Knee Pain: What Could Be Wrong and How to Treat it
If you suffer from chronic knee pain or knee joint instability, this practical guide can help you understand what structures may be injured, and how your condition can be treated.
Your first visit will involve a discussion of your current and past medical history, as well as an orthopedic exam of the injured area and any surrounding areas that may be contributing. 
For example, knee pain may be related to a problem within the ankle or the arch of the foot, so both areas are always looked at.
When the knee is assessed, I will examine the location of the pain, when the pain occurs, and what symptoms are experienced.
Here is a basic guide:
Location of the Pain
- Back of the knee – Baker’s cyst
- Front of the knee – Chondromalacia patella, Osgood Schlatter Disease, Patellar tendinitis
- Medial knee – MCL (Medial Collateral Ligament) Sprain or Tear, Medial meniscus injury, Osteoarthritis
- Lateral knee – LCL (Lateral Collateral Ligament) Sprain or Tear, Lateral meniscus injury, IT band syndrome (Iliotibial), Osteoarthritis
Common Symptoms and What They Mean
- Instability or ‘Giving out’ – Sprain or tear of the knee ligaments (ACL, PCL, MCL, LCL)
- Popping sound – When a pop is heard during an injury, it can indicated a tear of a knee ligament (ACL, PCL, MCL, LCL)
- Grinding or crepitus – Indicates advanced osteoarthritis where the bone has ground away the cartilage within the joint. This can be due to extensive ‘wear and tear’ or may develop secondary to an injury that did not heal properly
- ‘Bone on bone’ sensation – Also indicates advances osteoarthritis
- ‘Catching’ or locking – May indicate a medial meniscus tear, also known as a Bucket Handle Tear. Osteochondritis dessicans, also known as ‘joint mice’ can cause these symptoms as well. Joint mice are fragments of loose bone that are floating around within the joint fluid. Joint mice are usually due to poor healing after knee trauma.
- Swelling – If swelling occurs, it may indicate either an acute injury such as a recent ligament tear or fracture. Chronic fluid effusion from the joint may indicate weakness or a defect in the joint capsule, for example in the case of a Baker’s Cyst, where fluid is allowed to leak out of the back of the knee joint. Chronic fluid effusion may also indicate an injury within the joint or surrounding ligaments leading to friction, low-grade inflammation and swelling. *Swelling with heat, redness, pain and fever indicates infection which is a medical emergency.
Timing of the Pain
- First thing in the morning – Pain first thing in the morning that resolves with movement generally indicates osteoarthritis
- After prolonged sitting – Osteoarthritis
- After prolonged standing – Knee ligament laxity
- Going up stairs – ACL or PCL injury
- Going down stairs – Chondromalacia patella, ACL or PCL injury
- Going up or down spiral staircases – MCL, LCL, medial or lateral meniscus injury
Treatments for Knee Pain
Conventional treatment for knee injury usually includes the RICE protocol which involves Rest, Ice, Compression and Elevation. Often ASA (Aspirin), Ibuprofen and other NSAIDs are taken as well. While these treatments may be effective in reducing swelling and inflammation for an acute injury, they interrupt the body’s natural healing process and are not useful for sub-acute and chronic joint injury.
Mobility + Strengthening
For chronic knee pain, mobilizing and strengthening exercises are essential for healing. A joint that is immobilized with rest or bracing will not lubricate itself with joint fluid, and the cartilage and other connective tissues within the joint will dry out and become stiff.
Strengthening exercises are targeted at muscles groups surrounding the knee to stabilize the joint and prevent re-injury if imbalance in the musculature of the leg exists.
After your first visit, you will be given exercises to do at home that promote joint movement, muscle strengthening, and proper joint tracking. Other types of exercise such as swimming, pool running, qi gong, or cycling may be recommended.
Prolotherapy
Prolotherapy is a nonsurgical treatment for damaged cartilage and stretched or torn ligaments. This treatment has an 85% response rate and is highly effective for repairing knee damage and alleviating chronic knee pain and instability.
Prolotherapy injections usually contain a combination of dextrose (a sugar), lidocaine (anaesthetic) and saline. Injections are targeted where ligament and tendon insert onto the bone, and intra-articular injections into the joint space can also be done on the knee to access the anterior and posterior cruciate ligaments and the articular cartilage.
Injection of dextrose creates a controlled and localized area of inflammation where connective tissue injury has occurred. As a result, the body’s own healing cells are brought to the site of the injury and lead to rebuilding of ligament, tendon and cartilage tissue. Imaging studies show that injuries treated with prolotherapy promotes normal repair of dense, organized connective tissue fibers, in contrast to the disorganized fibers and scar tissue seen after chronic injury.
Prolotherapy can be used to treat a variety of knee conditions including:
- ACL, PCL, MCL, LCL tear or sprain
- Meniscus damage, Bucket handle tear
- Osteoarthritis
- Osgood Schlatter disease
- Patellar tendinitis
