Most people have had a minor knee problem at
one time or another. Most of the time our body movements do not cause problems,
but it's not surprising that symptoms develop from everyday wear and tear,
overuse, or injury. Knee problems and injuries most often occur during sports
or recreational activities, work-related tasks, or home projects.
The knee is the largest joint in the body. The upper and lower bones of
the knee are separated by two discs (menisci). The
upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected
by
ligaments,
tendons, and muscles. The surface of the bones inside
the knee joint is covered by
articular cartilage, which absorbs shock and provides
a smooth, gliding surface for joint movement. See an illustration of the
structures of the knee.
Although a knee problem is often caused by an
injury to one or more of these structures, it may have another cause. Some
people are more likely to develop knee problems than others. Many jobs, sports
and recreation activities, getting older, or having a disease such as
osteoporosis or arthritis increase your chances of
having problems with your knees.
Sudden (acute) injuries
Injuries are the most
common cause of knee problems. Sudden (acute) injuries may be caused by a
direct blow to the knee or from abnormal twisting, bending the knee, or falling
on the knee. Pain, bruising, or swelling may be severe and develop within
minutes of the injury. Nerves or blood vessels may be pinched or damaged during
the injury. The knee or lower leg may feel numb, weak, or cold; tingle; or look
pale or blue. Acute injuries include:
Sprains,
strains, or other injuries to the ligaments and
tendons that connect and support the kneecap.
A tear in the
rubbery cushions of the knee joint (meniscus).
Breaks (fracture) of the
kneecap, lower portion of the femur, or upper part of the tibia or fibula. Knee
fractures are most commonly caused by abnormal force, such as a falling on the
knee, a severe twisting motion, severe force that bends the knee, or when the
knee forcefully hits an object.
Kneecap
dislocation. This type of dislocation occurs more
frequently in 13- to 18-year-old girls. Pieces of bone or tissue (loose bodies) from a fracture or dislocation may get caught in the joint and
interfere with movement.
Knee joint
dislocation. This is a rare injury that requires great
force. It is a serious injury and requires immediate medical care.
Overuse injuries
Overuse injuries occur with
repetitive activities or repeated or prolonged pressure on the knee. Activities
such as stair climbing, bicycle riding, jogging, or jumping stress joints and
other tissues and can lead to irritation and inflammation. Overuse injuries
include:
Inflammation of the small sacs of fluid that
cushion and lubricate the knee (bursitis).
Inflammation of the tendons
(tendinitis) or small tears in the tendons
(tendinosis).
Thickening or folding of the knee ligaments (Plica
syndrome).
Pain in the front of the knee from overuse, injury,
excess weight, or problems in the kneecap (patellofemoral pain syndrome).
Irritation and inflammation of the band of
fibrous tissue that runs down the outside of the thigh (iliotibial band syndrome).
Conditions that may cause knee problems
Problems
not directly related to an injury or overuse may occur in or around the
knee.
Osteoarthritis
(degenerative joint disease) may cause knee pain that is worse in the morning
and improves during the day. It often develops at the site of a previous
injury. Other types of arthritis, such as
rheumatoid arthritis,
gout, and
lupus, also can cause knee pain, swelling, and
stiffness.
Osgood-Schlatter disease causes pain,
swelling, and tenderness in the front of the knee below the kneecap. It is
especially common in boys ages 11 to 15.
A problem elsewhere in the body, such as a
pinched nerve or a problem in the hip, can sometimes cause knee pain.
Osteochondritis dissecans causes pain and decreased
movement when a piece of bone or cartilage or both inside the knee joint loses
blood supply and dies.
Treatment
Treatment for a knee problem or injury
may include first aid measures, rest, bracing, physical therapy, medicine, and
in some cases surgery. Treatment depends on the location, type, and severity of
the injury as well as your age, health condition, and activity level (such as
work, sports, or hobbies).
Review the Emergencies and Check Your Symptoms
sections to determine if and when you need to see a doctor.
After
an acute (sudden) injury, there is an obvious broken bone with pieces of bone
visible in a wound or a bone sticking through the skin. Note: Do not try to push the bone back into the skin. Cover
the area with a clean bandage.
Check Your Symptoms
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review
health risks that may increase the seriousness of your
symptoms.
If you have any of the following
symptoms, evaluate those symptoms first.
After
an acute (sudden) injury, there is an obvious broken bone with pieces of bone
visible in a wound or a bone sticking through the skin. Note: Do not try to push the bone back into the skin. Cover
the area with a clean bandage.
Check Your Symptoms
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review
health risks that may increase the seriousness of your
symptoms.
If you have any of the following
symptoms, evaluate those symptoms first.
If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.
Home Treatment
Home treatment may help relieve
pain, swelling, and stiffness.
Rest and protect an injured or sore area.
Stop, change, or take a break from any activity that may be causing your pain
or soreness. When resting, place a small pillow under your
knee.
Ice will reduce pain and swelling.
Apply
ice or cold packs immediately to prevent or minimize swelling. Apply the ice
or cold pack for 10 to 20 minutes, 3 or more times a day.
For the first 48 hours after an injury,
avoid things that might increase swelling, such as hot showers, hot tubs, hot
packs, or alcoholic beverages.
After 48 to 72 hours, if swelling is
gone, apply
heat and begin
gentle exercise with the aid of moist heat to help
restore and maintain flexibility. Some experts recommend alternating between
heat and cold treatments.
Compression, or wrapping
the injured or sore area with an elastic bandage (such as an Ace wrap), will
help decrease swelling.
