Many people across the world will experience knee pain at least once in their lifetime. As one of the most important and weight-bearing joints in the human body, any number of its parts can be damaged by sports activities, overuse, or simply the wear and tear of aging.
Knee pain might occur at the back of the knee, laterally, or medially—whatever the case may be, the location of your knee pain will provide clues for not only what is wrong but how to treat the issue. Remember to always get a firm diagnosis from a trained knee care professional, like the ones at KneeCare Clinics.
Back of Knee Pain
Also called “posterior knee pain,” discomfort can be coming from any portion of the complicated anatomy behind the knee. For example, not only is the knee joint heavily involved in the movement of the leg but there are a number of large thigh and calf muscles that connect and pass through this area; furthermore, important nerves and vessels also cross the back of the knee to supply blood to the feet and lower legs. When any of these things become injured/agitated, the pain can be sharp, dull, or burning. It may also come on suddenly or gradually, AND it may be constant or occur only when you straighten the knee. It often comes with these one or multiple symptoms as well:
- Swelling behind the knee
- A lump behind the knee
- Fluid around the knee
- Clicking knee
- Sensation that the knee is locking
Causes of Back of Knee Pain
- Baker’s Cyst – Also called popliteal cyst, a Baker’s cyst is a very common reason for rear knee pain. When the fluid-filled sacs behind the knee—called bursae—leak out of the joint, they can collect into a lump. In turn, when these cysts become enlarged, they can exert pressure on muscles and nerves located at the back of the knee and surrounding areas.
- Cartilage Tears – Damage to the cartilage (i.e., if the meniscus is torn) can cause pain all over the knee with more acute pain toward the rear. The menisci are the pieces of cartilage that cushion the knee joint, so when the posterior portion of the meniscus is torn, the pain is centralized behind the knee. Another common type of cartilage that gets injured is the chondral, which provides a smooth covering for bones.
- Muscle Strain or Injury – There are a number of muscles that criss-cross at the back of the leg that all help to bend your knee, point your toes, and so on. When these become fatigued, strained, or torn, it can be felt as posterior knee pain. For example, you often hear the phrase “pulling a hamstring,” which may cause not only pain in the trio of muscles that run down the back of your thigh but also at the back of the knee. Other areas that can be injured are the gastrocnemius muscles and the soleus muscles that make up your calf. When any of these muscles are stretched too far or even torn, it can take months to heal and may be painful at the back of the leg—including the knee—for months.
- Arthritis – Arthritis is a degenerative disease in which the cartilage that cushions and supports the knee joint gradually wears away. Pain may be caused by the natural wear and tear on our knee (osteoarthritis) with age or inflammation in the joint (rheumatoid arthritis). Arthritis can often lead to a flexion contracture, which makes the knee difficult to straighten or extend, and it can put strain on the posterior capsule, causing pain in the back of the knee, especially when you walk.
Inside Knee Pain
The inside of the knee, also called the medial knee or medial compartment, is the area closest to your opposite knee. Again, this is made up of a complex anatomy of parts that work together, such as the medial collateral ligament (MCL), medial meniscus, and more. Tissues keep it all connected and moving freely; for instance, the plica is a fold in the thin tissue that forms the joint of your knee, or another example is the bursa, which operates as a cushion to decrease friction. Damage to any one of these areas—whether its sports, lifestyle choices, or simply an accident— can cause pain at the back of the knee among other symptoms, including:
- Knee locking or catching
- Sense of imbalance
- Difficulty walking or going up/down stairs
- Hearing a clicking sound when bending the knee
Causes of Inside Knee Pain
- Medial Collateral Ligament (MCL) Injury – This is usually seen as the most common and direct cause of medial knee pain. The MCL is one of the most important ligaments in the leg, keeping your knee stable and controlling its sideways movements. A sprain, tear, or other injury to the MCL is usually because of a blow to the outer aspect of the knee, thereby, pushing the knee inward and causing a strain along the inner aspect of the knee. The pain that comes on is usually immediate after an MCL injury.
- Medial Meniscus Tear – The medial menisci are thick, elastic bands of cartilage in the shape of a crescent that act as shock-absorbing structures between your shin bone (tibia) and your thigh bone (femur). A tear in the medial meniscus from a blow or knee rotation can happen to both athletes and older people alike. Still, perhaps one of the most common reasons for inner knee pain is simply that the menisci have worn down over time, causing discomfort when a person moves or bends their knee.
- Medial Plica Syndrome – Sometimes part of the synovial membrane folds into the joint space, forming a synovial fold. This fold (also called the plica) is located inside the knee and effectively stabilizes the knee joint. In many cases in which a person has increased their activity level, the overuse can cause inflammation to the plica. A doctor may even be able to feel a nodule on the inner side of the knee that is tender to the touch.
