Knee pain: An overview of possible causes and therapies
The knee joint is the largest joint in the human body and enables, among other things, walking, running, jumping, standing and sitting. The angular joint consists of bones, articular cartilage, tendons, ligaments, muscles and other joint structures that can be affected or even destroyed by inflammation, injuries and signs of wear.
The knee is exposed to great stress. Above all, people with deformities such as bow legs or X legs, overweight or people who kneel a lot due to work, such as tilers, often have pain in the knee area. These are often noticeable in certain sporting activities, when running, climbing stairs and / or going downhill. The pain intensity ranges from mild, temporary symptoms to severe, persistent pain that restricts walking or even makes it impossible.
Knee pain is mostly due to injuries in young people, while older people are more likely to experience signs of wear and tear (arthrosis). Slight, briefly occurring knee problems often go away on their own. In the event of persistent complaints or injuries, for example after an accident, medical advice should be sought.
Knee pain is pain that occurs in the area of the knee. They can be located above, below, to the side, on or behind the kneecap as well as in the back of the knee or deep in the joint. The causes are diverse and range from a slight overload to progressive degeneration of the knee joint. Both the articular cartilage and the surrounding structures such as ligaments and muscles can be affected.
The knee joint connects the lower leg (shin, tibia) and the thigh (femur). The two crescent-shaped menisci (cartilage discs) in the knee joint act as a buffer between the two bones. At the front, the bony patella lies on the knee joint, which is held together by ligaments such as the inner, side and cruciate ligaments, and by muscles.
If one or more of these joint structures become ill or damaged, pain and other complaints such as restricted movement can occur. Depending on the cause, the pain can be felt as pressing, stinging or pulling. They can occur on, behind, below, above, or to the side of the kneecap, in the back of the knee, or inside the knee joint.
Those affected often feel it during certain sporting activities when they run, climb stairs and / or go downhill. In some cases, the pain radiates to the calf or thigh, sometimes buttocks also show up. If swelling occurs due to inflammation, the affected area is often red and overheated.
The duration and intensity of the complaints can vary greatly from case to case. For example, some sufferers experience only slight, temporary knee problems, while others have to deal with persistent, massive pain that leads to walking restrictions or even makes it impossible.
Knee pain from injury
Injuries are among the most common causes. For example, impact accidents and falls can cause fractures in the area of the knee joint, such as fractures of the kneecap, the thigh rolls or the shin plateau. Such fractures usually have to be treated surgically by performing osteosynthesis (surgical treatment of the fracture with implants). Affected bone parts are fixed with titanium or steel plates and so-called intramedullary nails or set screws. In addition, the joint surface, which is often indented in accidents, is relined with the body's own bone or ceramic material.
Fractures of the kneecap are rare, but heal well with simple fractures and appropriate care. In the event of transverse fractures, a surgical intervention must be carried out, since otherwise the tremendous strength of the quadriceps can lead to serious complications, such as failure to heal the fracture (pseudoarthrosis).
Accidental dislocations (dislocation) of the knee joint often lead to restricted usability, as many ligaments tear. A dislocation of the patella (patellar luxation) or a patellar lateralization in which the patella moves laterally due to instability are also possible.
The most common ligament tears in the area of the knee include cruciate ligament tears and internal or external ligament tears. A cruciate ligament rupture is often the result of sports accidents, for example when playing football, skiing or playing handball. The so-called flexion valgus external rotation position results in a cruciate ligament rupture, in which the knee is unintentionally bent, rotated in the X-leg position and turned outwards, while the lower leg remains stationary.
Cruciate ligament tears are accompanied by vascular tears that lead to bleeding in the knee joint. In the event of an accident, the knee cap tendon or the hamstring tendon may tear.
Injuries to the meniscus also often lead to knee problems. A meniscus rupture (meniscus tear), a meniscus crush, an abnormality such as the disc meniscus or degenerative changes to the meniscus can occur.
Overload as the cause of knee pain
Excessive strain can irritate the bones, cartilage, muscles, tendons and ligaments, which can result in inflammation. In patellar tip syndrome, this causes chronic overloading of the patellar extensor at the bone-tendon transition of the patellar tip.
The syndrome, also known as the "jumper’s knee" (English "Jumper’s knee"), shows a similar symptoms to that of the "tennis arm" and is often perceived as very painful. Overloading the patellar tendon leads to hardening and limescale deposits in the tendon attachment on the patella. Athletes who practice athletics or ball sports often suffer from patellar tip syndrome.
In so-called chondromalacia patellae, those affected also have severe knee pain. The disease, which is also called "Runner’s knee" in English, leads to softening and degeneration of the cartilage on the underside of the kneecap. Young and sporty people are particularly affected. The symptoms often appear on the front of the knee or in the form of kneecap pain.
Most of the time, overuse, particularly high force on the cartilage, functional disorders of the thigh muscles, trauma, chronic wear and inflammation of the knee joint, the x-leg position, a kneecap or a ligament weakness lead to chondromalacia patellae.
