The knee is a complicated joint. It moves like a door hinge, allowing a person to bend and straighten their legs so they can sit, squat, jump, and run.
Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout, and infections — also can cause knee pain.
Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.
The knee is made up of four components:
- bones
- cartilage
- ligaments
- tendons
The femur, commonly known as the thighbone, is at the top of the knee joint. The shinbone, or tibia, makes up the bottom of the knee joint. The patella or kneecap covers the meeting point between the femur and tibia.
The cartilage is the tissue that cushions the bones of the knee joint, helping ligaments slide easily over the bones and protecting the bones from impact.
There are four ligaments in the knee that act similarly to ropes, holding the bones together and stabilizing them. Tendons connect the muscles that support the knee joint to bones in the upper and lower leg.
Symptoms
The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:
- Swelling and stiffness
- Redness and warmth to the touch
- Weakness or instability
- Popping or crunching noises
- Inability to fully straighten the knee
Mechanical problems
Some examples of mechanical problems that can cause knee pain include:
- Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.
- Iliotibial band syndrome. This occurs when the tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners and cyclists are especially susceptible to iliotibial band syndrome.
- Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you’ll be able to see the dislocation.
- Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can place more stress on your knee joint. In some cases, problems in the hip or foot can cause knee pain.
When to see a doctor
Call your doctor if you:
- Can’t bear weight on your knee or feel as if your knee is unstable (gives out)
- Have marked knee swelling
- Are unable to fully extend or flex your knee
- See an obvious deformity in your leg or knee
- Have a fever, in addition to redness, pain, and swelling in your knee
- Have severe knee pain that is associated with an injury
There are many different types of knee injuries. Below are 10 of the most common injuries of the knee.
1. Fractures
Any of the bones in or around the knee can be fractured. The most commonly broken bone in the joint is the patella or kneecap.
High impact trauma, such as a fall or car accident, causes most knee fractures. People with underlying osteoporosis may fracture their knees just by stepping the wrong way or tripping.
2. Anterior cruciate ligament injuries, ACL
The anterior cruciate ligament (ACL) runs diagonally down the front of the knee, providing critical stability to the joint. Injuries to the ACL can be serious and require surgery.
ACL injuries are graded on a scale from one to three. A grade 1 sprain is a mild injury to the ACL, while a grade 3 refers to a complete tear.
Athletes who participate in contact sports such as football or soccer often injure their ACLs. However, contact sports are not the only cause of this injury.
Improperly landing from a jump or quickly changing the direction of motion can lead to a tear in the ACL.
3. Dislocation
Dislocating the knee happens when the bones of the knee are out of their proper placement and alignment.
In a knee dislocation, one or more of the bones may slip out of place. Structural abnormalities or traumas, including car accidents, falls, and contact sports, can cause a knee dislocation.
4. Meniscal tears
When people refer to torn cartilage in the knee, they are probably talking about a meniscal tear.
The menisci are two rubbery wedges of cartilage between the thighbone and shinbone. These pieces of cartilage can tear suddenly during sporting activities. They may also tear slowly due to aging.
When the meniscus tears due to the natural aging process, it is referred to as a degenerative meniscus tear.
With a sudden meniscus tear, a pop may be heard or felt in the knee. After the initial injury, pain, swelling, and tightness may increase over the next few days.
5. Bursitis
Bursae are small fluid-filled sacs that cushion the knee joints and allow the tendons and ligaments to slide easily over the joint.
These sacs can swell and become inflamed with overuse or repeated pressure from kneeling. This is known as bursitis.
Most cases of bursitis are not serious and can be treated by self-care. However, some instances may require antibiotic treatment or aspiration, which is a procedure that uses a needle to withdraw excess fluid.
6. Tendonitis
Tendonitis or inflammation in the knee is known as patellar tendinitis. This is an injury to the tendon that connects the kneecap to the shinbone.
The patellar tendon works with the front of the thigh to extend the knee so a person can run, jump, and perform other physical activities.
Often referred to as jumper’s knee, tendonitis is common among athletes who frequently jump. However, any physically active person can be at risk of developing tendonitis.
7. Tendon tears
Tendons are soft tissues that connect the muscles to the bones. In the knee, a common tendon to be injured is patellar.
It is not uncommon for an athlete or middle-aged person involved in physical activities to tear or overstretch the tendons. Direct impact from a fall or hit may also cause a tear in the tendon.
8. Collateral ligament injuries
Collateral ligaments connect the thighbone to the shinbone. Injury to these ligaments is a common problem for athletes, particularly those involved in contact sports.
Collateral ligament tears often occur due to a direct impact or collision with another person or object.
9. Iliotibial band syndrome
Iliotibial band syndrome is common among long-distance runners. It is caused when the iliotibial band, which is located on the outside of the knee, rubs against the outside of the knee joint.