- Bursitis – Bursae are small, fluid-filled sacs that prevent muscles, tendons, and bones from rubbing together. In particular, the bursa sac between the MCL and the three tendons in the knee is referred to as the “Pes Anserinus.” Sometimes acute injury, overuse of the knee, osteoarthritis, obesity, or a medial meniscus tear can cause excessive secretion of fluids and inflammation of the bursae. This condition is known as bursitis.
- Arthritis – Whether it’s osteoarthritis or rheumatoid arthritis, the pain inside the knee can be caused by the breaking down of cartilage that cushions the knee. As a result, severe pain and tightness inside the knee can be felt in the morning but sometimes decreases during the day. Over time, the friction may develop into painful bone spurs.
Outside Knee Pain
Lateral knee pain refers to the pain that occurs on the outside of the knee. That is, on the left side of your left knee or the right side of your right knee. While the outer side of the knee is not the most common place to experience knee pain, it can still be a cause of discomfort that limits your daily activities. It may come on suddenly after an injury, or it can develop gradually over time due to problems with any one of the structures in the outer side of the knee, such as the iliotibial band, lateral meniscus, lateral collateral ligament, etc. Therefore, the symptoms may vary between:
- Increased pain while performing activities (running, squatting, etc.) that may subside during rest
- Inflammation and swelling on the outside of your knee
- Bruising around the joint
- Stiffness or knee locking up
- Instability of the knee joint
Causes of Outside Knee Pain
- Iliotibial Band Syndrome – As one of the most common reasons for lateral knee pain, Iliotibial band syndrome occurs when there is inflammation of the band of connective tissues running along the outside of the knee. More specifically, these tissues are known as the iliotibial band, which runs from the outer hip and extends down along the side of your thigh, attaching the patella, tibia, and biceps femoris tendon. Repetitive extension and flexion of the knee can cause the iliotibial band to tighten, become inflamed, and then rub against the outside of the joint. This causes pain on the outer part of the knee but can also be felt higher up in the outer thigh as well.
- Lateral Meniscus Tear – Working along with the medial meniscus to cushion and support the joint, the lateral meniscus is a tough, semi-circular piece of cartilage that sits in between the femur (thigh bone) and tibia (shinbone) on the outer side of the knee. This cartilage is often torn during a sudden twisting motion when the foot is planted and the body turns to the side, which means this injury happens during sporting events. However, it is not just reserved for athletes as a torn lateral meniscus can happen at any age as the cartilage becomes less resilient.
- Lateral Collateral Ligament (LCL) Injury – The lateral collateral ligament (LCL) is one of the four main ligaments of the knee, acting as a band of tissue that runs down the outer side of your knee and connects the femur and tibia. It is primarily responsible for stabilizing the outer portion of the knee. An injury to the LCL is often caused by a blow to the inside of your leg that stretches the outside (lateral side) of the knee and either partially or completely tearing the ligament.
- Proximal Tibiofibular Joint Dislocation – While a proximal tibiofibular joint dislocation is not the most common cause of lateral knee pain, it is one of the most significant sources for many people. The dislocation occurs at the joint at the top of the shin bone where it connects with the fibular, which is the small, thin bone that runs down the outer side of the shin. It takes a large force to dislocate the joint (i.e., a car accident), but it can also partially dislocate usually due to a fall or a physically-demanding activity.
- Arthritis – Arthritis in the outer knee occurs when the cartilage that normally protects the bony surfaces of the joints erodes away. This results in painful bone-on-bone pressure and increased internal joint friction, eventually leading to the development of bone spurs. Whether due to age or a condition, some people may suffer significant wearing of the cartilage in the outer compartment of the knee joint and this can lead to lateral knee pain.
Treatments for Knee Pain from Kneecare Clinics: Inside, Outside, and Back of Knee
There are many strategies to take that may be helpful for immediate—but temporary— treatment/reduction of knee pain. These include:
- RICE – Rest, ice, compress, and elevate your painful inflammation-related injuries to help bring down swelling.
- NSAIDs – Use nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) for pain relief.
- Low-impact physical activities – Complete daily activities, like stretching exercises, to improve your joint’s range of motion and reduce joint pain over time.
- Proper footwear – Wear proper footwear with shock absorbers for any physical activity.
However, for more permanent treatment of your significant knee pain, contact the experts at Kneecare Clinics. Our specialties lie in offering treatment for arthritis and bursitis, but we are able to treat a variety of conditions with our personalized treatment plans that include:
- Knee braces
- Injections, including viscosupplementation, steroid, trigger point, and platelet-rich plasma injections
- Physical therapy
- Diet and weight counseling
Get Started at Kneecare Clinics
Reduce knee pain and restore your quality of life. You can find a deeper level of enjoyment in your personal relationships, careers, hobbies and more with the help of Kneecare Clinics! Contact us now or speak to our patient advocate to get started.