritis conditions. These conditions include other more obscure forms including psoriatic arthritis. OInflammatory arthritis can also be caused by many other conditions, for example by the formation of uric acid crystals, infections or other underlying diseases like lupus. We have most probably yet to even begin to identify the full complexity and subtlety of many of these conditions, some of which may it seems may be more to do with the health of the gut than anything else. 

Rheumatoid arthritis is a form of an autoimmune disorder that affects the lining of your joints which in medical terminology is called synovium. Oveor time the generative aspect of rheumatoid arthritis causes thickening of the synovium in the joint. There is a significant genetic component and the markers of these genes can be tested for in the blood. 

Rheumatoid arthritis can occur at any age but most often develops between the ages of 25 and 50, it affects more women than men. Rheumatoid arthritis typically impacts the small joints of the hands and feet but it can also affect other parts of the body.

 If you have persistent painful swelling and or redness and stiffness of one or more joints in your body over time you need to get checked out!! These kind of conditions can often  be identified with blood tests and x Rays. They are managed most effective with a combination of medicines and specific adjustments to lifestyle, diet and wellbeing. 

Knee Pain Caused By Metabolic Disorders 

Metabolic causes of knee pain are not issues specific to the knee itself, they are conditions of the whole system that leave toxin build ups in the joint, such as gout. Build ups of uric acid crystals in the joints can cause episodes of gout, one of the most common metabolic complaints that can affect the knee.

Gout is an obscure and temporary form of arthritis and can be extremely painful. It causes swelling and inflammation in the knee and can reduce the range of motion in the knee for the duration of an attack.
Gout specific medications and anti-inflammatory medications are effective treatments once you have an episode of gout to get over. Adjusting to a more healthy diet and lifestyle has been found by my many to work preventatively. 

Pseudogout is a similar condition that is often mistaken for gout. Pseudogout causes calcium-containing crystals to develop in the joint fluid, leading to swelling in the knee. Pseudogout often responds to similar forms to management to true gout.

Knee Pain Caused By Infections

Infections of the knee and it’s surrounding tissues can most definitely be a cause of knee pain. Infections of the skin around the knee can cause pain in the area. If you have redness and pain in the skin itself after a cut that would be a classic set of symptoms indicating pain from infected skin around the knee. A reason to see your doctor! 

Occasionally people suffer with acute infections of the knee joint itself known as ‘septic arthritis’ which is basically when you have a ‘bug’ get into the joint. Septic arthritis typically causes extreme discomfort and difficulty using the affected joint. If you have septic arthritis the knee joint is generally swollen, red and warm, and you may also experience a fever. These types of infections often occur at times when our system is weakened and run down which allows the natural ‘bugs’ in our system to multiple somewhat. Septic arthritis happens most commonly in the very young and the very old.  

If you even have the slightest doubt over whether you or a family member may have a joint infection get checked out immediately. The presence of an infection in the knee joint can cause irreparable damage. Treatment for septic arthritis of the knee involves an aggressive antibiotic protocol and aspiration of the joint fluids with a big needle .. yay !

Closing Thoughts

The human knee bears so much weight in such an unstable manner that it may be the strongest joint in the human body. A clue to how extreme life is for our knees can be found in the human fossil record. At the evolutionary ‘moment’ we started standing upright our knees enlarged dramatically in response to the stress to bearing the entire weight of our upper body. Perhaps this fact over any other is a reminder of how hard our knees work for us, and of why they so often struggle.

If you are suffering with knee pain and you are not sure what the cause is we would be delighted to help. If you can’t reach us, find another clinical team somewhere who can start the process of relieving and resolving your pain and its underlying causes.  Your knees are most definitely worth the trouble.