KNEE PAIN - when every step hurts

In younger people the most common causes of knee pain are injuries to the ligaments and meniscus due to strain, especially in athletes. In older people it is usually a matter of degenerative diseases and other inflammatory processes. Genetics, as well as physical (in)activity, also play an important role.

Physical activity is important because only strong muscles stabilize the knee joint and prevent it from being overloaded. However, excessive physical activity can also lead to damage to the joint due to prolonged and excessive load. This often happens with professional athletes. Below are the most common causes of knee disorders:

• Knee injury. Knee injuries most often occur during sports activities due to high physical load or an inadequate body position. The meniscus and the anterior cruciate ligament, which serves to stabilize the knee joint, are most often affected.
  More serious injuries are treated surgically, while milder injuries are successfully treated with physical therapy.
• Limited movement (knee contracture). Limited knee movement or knee contracture occurs relatively often after injuries or operations. Before or after surgical procedures, the knee is placed in a state of rest using a cast, bandage or splint. When the recovery period begins, it is important to start bending the knee as soon as possible in order to restore mobility and synovial fluid to the joint.
  To achieve faster mobility after surgical interventions, therapy with continuous passive mobilization using a CPM device is effective. In addition to the knee, the CPM device can be used for therapy of the elbow, hip, shoulder joint and ankle joint.
• Patellofemoral instability. During certain movements the kneecap shifts and moves out of its usual position. Treatment is carried out with rest (immobilization), and then with physical therapy. In rare cases, surgical intervention is necessary.
• Iliotibial band syndrome. The iliotibial band (ITBS) is a ligament that extends from the outer side of the thigh to the outer part of the knee. Due to friction against the bone, this ligament can become irritated and lead to swelling.
  It most often appears in people who run regularly. The knee pain usually subsides once the injured area warms up. If the injury is more serious, the pain will become stronger and in that case medical intervention is necessary.
• Osgood-Schlatter disease. It most often occurs in boys up to 18 years of age whose bones and other parts of the knee are still developing. A painful lump or swelling may appear below the knee. The condition can worsen due to excessive physical activity, and as physical activity decreases the pain also subsides.
• Jumper’s knee. Jumper’s knee usually occurs in athletes due to chronic damage to the tendon that extends the knee. Knee pain occurs while running or jumping. Treatment is carried out with rest and the use of appropriate medications (analgesics).
• Prepatellar bursitis. As a consequence of trauma or due to the deposition of crystals, inflammation of the bursa located on the front of the knee can occur. It occurs in patients who, most often due to the nature of their work, spend long periods in a kneeling position. For this reason this type of pain is popularly known as “floor-layer’s knee”.
  Treatment is carried out with rest and analgesics, while in more severe cases the bursa needs to be drained.
• Pes anserine bursitis. It represents inflammation of the bursa located beneath the pes anserinus tendon in the knee. The cause of the inflammation may be excessive physical activity, and it often occurs in people who suffer from diabetes or have insulin resistance. The pain in the knee manifests in the inner part of the knee, and pain below the knee, redness and elevated temperature often occur. In most cases it is treated with the application of cold compresses and anti-rheumatic ointments.
• Arthritis of the knee. Like any other joint, the knee can be affected by rheumatoid arthritis. The disease can develop suddenly, and a large amount of fluid is often present in the knee. The diagnosis is usually defined on the basis of analysis of the synovial fluid from the knee. In a joint affected by arthritis there is always a large amount of white blood cells (leukocytes). In degenerative diseases and injuries the number of white blood cells is low.
• If you have difficulty bending or extending the leg, the knee is painful and stiff, and after prolonged movement swelling occurs, it is possible that this is osteoarthritis. All of the listed complaints arise as a consequence of wear of the knee cartilage.
  The disease occurs more often in people over 65 years of age, but younger people are not spared either. It most often occurs in those people who have overloaded the knee too much or have had injuries to various parts of the knee.
• Inflammatory arthritis. The symptoms of this type of arthritis are knee pain, nausea and vomiting. As with other autoimmune diseases, the immune system, which should fight against microbes, mistakenly attacks a part of the body, in this case the knee.
• Knee pain due to gout and CPPD. Gout is an inflammatory arthritis that arises due to a high level of uric acid in the blood. This happens due to improper functioning of the kidneys, urinary infections, inflammation of the bladder and similar bacterial infections. Uric acid that remains in the body causes sudden severe pain in the joints, swelling, redness and inability to move.
  The disease called calcium pyrophosphate dihydrate deposition (CPPD) is a type of arthritis that, if left untreated, can lead to degeneration, inflammation and disability. There appears swelling, redness and pain.

• Septic arthritis. An extremely painful infection of the joint that arises when microbes reach the joint through the bloodstream and infect it. The pain is very strong and intense, and it often arises as a consequence of open wounds.
• Knee pain due to gonarthrosis. Gonarthrosis is a common degenerative disease that begins with mild pain that occurs with greater physical load. The pain is periodic, so visits to the doctor are often postponed. That is why the diagnosis of gonarthrosis is established several years later compared to the first signs of the disease.
  In the initial stages of the disease, pain occurs when going down the stairs. As the disease progresses the pain is felt even during everyday walking, and sometimes even while lying in bed. Gonarthrosis requires a visit to the doctor and further treatment.

• Baker’s cyst (popliteal cyst). A Baker’s cyst is a cavity located at the back of the knee that is filled with synovial fluid. If the cyst is large, it can create a feeling of tightness and cause pain behind the knee. A Baker’s cyst can rupture and its contents can leak into the lower leg. In adults this problem is usually associated with gonarthrosis.
  A Baker’s cyst is treated by draining the contents from the knee and applying local corticosteroids that are used to relieve inflammation.