Typically, the pain starts off as a minor irritation. It can gradually build to the point where a runner must stop running for a period to let the iliotibial band heal.
10. Posterior cruciate ligament injuries
The posterior cruciate ligament is located at the back of the knee. It is one of the many ligaments that connect the thighbone to the shinbone. This ligament keeps the shinbone from moving too far backward.
An injury to the posterior cruciate requires powerful force while the knee is in a bent position. This level of force typically happens when someone falls hard onto a bent knee or is in an accident that impacts the knee while it is bent.
Treatment Options
If knee pain becomes chronic, is severe, or lasts for more than a week, a person should consult a doctor. It is important to see a doctor if there is a reduced range of motion in the joint or if bending the knee becomes difficult.
In cases of blunt force or trauma, a doctor should be seen immediately after an injury has occurred.
Treatment will vary based on the cause of the knee pain and the specifics of the injury. In cases of strain or overuse injuries, rest and ice will typically allow the knee to heal over time.
Treatment may also involve managing pain and inflammation with medication. In most cases, a person will need to rest for a period of time.
Tears or other trauma-induced injuries may require bracing, popping the knee back into place, or surgery. In the case of surgery, a person will likely not be able to use the knee after the procedure and may need either crutches or a wheelchair while recovering.
In some cases, physical therapy may be needed to help a person regain movement and strength in their knee and leg.
Prevention
Preventing knee injuries is not always possible, but a person can take precautions to reduce the risk. For instance, people who run or play sports should wear the appropriate shoes and protective gear.
In cases of iliotibial band syndrome and overuse injuries, a person may want to consider reducing the number of miles they run.
Certain exercises also help strengthen the smaller leg muscles, which may help prevent injury. Finally, stretching before and after exercise can help prevent injury to the knees.
Proper nutrition, especially for athletes, is also important. Protein, calcium, and vitamin D are essential for maintaining healthy bones, muscles, and ligaments.
Posterior knee pain is frequently associated with a number of structures comprising this area of the knee. The popliteus is a small muscle residing across the posterior aspect of the knee joint, in close proximity to an array of neurovascular structures. Due to its location and muscle action, the popliteus is a big player in the healthy functioning of the knee joint.
Injury to the popliteus muscle may arise in a weight-bearing position with a varus force to the knee whilst the tibia is externally rotated, or a forced hyperextension moment with the tibia internally rotated1. During typical sporting movements such as football or netball – where the foot is planted by means of rubber-soled or a studded shoe – the femur is forced to rotate externally on the tibia. It is uncommon that the popliteus is injured in isolation, and is usually accompanied by further injury to the posterolateral corner (PLC) or other surrounding structures
Anatomy and biomechanics
The popliteus muscle is a broad thin triangular muscle, which spans the majority of the space of the popliteal fossa at the back of the knee (see Figure 1A). Its origin is at the lateral femoral condyle of the femur and the lateral meniscus, and it then courses down and across the back of the knee joint to insert on the posteromedial aspect of the tibia. The popliteus tendon is positioned outside of the knee joint and the synovial joint lining but does lie within the joint capsule as it passes through the popliteal hiatus (Figure 1B).
| Table 1: Layers of the posterolateral corner | |
|---|---|
| Layer 1 | Biceps femoris and iliotibial tract |
| Layer 2 | Patella retinaculum and patellofemoral ligament |
| Layer 3 | |
| -Superficial | LCL and fabellofibular ligament |
| -Deep | Popliteus tendon, popliteo fibular ligament, arcuate ligament, coronary ligament, and capsule |
The popliteus is innervated from the tibial nerve roots L4, l5, S1. The popliteus is the primary internal rotator of the knee while in a non-weight bearing position. In contrast, the popliteus externally rotates the femur on the tibia during load bearing which is often described as ‘unlocking’ of the knee joint. The popliteus, therefore, functions to provide both static and dynamic stability to the PLC of the knee joint. The PLC is a poorly understood area of the knee joint that can vary slightly from person to person; some authors have described no attachment of the popliteus to the lateral meniscus in 45% of cadavers7. The PLC has also been referred to as the arcuate complex, comprising the fibular collateral ligament (also called the lateral collateral ligament, LCL), arcuate ligament, popliteus muscle and tendon, popliteal fibular ligament, Fabello-fibular ligament, and posterolateral capsule – see table 1 for more detail8.
