Knee Pain: Causes and what to do

The knee is affected by many sports and everyday injuries, which, in turn, can cause bone fractures, ligament strains and tears, cruciate ligament tears or even meniscus injuries. Furthermore, osteoarthritis (of the knee) can occur as a consequence of the above-mentioned injuries or as part of the natural aging process.

Generally, the causes of knee pain can be summarized as follows:

• Injuries (for example sports injuries)
• Osteoarthritis (wear and tear of the joint)

Often, degenerative changes in the knee joint start to become noticeable at the age of 35 years. Such degenerative changes can have different causes:
 
Malalignment (deviations of the normal knee joint axis, e.g. bowlegs or knock knees) and overloading, injuries and vascular diseases, or be a consequence of joint disorders (such as rheumatism). 

However, studies also show that a degenerative change of the knee joint can be present without any symptoms, i.e. the affected person does not feel any pain although they display signs of wear and tear. 

In the case of painful degenerative changes in the knee area, stabbing or pulling pains after long rest periods, such as morning start-up pain, are typical. If there is permanent or increasing discomfort in the knee joint, regular exercise and training are usually the remedy of choice. 

In individual cases, stretching and bending or general strain on the knee may also become painful over time. Depending on the cause and severity, knee pain should be treated conservatively, for example, with anti-inflammatory painkillers, physical therapy and exercises. Surgery is only necessary in the rarest of cases.

For prevention purposes, timely measures are recommended, which can also be carried out by the affected individual. These include muscle strengthening through targeted exercises and, if necessary, using supportive braces.

TThe knees are often under a lot of strain in everyday life and sports. They cushion jumps and are in constant alternation between stretching and bending when walking and running. Tendons, ligaments, muscles, fascia and cartilage in the knee joint are involved in these movements, and these naturally wear out over the course of a human life. How quickly wear and tear progresses depends on a variety of factors.

The knee joint is often subjected to heavy physical strain in everyday life and is, therefore, susceptible to injury. In the case of so-called non-specific or functional knee pain, discomfort occurs due to, for example, muscular imbalances despite an absence of any pathological findings such as an injury or arthrosis. However, the knee joint is also a load-bearing structure, which becomes healthier and stronger the more load we put on it. Despite the lifelong stress on these joints, the majority of people do not experience any health problems regarding their knee joints. The reasons why some people are more prone to develop pain due to osteoarthritis than others are not yet conclusively understood. However, like back pain, injuries of larger joints are always a multifactorial event and, thus, numerous factors have an influence, including lifestyle, genetic conditions, diet, exercise and mental health.

In order to take targeted action against knee pain, you should know its cause. The most common triggers are:

Once the cause has been found, you can treat knee pain specifically. If there is an acute sports injury such as a torn ligament, you should apply the R.I.C.E. rule (rest, ice, compression, elevation) to achieve symptom control. In the case of an acute knee injury, try elevating the injured knee and cooling the knee joint for shorter time intervals (of about 10 minutes) - make sure the cooling is not too strong and painful.

To prevent injuries and overstraining during sports, a knee support can help. It stabilizes and protects the knee and relieves it so that pain quickly subsides or does not occur in the first place. In general, braces and compressions provide more support during sports and can therefore reduce the risk of injury. Another way to combat and alleviate knee pain caused by osteoarthritis or injury is taping. If knee pain has resulted from years of overuse or misalignment, or if there is medically diagnosed knee osteoarthritis, structured and very regular flexibility and strength training is advisable. The experts for the introduction and possible support during such a training are physiotherapists and movement scientists. Therapy with heat can also help to relieve the pain and make more movement possible.

Especially if the cause of the knee pain is osteoarthritis, you should additionally check your eating habits. In the UK, two-thirds of adults are now overweight. The joints in our knees and feet carry us through life every day and are subjected to particularly high stress when we are overweight, which significantly accelerates wear and tear. A healthy diet prevents obesity and thus joint problems. In addition, there are indications that the choice of our diet can have a positive influence on existing inflammatory processes in the body - here it is certainly helpful to take advantage of professional advice.

There are many exercises you can do at home to counteract knee pain. Regular exercise can prevent knee injuries and early signs of wear and tear. A classic, effective exercise to strengthen the leg, gluteal and back muscles is squats:

• Stand normally with your feet hip-width apart.
• Bend your knees until you are in a sitting position. While doing this, stretch your arms forward in parallel and make sure your back remains straight.
• Hold the position for a few seconds.
• Come back to the starting position. 

Repeat the exercise twice a day with 20 squats per set. To take the pressure off your knees, it's also important to have a healthy and strong core. Studies show that the prognosis for knee injuries is better when the core is also strengthened. That's why your sports routine should always include exercises to strengthen and stretch the abdominal and back muscles - studies have long shown that the prognosis for knees and hips is better when core exercises are also performed.

Dr. Michael Richter has been a state-certified physiotherapist since 1999 and works at the renowned “Rückenzentrum Am Michel” in Hamburg, Germany - an interdisciplinary center specializing in the treatment of people with acute and chronic musculoskeletal complaints.

He is an expert in manual therapy and exercise therapy and has been treating people with back and joint problems for 20 years. In addition to his enthusiasm for the manual treatment of patients, pain education is very close to Michael's heart and it has been his ambition for years to inform patients and colleagues with the best and scientifically sound facts on the subject of pain.

In addition to his practical work with patients, Michael was involved in teaching and research as a substitute professor in the field of physiotherapy at the Münster School of Health in Münster, Germany.