The knee is a very unique joint. It serves to bear weight and has many structures within and around it.
Inner knee pain is a symptom associated with injuries from overuse, sports activities or long-term wear and tear.
Inner Knee Pain Causes
1. Knee Contusion
This occurs when there is a blunt force directed to the knee or after a fall. It presents as a blue-black coloration of the knee skin, swelling, stiffness, and difficulty in bending the knee.
2. Arthritis
This is is an inflammatory joint disorder, it presents as joint pain or stiffness. It is most common in women and occurs more with aging. Children can also have arthritis.
There are different forms of arthritis but the major types of arthritis that affect the knee are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
Osteoarthritis
It is the most common form of knee arthritis, mostly seen in people over 50 years. It is degenerative wear and tear of the cartilage in the joint that causes two ends of bones to rub against each other.
Rheumatoid Arthritis
It is an autoimmune disorder where the immune system attacks the normal tissues – cartilages, ligaments or bones in the joint.
Post-traumatic Arthritis
Developed after a knee injury.
3. Medial Collateral Ligament Injury (MCL Injury)
Sometimes an injury can lead to the overstretching of knee ligaments. A partial or complete tear of the MCL can occur with sharp knee twisting or a direct impact.
It is more common in athletic activities like soccer, football, rugby, and martial arts.
Other associated symptoms include:
- Swelling
- A locking knee
- Popping sound at the time of impact
- Instability while walking or standing
4. Medial Meniscus Tear
The medial meniscus can tear during sports or after a fall. It can be injured along with the anterior cruciate ligament or medial collateral ligament. It is also seen in older people due to the degeneration of the meniscus. It also causes knee swelling and instability.
5. Synovial Plica Irritation (Plica Syndrome)
Synovial plica is a fold of synovial membrane located on the inside of your kneecap, it can become inflamed or irritated following a sudden twist. Other symptoms associated are a locking knee and cracking sound.
6. Pes Anserine Bursitis
A bursa is a fluid-filled sac that helps the movement across a joint.
Pes Anserine Bursitis is the inflammation of the bursa located at the medial side of the knee, where the MCL attaches to the shinbone (tibia). There is an excess production of synovial fluid causing pressure and swelling.
Its causes are:
- Obesity
- Osteoarthritis
- Medial meniscus tear
- A tight hamstring muscle
Who’s At Risk?
- Athletes
- Sportsmen
- Seniors
- Overweight individuals
Predisposing Factors
The followings are underlying factors that can predispose to knee pain:
- Increased wear and tear of the knee
- Poor sporting or exercise techniques
- Repetitive stress
- Direct impact or injury
- Weak leg muscles
When To See A Doctor
If the pain is severe, persistent or associated with other symptoms like difficulty walking or a fever, you should see your doctor for a diagnosis and treatment.
Diagnostic Tests
A doctor will take a detailed history of symptoms, your medical history and then examine the affected knee. Imaging such as X-ray or MRI may be required to determine the exact cause of pain or extent of the injury.
The doctor will then recommend an appropriate and effective treatment depending on the severity of your symptom.
Treatment
RICE Therapy:
RICE is an acronym. Here’s what it means:
- Rest– avoid physical activity and keep your leg still. Your doctor may recommend using crutches in severe cases.
- Ice– apply cold packs to the back of your thigh for 15 to 20 minutes every two to three hours during the day. Don’t apply ice directly to your skin, you can wrap it in a tea towel.
- Compression– compress by wrapping a bandage around the thigh to limit any swelling and movement that could cause further damage.
- Elevation– keep your leg raised and supported on a pillow as much as possible, to help reduce any swelling.
Medication:
Acetaminophen and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) help to alleviate symptoms of inflammation such as pain and swelling.
Electrotherapy:
Ultrasound, laser therapy and transcutaneous electrical nerve stimulation (TENS) are forms of electrotherapy, which are beneficial in relieving pain and reducing swelling.
Ultrasound treatment involves applying high-frequency sound waves to the injured tissues while transcutaneous electrical nerve stimulation involves applying electric currents to the tissue around the injury.
Surgery:
Conservative treatment is usually the first treatment of choice even in a minor tear of ligament or meniscus. Sometimes, especially when an almost full function needs to be restored (like in athletes), surgery may be preferred.
In severe cases of arthritis, knee replacement surgery is usually performed with good outcomes.
Steroidal Injections:
Corticosteroid injections are useful for treating flare-ups pain and swelling with fluid buildup in the knee like in pes anserine bursitis.
Physical Therapy:
Gentle exercise and stretches help alleviate the pain. You should consult your doctor to find out when you can start physical therapy. It helps increase your knee mobility.
Assistive Devices
Assistive devices in the form of braces provide stability and support during daily and athletic activities. Each knee brace has a specific function.
- Knee Brace: Protects and supports the knee, while alleviating joint pain. It can also be used as a preventive measure.
- Hinged Knee Brace: Stabilize the knee, controls your knee range of motion and prevents hyperextension.
- Knee Sleeve: used for compression of the leg to promote healing. It provides less knee support.
- Patella Strap: Places pressure on the tendon below the knee to spread pressure and alleviate stress on the joint.
- Taping: Taping is similar to wrapping bandage around your knee. A good taping technique can provide excellent support similar to the hinged knee braces, but the effectiveness of tape will reduce over time as the tape stretches slightly.
- Massage Therapy: Frictional massage can be done after healing of ligament injury by yourself or a therapist. It should be avoided in the early acute stages.
- Glucosamine and Chondroitin Sulfate Supplements: They are used in osteoarthritis of the knee, it is believed to promote formation as well as cartilage healing.
- Hyaluronic Acid Injection: Hyaluronic acid is a component of the synovial fluid, loss of it appears to contribute to joint pain and stiffness. Studies have shown that hyaluronic acid injections may help more than pain-relief medications for some people with osteoarthritis.
Prevention
It should be noted that not all knee injuries are preventable as some are related to aging or overuse. Exercises to strengthen and stretch the leg muscles before sporting activities are effective ways to prevent knee injuries.
Also, maintaining a healthy weight is one way to prevent arthritis or its complications.
Summary
Knee pain is a common symptom of many different knee injuries. You can apply the RICE therapy initially when you notice any discomfort in your knee. Consulting your doctor will be appropriate once the pain is persistent or you notice other symptoms like joint swelling or stiffness.
He has worked as a team physician for the Detroit Lions, Western Illinois University, Southeastern Iowa Community College, and several high schools.
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