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Why Does My Knee Hurt?

Don Butterfield was playing soccer a few years ago when he stuck his leg out to defend a shot.

“The ball hit my toe awkwardly and twisted my knee,” he explains.  

He knew right away he was in trouble when he experienced severe pain and couldn’t bend his knee. He made an appointment with Dr. Christopher Dolan at Great Basin Orthopaedics (GBO), who confirmed that it was a torn meniscus as a result of a traumatic sports injury, and that it would require surgery. 

Living in Northern Nevada, we probably all know a skier, hiker, runner or soccer player who has experienced a knee injury. However, as the largest and one of the most used joints in the body,

this versatile joint can be hurt in any number of ways from twisting it stepping off a ladder or falling wrong to experiencing a car accident or arthritis. Age and excess weight can also contribute to knee pain.

What hurts?

The knee joint is composed of three bones — the femur (thigh), tibia (shin) and patella (kneecap), held together by ligaments, tendons and two groups of muscles — hamstrings and quadriceps. The joint is lined with cartilage and menisci, which help the knee move while also providing some lubrication. The bones, tendons and muscles are cushioned by small fluid-filled sacs called bursae.

This intricate construction allows for a lot of different opportunities for pain, but we can put knee injuries in five basic categories:

  • Sprains: Caused by stretching or tearing of an inside ligament; symptoms will include pain, mobility and stability issues, localized discomfort and tenderness to the touch.
  • Strains: Caused by over-stretching of tendons in the knees; symptoms include pain on the outside of the knee at the side, functional and movement issues.
  • Cartilage injuries: Caused by overuse and sudden acute injuries; symptoms include locking, tenderness with pressure, palpitation, weakness in the knee and instability. Pain is typically not a common symptom.
  • Bursitis: Caused by inflammation and irritation of the bursaie surrounding the knee joint; symptoms include pain, mobility issues and swelling.
  • Fractures and dislocations: Common in athletes, these are caused by sudden high momentum or impact. Symptoms include pain, swelling, bruising, tenderness, muscle spasms and trouble bending the knee. 

Related: Racing to Better Knee Health

How do I address it?

Depending on the cause of the knee pain, there are some remedies that can be tried before calling the doctor. Over-the-counter medications like ibuprofen (Advil) and naproxen sodium (Aleve), as well as lotions that contain numbing agents, can help ease pain.

Most athletes are familiar with the RICE formula: 

  • Rest: Take a break from normal activities to give your knee time to heal and prevent further damage.
  • Ice: Ice reduces both pain and inflammation. Be sure to wrap the ice pack in a thin cloth to protect your skin, and don’t use it for longer than 20 minutes at a time.
  • Compression: This can help prevent fluid build-up in damaged tissue and maintains knee alignment and stability.
  • Elevation: To help reduce swelling, you can try propping your injured knee up on pillows.

You may also experience temporary relief by applying a heat pack or hot water bottle to the painful area of your knee.

When to call the doctor

Of course, sometimes you just know, as Butterfield did, that it’s time to seek out a professional opinion.

The American Academy of Orthopedic Surgeons (AAOS) recommends seeking treatment as soon as possible if you experience any of these symptoms:

  • Hear a popping noise and feel your knee give out at the time of injury
  • Have severe pain
  • Cannot move the knee
  • Begin limping
  • Have swelling at the injury site

Some other signs could include: the inability to bear weight; if you’re unable to fully extend or flex your knee; if you see an obvious deformity in your knee; or you have a fever that seems related to the injury.

When you see an orthopaedic specialist, they will ask many questions — including when the symptoms began and if they’re connected to a specific injury or movement. They’ll also want to know what improves or worsens symptoms and whether or not you’re experiencing swelling, instability or locking of your knee. 

What are my options?

After the doctor goes over this extensive list of questions with you, they’ll examine the knee, checking for tenderness and pain. Depending on what they find, they may order an x-ray or MRI.

Related: Using magnets to get to the root of the problem

Once your doctor has confirmed their diagnosis, they’ll discuss different treatment options, keeping your goals and preferences in mind.

These could include:

  • Immobilization: A brace will prevent the knee from moving by holding the bones in place while they heal. Crutches could also be prescribed to keep weight off the knee.
  • Physical Therapy: A physical therapist will determine which treatments will work best to help you regain movement, restore function and alleviate pain. Some of the most common are ultrasound, electrical stimulation, manual therapy, ice or heat therapy, mechanical traction, laser therapy, massage and dry needling. The physical therapist may also prescribe specific at-home exercise to support the healing process.

Related: Dry Needling 101 — understanding this powerful therapy tool

  • Surgery: Many fractures and injuries will require surgery to restore full function. The most commonly performed surgical procedure is arthroscopy, which involves inserting an arthroscope into the joint through a small incision, allowing the surgeon to see and possibly repair the joint with less trauma and scarring. More complicated injuries will require more extensive surgeries, including potentially full replacement when the arthritic or damaged joint is replaced with a prosthesis.

Dr. Dolan and Butterfield agreed that arthroscopic surgery was Butterfield’s best bet to get back to his active lifestyle that includes soccer, skiing and mountain biking.

“Dr. Dolan said he could remove the part that was torn or repair it, but the repair would mean six months recovery time versus six weeks,” Butterfield recalls.

As the meniscus tends to be harder to repair with age, Butterfield agreed that it would be easier to remove it.

Related: Arthroscopy is one of many options to ease joint pain

Butterfield got his wish and was back to playing soccer within six weeks of the accident. Now, a few years later, he says he can do everything he used to do.

“I feel like I’m at 100% with my knee,” he says. “I’m playing soccer, skiing and riding my bike. I feel like I don’t have any limitations.”

Don’t let knee pain keep you from doing the things you want to do, whether that’s playing soccer or walking your dog around the block. Learn more about your options by contacting GBO for a consultation.