Posterior knee joint assessment
It’s not possible to cover the entire assessment of the posterior knee joint in this article, but one review draws on the essential key elements that should be included. Clinicians from the University of California outlined the physical assessment of the posterior knee joint. They concluded that an assessment must include joint movements, muscle activity, and ligament integrity testing. The instability of the PLC may involve a lesion to the popliteus but may also include some of the other structures of the PLC.
| Box 1: Posterior knee joint assessment recommendations |
|---|
| Assessment of the patient in standing and prone lying. Pain or ‘fullness’ in the posterior knee can be the sign of a cyst or a joint effusion. |
| Active and passive range of movement of the knee joint in flexion, extension, and tibiofemoral rotation. |
| Resisted knee flexion should be performed with the knee joint positioned in both neutral and external rotation. |
| Palpation of the joint line, the tendons of the hamstrings, gastrocnemius, and the popliteus should be carried out. |
| The posterior draw tests the integrity of the PLC and the posterior cruciate ligament (PCL). This test can be carried out by holding the proximal tibia and applying pressure in a posterior direction. Instability demonstrated at 90 degrees’ knee flexion indicates a PCL lesion, while instability and 30 degrees knee flexion indicate injury to the PLC. |
| It is essential to examine posterolateral rotational stability. There are several key tests to perform this such as the recurvatum test, reverse pivot shift, and dial tests. The recurvatum test can be performed by holding the great toe of the involved limb with the knee fully extended. Gently lift the extremity and a PLC injury may be evident if the knee falls into hyperextension, varus, and external rotation. |
Types of arthritis
More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:
- Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
- Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
- Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
- Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
- Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain, and redness. Septic arthritis often occurs with a fever, and there’s usually no trauma before the onset of pain. Septic arthritis can quickly cause extensive damage to the knee cartilage. If you have knee pain with any of these symptoms, see your doctor right away.
Other problems
Patellofemoral pain syndrome is a general term that refers to pain arising between the kneecap (patella) and the underlying thighbone (femur). It’s common in athletes; in young adults, especially those who have a slight mal tracking of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.
Risk factors
A number of factors can increase your risk of having knee problems, including:
- Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and downstairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
- Lack of muscle flexibility or strength. A lack of strength and flexibility can increase the risk of knee injuries. Strong muscles help to stabilize and protect your joints, and muscle flexibility can help you achieve a full range of motion.
- Certain sports or occupations. Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball jumps, and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of a knee injury. Jobs that require repetitive stress on the knees such as construction or farming also can increase your risk.
- Previous injury. Having a previous knee injury makes it more likely that you’ll injure your knee again.
Complications
Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage, and disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.
Prevention
Although it’s not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration:
- Keep extra pounds off. Maintain a healthy weight; it’s one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
- Be in shape to play your sport. To prepare your muscles for the demands of sports participation, take time for conditioning. Work with a coach or trainer to ensure that your technique and movement are the best they can be.
- Practice perfectly. Make sure the technique and movement patterns you use in your sports or activity are the best they can be. Lessons from a professional can be very helpful.
- Get strong, stay flexible. Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can contribute to injury, stretching is important. Try to include flexibility exercises in your workouts.
- Be smart about exercise. If you have osteoarthritis, chronic knee pain, or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics, or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.
Knee Injuries Exercises
Benefits of Massage for Knee Injuries
- Bringing blood flow to the joint.
- Improving circulation in the area.
- Reducing the swelling.
- Bringing in new joint fluid.
- Reducing overall pain and stiffness.
If you are dealing with issues like pain, stiffness, or swelling in your knees, massage may potentially be of benefit to you. Whether your symptoms are caused by osteoarthritis or another condition that impacts your joints, there is some evidence showing value in this supplementary treatment. While physical therapy or pain medication may be more frequently prescribed, massage can be an additional option that may positively impact your day-to-day function. Because many of the commonly prescribed treatments for knee pain have side effects and some are of limited benefit, many people are left searching for alternative options. One such treatment is knee massage. Several different studies have found that massaging a sore or arthritic joint can have a number of benefits including Massage may also help improve the tone and increase the overall flexibility of the muscles that lend support and stability to the affected knee. While these physiological benefits are important, what is truly impactful is the effect they may have on your daily life. Research seems to suggest that massage therapy can positively affect pain levels, stiffness, and overall day-to-day function in individuals dealing with osteoarthritis in their knees. This seems to be especially true in the short term when dealing with a flare-up of pain. One other benefit is that there are minimal side effects associated with massage. While this intervention is not meant to replace more traditional treatments like physical therapy, weight loss, and pain medication, it can be a nice supplement that rarely has negative consequences.
Tips for Knee Massage
If you want to try massage for your painful knees, it’s important to make sure you do so safely. First, be sure to speak to the healthcare provider that manages your pain to ensure that massage is appropriate for you. Certain styles of massage may be inappropriate and even harmful for people with an inflamed joint, so it is best to talk to your doctor first. Also if you have certain conditions, you may way to steer clear of massage as it may have a negative impact. These conditions include:
- Pre-existing high blood pressure
- Osteoporosis
- Varicose veins
Finally, it is crucial to remember that a massage should improve your pain, not make it worse. The “no pain, no gain” philosophy is not appropriate under these circumstances.