The pain syndrome referred to as “runner's knee” in German-speaking countries is a deficiency and overuse disease, the so-called iliotibial ligament syndrome, which also causes knee problems. They arise because the iliotibial tract (tendon plate that runs from the outside of the thigh to the shin) rubs against the bones of the knee joint. The irritation leads to inflammation of the tissue.
The so-called plica syndrome also frequently leads to knee pain, in which enlargements and thickenings or folds (plica) of the joint skin swell due to inflammation and form painful pinches in the joint. The folds can appear above and below the kneecap, laterally and towards the center of the joint, causing pain behind the kneecap as well as swelling and even cartilage damage. Power and cycling athletes are often affected. In addition, an earlier injury can lead to Plica syndrome.
Knee pain due to inflammation
Inflammation of the knee often leads to discomfort. Arthritis (inflammation of the joints) can have different causes. One of the most common forms of arthritis is rheumatoid arthritis. The cause of the disease is a malfunction of the immune system, so that your own joints and tissues are attacked and destroyed. That is why rheumatoid arthritis is an autoimmune disease. Usually it shows itself symmetrically through swelling of both knee joints, typical are morning stiffness of the joints and movement-dependent pain.
Other causes of inflammation can include, for example, irritation (e.g. in the runner's knee). Infections by viruses or bacteria can also cause inflammation in the knee area. These include the infectious diseases rubella, ringed rubella, hepatitis B, hepatitis C, HIV and mumps. Bacteria that can cause inflammation in the knee are, for example, staphylococci, streptococci, salmonella, campylobacter and borrelia. Fungi, such as the Candida genus, can also cause inflammation.
Pain in the knee is often due to what is known as bursitis, bursitis. In the knee, for example, there are bursae on the side, on or below the kneecap, or as a connection to the interior of the joint. The internal bursa are primarily injured when broken. The bursae in front of and below the kneecap are often inflamed due to the high pressure load to which they are subjected. For example, tilers are more often affected by chronic bursitis. But falls and crashes or an inflamed wound can cause bursitis.
People who are affected by so-called chronic internal knee diseases also often suffer from the Baker's cyst, a sac filled with fluid in the back of the knee. Causes include rheumatoid arthritis and chronic meniscal damage. If there is an injury or damage to the knee, more synovial fluid is formed due to inflammatory processes. As a result, the internal joint pressure increases, causing the surrounding connective tissue to relax. A cyst filled with fluid develops, the Baker's cyst.
Cartilage bone damage as the cause
Another disease that affects boys between the ages of 10 and 14, but also athletes, is Osgood-Schlatter's disease. In the case of the growth disorder, pieces of bone detach due to irritation of the patellar tendon (patellar tendon) on the anterior tibia and can die, resulting in what is known as aseptic osteonecrosis. This is a dead bone area at the base of the patellar ligament (patellar tendon) below the patella.
The causes are assumed to be training-related micro injuries or overloads, a reduced resilience of the tibia during hormonal changes in puberty, obesity and local circulatory disorders.
Sinding Larsen Johansson disease primarily occurs in male adolescents and athletes. The painful inflammatory reaction at the origin of the patellar tendon at the tip of the kneecap can cause a piece of bone to detach from the kneecap and die. The cause of Sinding-Larsen-Johansson's disease is an overload.
Knee pain in children and adolescents can also be attributed to Panner's disease (osteochondrosis dissecans). Bone necrosis mainly affects boys aged six to ten years. This leads to the formation of a so-called joint mouse, a free part of the cartilage bone, the cause of which is due to circulatory disorders, overloading or an unknown trigger. The free joint body can settle into the joint and cause severe pinching, damage to the cartilage and later arthrosis.
Another cause in young children (and less often adolescents) is Blount's disease. Affected people suffer from deformation of the lower leg bone due to a growth disorder in the medial growth plate.
Chondropathia patellae is a cartilage disease on the back of the kneecap. Typical complaints include pain when climbing stairs, getting up after long periods of sitting and squatting down. The articular cartilage on the back of the kneecap is subject to degenerative changes that only become painful when the degeneration has already progressed so far that the kneecap bone underneath is also affected. If the thigh bone is involved, the patient is referred to as patellofemoral pain syndrome. See also knee pain.
Pain in the knee due to metabolic disorders
The cause can be an acute gout attack. Crystals of uric acid that have not been broken down are deposited in the joints and internal organs, among other things, and can cause severe pain. Uric acid is also a metabolic product in healthy people. However, it is normally broken down sufficiently by the metabolism.
Metabolic disorders can lead to the formation of uric acid, which can result in deformity and damage to the joints. The so-called pseudo-gout is the formation and deposition of pyrophosphate crystals, which can also lead to severe joint pain.
People who suffer from hemophilia have knee pain due to bleeding in the joint. The first bleeding in a joint (initial bleeding) is often caused by an accident. Enzymes are released through the synovial membrane, through which the blood in the joint is broken down. Therefore, the synovia (joint lubrication), which is more heavily traversed by blood vessels, increases with large effusions. As a result, there is a cycle of bleeding and inflammation.