Don't wrap it too tightly, since this can
cause more swelling below the affected area. Loosen the bandage if it gets too
tight. Signs that the bandage is too tight include numbness, tingling,
increased pain, coolness, or swelling in the area below the
bandage.
Don't expect the bandage to protect or stabilize a knee
injury.
Talk to your doctor if you think you need to use a wrap for
longer than 48 to 72 hours; a more serious problem may be present.
Elevate the injured or
sore area on pillows while applying ice and anytime you are sitting or lying
down. Try to keep the area at or above the level of your heart to help minimize
swelling.
Reduce stress on your sore knee (until you can get advice
from your doctor):
Use a cane or crutch in the hand opposite
your painful knee.
Use two crutches, keeping weight off the leg
with the sore knee. You can get canes or crutches from most pharmacies.
Crutches are recommended if a cane causes you to walk with a limp.
Gently massage or rub the area to relieve pain
and encourage blood flow. Do not massage the injured area if it causes
pain.
Try the following exercises to maintain flexibility:
Avoid high-impact exercise, such as running,
skiing, snowboarding, or playing tennis, until your knee is no longer painful
or swollen.
Do not smoke. Smoking slows healing because it decreases
blood supply and delays tissue repair. For more information, see the topic
Quitting Tobacco Use.
Medicine you can buy without a prescription
Try a nonprescription
medicine to help treat your fever or pain:
Note: Do not use
a nonsteroidal anti-inflammatory medicine, such as ibuprofen or aspirin, for
the first 24 hours after an injury. Using these medicines may increase the time
it takes your blood to clot and cause more severe bruising from bleeding under
the skin.
Aspirin (also a nonsteroidal
anti-inflammatory drug), such as Bayer or Bufferin
Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.
Safety tips
Be sure to follow
these safety tips when you use a nonprescription medicine:
Carefully read and follow all
directions on the medicine bottle and box.
Do not take more than
the recommended dose.
Do not take a medicine if you have had an
allergic reaction to it in the past.
If
you have been told to avoid a medicine, call your doctor before you take
it.
If you are or could be pregnant, do not take any medicine other
than acetaminophen unless your doctor has told you to.
Your knee, lower leg, or foot becomes pale or cool or
looks blue.
Symptoms do not improve with home
treatment.
Symptoms become more severe or frequent.
Prevention
The following tips may prevent knee
problems.
General prevention tips
Wear your seat belt in a motor
vehicle.
Don't carry objects that are too heavy. Use a step stool.
Do not stand on chairs or other unsteady objects.
Wear knee guards
during sports or recreational activities, such as roller-skating or soccer.
Stretch before and after physical exercise, sports, or
recreational activities to warm up your muscles.
Use the correct
techniques or positions during activities so that you do not strain your
muscles.
Use equipment appropriate to your size, strength, and
ability. Avoid repeated movements that can cause injury. In daily routines or
hobbies, look at activities in which you make repeated knee
movements.
Consider taking lessons to learn the proper technique
for sports. Have a trainer or person who is familiar with sports equipment
check your equipment to see if it is well suited for your level of ability,
body size, and body strength.
If you feel that certain activities
at your workplace are causing pain or soreness from overuse, call your human
resources department for information on other ways of doing your job or to talk
about using different equipment.
Tips specific to the knee
Keep your knees and the muscles that support
them strong and flexible. Warm up before activities. Try the following
stretches:
Avoid activities that stress your knees, such
as deep knee bends or downhill running.
Wear shoes with good arch
supports.
Do not wear high-heeled shoes.
When playing
contact sports, wear the right shoes that are made for the surface you are
playing or running on, such as a track or tennis court.
Replace
running shoes every 300 to 500 miles (480 to 800 kilometers).
Tips specific to female athletes
Sports trainers
recommend training programs that help women learn to run, jump, and pivot with
knees bent to avoid knee injuries. In sports such as soccer, basketball, and
volleyball, women who bend their knees and play low to the ground have fewer
knee injuries than women who run and pivot with stiff legs.
Knee brace use
Some people use knee braces to
prevent knee injuries or after a knee injury. There are many types of knee
braces, from soft fabric sleeves to rigid, metal hinged braces, that support
and protect the knee. If your doctor has recommended the use of a knee brace,
follow his or her instructions. If you are using a knee brace to help prevent
problems, follow the manufacturer's instructions for use.
Keep bones strong
Eat a nutritious diet with enough
calcium and
vitamin D, which helps your body absorb calcium.
Calcium is found in dairy products, such as milk, cheese, and yogurt; dark
green, leafy vegetables, such as broccoli; and other foods. For more
information, see the topic
Healthy Eating.
Exercise and stay active.
It is best to do weight-bearing exercise, such as walking, jogging, stair
climbing, dancing, or lifting weights, for 45 to 60 minutes at least 4 days a
week. Weight-bearing exercises stimulate new bone growth by working the muscles
and bones against gravity. Exercises that are not weight-bearing, such as
swimming, are good for your general health but do not stimulate new bone
growth. Talk to your doctor about an exercise program that is right for you.
Begin slowly, especially if you have been inactive. For more information, see
the topic
Fitness.
Avoid drinking more than one
alcoholic drink per day. People who drink more than this may be at higher risk
for weakening bones (osteoporosis).
Alcohol use also increases your risk of falling and breaking a
bone.
Stop or do not begin smoking. Smoking puts you at a much
higher risk for developing osteoporosis. It also interferes with blood supply
and healing. For more information, see the topic
Quitting Tobacco Use.
Possible abuse
Bruises are often the first sign of
abuse. Seek help if:
You suspect abuse. Call your local child or
adult protective agency, police, or a doctor, nurse, or
counselor.
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