Self Massage
If you want to try self-massage, the American Massage Therapy Association suggests the following techniques to help maximize the benefit of your treatment. These strokes can be performed with or without a lubricating agent (like moisturizer cream) and may even be done over loose-fitting pants.
- Begin by rhythmically drumming the palm of your closed hands on the upper, middle, and lower portions of your thigh. Keep the pressure light and complete 30 to 60 seconds of tapping in each section of your leg before moving on. When you finish, repeat the entire process two more times.
- Next, sit with your knee extended and your heel on the floor. Use the palm of your hand and glide from the top of your thigh down to just above the knee. Release the pressure and repeat the stroke five to 10 more times.
- After you have finished with the top of the thigh, repeat this same sequence on the inner thigh and the outer thigh. Again, complete five strokes in each area.
- Once you finish with the thigh, use all of your fingers and press firmly into the tissue surrounding the knee itself. Manipulate the area back and forth in short strokes and complete five repetitions on the top, bottom, inside, and outside of the knee.
- Finally, sit with your legs extended in front of you and use the palm of your hand to glide down your leg to your knee cap, over to the outside of the thigh, and back up to the starting position again. Repeat this sequence five times before finishing the self-massage.
Pro Massage Therapist
Massaging your knee is also good for your body. Not only because it will relax you, but also it has a lot of advantages for your health.
Here are the Five Benefits of Massage Therapy for the Knees:
- Stimulates Blood Flow. This is the major thing that you can benefit from a knee massage. It allows blood and oxygen to get into the joint. The more blood flow you have in and around your knees, the more it is able to make healing faster and easier.
- Helps The Knee To Relax. By massaging your knees, it has the tendency to relax. And with a more relaxing knee joint, it begins the process by which your body is able to heal itself.
- Relieves Pain. If you are experiencing any knee pain, massaging it will help you relieve that throbbing feeling by putting the right amount of pressure on it. By doing this, it allows proper blood flow that will aid you in relieving the pain. You can experiment with different motions and how much pressure you apply to find a rhythm that feels best for you. If certain areas are tender, try to massage around them so you don’t cause yourself any further pain. But if you have a severe knee injury, a knee massage is not advisable. The rule of thumb is that if it hurts, don’t do it. This type of stimulation may be too intense for your knee and you may want to look for a more gentle treatment option.
- Soothes Your Mind. Knee Massage is not only good for your health, physically. But, it is also good for your mind. When you are stressed with activities at work, school, or at home, having a massage will have that peace of mind and will make you feel relaxed.
- More Practical. Rather than depending on medicines like pain relievers, why won’t you try massaging your knees by yourself? It saves money and you can avoid any adverse effects in your body.
For those who think that knee massage may be too painful, there is a great alternative, too. Passive stretches are the perfect way of relieving stress in the knees without the intensity of the massage. It allows the knees to find comfort where it once felt only pain. This relaxation allows the nerves in your knee to calm down, creating space so that they are not being squeezed. Just remember that the end goal of both activities is comfort and relaxation.
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If you are uneasy about performing a self-massage but still want to harness the potential of this treatment, a massage therapist can be a nice option. These professionals are trained to select the style of massage that is most beneficial for your painful or arthritic knees.
In fact, one study found that participants with knee osteoarthritis who received a weekly, 60-minute massage for eight weeks had lower pain and better daily function in the short term than those who received standard care. If you decide to visit a massage therapist, be sure to follow these helpful guidelines.
- Be open and clear with your therapist about your knee condition, including which movements or activities cause pain. This helps them customize your treatment to ensure it is beneficial.
- Communicate with the therapist if you are experiencing any pain during the massage. The ultimate goal is to reduce the pain, not increase it. As such, it is not productive to aggravate the area with overly aggressive techniques.
When to See a Doctor
While sore or arthritic knees can benefit from the massage techniques that are described above, it is important to pay attention to other important signs or symptoms that may suggest a more serious concern. If you are experiencing worsening pain, swelling, warmth, or redness in the knee or if your symptoms are accompanied by a fever or difficulty bearing weight through your legs, it is important to see your doctor. In addition, any knee pain that occurs after a trauma (like a fall or motor vehicle accident) should be reported to your physician immediately as more involved testing or treatment may be needed.
more info at: https://medlineplus.gov/kneeinjuriesanddisorders.html https://www.emedicinehealth.com/knee_injury/article_em.htm https://en.wikipedia.org/wiki/Knee_dislocation https://www.amtamassage.org/publications/massage-therapy-journal/knee-self-massage/
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.