Other metabolic diseases that can lead to knee pain include hemochromatosis (iron storage disease) and hypercholesterolemia.
Joint wear as the cause of knee pain
Signs of wear in the knee joint (gonarthrosis) can lead to severe knee problems. The cartilage in the joint can be completely destroyed. Previous injuries such as a cruciate ligament tear or meniscal damage are often triggers. As the wear progresses, the patient can no longer move his joint without being in pain.
In the worst case, the knee stiffens. Therefore, therapies for gonarthrosis not only aim to relieve those affected of the symptoms, but also to maintain the mobility of the joint. This may require surgery and even an artificial knee joint. With early treatment, wear can be stopped in most cases.
Furthermore, knee and leg pain can occur with growing pains, a flexible joint, chronic fatigue syndrome, fibromyalgia and tumors. Due to the large number of possible causes, these explanations represent only a selection of the more frequently occurring triggers. In principle, a doctor should be consulted in the event of persistent or recurring complaints.
Risk factors include activities that are performed while kneeling or crouching, such as tiling or parquet laying, as well as sports that can strain the knee, such as running or skiing. However, the main risk factor for pain in the area of the knee is overweight due to the increased joint strain and lack of exercise.
Because the causes range from a short-term overload to accidents to metabolic diseases, a differentiated diagnosis is important. The doctor will first ask questions about possible accidents and previous illnesses. The exact localization of the pain is also important in order to track down the cause. The doctor will carry out various movement tests so that a movement restriction - if any - can be determined.
External examination of the knee can provide information about swelling and redness. Depending on the case, further examinations such as X-rays, blood tests, for example for inflammation values, ultrasound examinations (sonographies), magnetic resonance imaging (MRI), joint punctures during joint effusions and arthroscopies (knee joint mirrorings) are necessary.
Treatment for knee pain
The treatment depends on the cause of the problem. While short-term, acute complaints often go away on their own, persistent and / or recurring pain in the knee requires therapy. Anti-inflammatory pain relievers are often prescribed. In addition, joint injections and joint irrigation with cortisone-containing agents are used if necessary. Local analgesics can also be administered into the joint.
It depends on the diagnosis whether movement or protection is sensible. Good results are often achieved with physiotherapy. In addition, special muscle training for strengthening and stretching, certain sports such as swimming or cycling, heat or cold therapy, water and bath therapy, ultrasound therapy or orthopedic bandages, shoe heels or walking supports can help.
If these therapies do not provide relief, surgery may be necessary. Usually surgery is performed using arthroscopy (knee mirroring). If the degeneration of the knee joint is already very advanced, an artificial joint can be used.
In addition to adequate, adequate exercise, a balanced diet is also preventative. In this way, bones and cartilage are supplied with all important nutrients. At the same time, the composition and amount of synovial fluid is positively influenced, which ensures reduced friction between the joint partners. If the knee is moved, it mixes the synovial fluid and "oils" it at the same time, so that the cartilage is also nourished.
Naturopathic treatment for knee pain
From the perspective of naturopathy, knee pain is always viewed in the context of other body structures. For example, the nerve (nervus femoralis), which is responsible for supplying the knee, runs from the lumbar spine between two muscle parts of the hip flexor (M. Iliopsoas). However, this muscle is often shortened by sitting for long periods in the office and lack of exercise. If pain occurs after getting up or without mechanical stress and there is no conventional medical explanation, the complaints in osteopathy are often viewed as a result of a pinching off of this nerve.
Acupuncture has long been used in Europe as part of traditional Chinese medicine (TCM) to relieve symptoms. Thin needles are placed at certain points along meridians (orbits in which the life energy "Qi" flows).
The procedure by which these points are heated is called moxibustion, the massage of the points acupressure. Acupuncture can provide relief, especially for knee arthrosis. This is proven by scientific studies.
Therapy with leeches placed on the skin can be promising. The leeches release many health-promoting substances with their saliva (salvia). For example, the enzymes widen the blood vessels, inhibit blood clotting and have anti-inflammatory and analgesic effects.
Other methods used in naturopathy are cupping, in which cupping glasses are pulled along the muscle pathways, and Ayurveda therapy, which consists of a combination of massages, external applications with herbal oils and bags, a special diet and yoga exercises.
Phytotherapy, which uses various medicinal plants, is also often part of the natural treatment for knee pain. (ag)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Detmar Jobst, Martin Mücke: Knee pain with osteoarthritis signs, DEGAM S1 recommendation for action, German Society for General Medicine and Family Medicine (DEGAM), (accessed 02.09.2019), AWMF
- Michael Hammer: Rheumatoid Arthritis (chronic polyarthritis), Deutsche Rheuma-Liga Bundesverband e.V., (accessed 02.09.2019), Rheumatism League
- Frank Pessler: Chondromalacia patellae, MSD Manual, (accessed 02.09.2019), MSD
- Danielle Campagne: Injuries to the Knee Extension Mechanism, MSD Manual, (accessed September 2, 2019), MSD
- Kay Bartrow: Knee weak point: Targeted practice for pain, injuries and arthrosis, Trias Verlag, 2015