Knee problems

• Why do I have knee pain?
   
• How can I help myself?
   
• I have just injured myself
   
• I have had a problem for over 3 months that is not getting better
   
• When should I seek medical attention?
   
• What treatments are available?
   
• How do I get help?
   
• Resources for patients
   
• Helpful links
   
• Videos

 

The main muscles surrounding the knee are the Quadriceps (front of thigh), Hamstrings (back of thigh) and Calf (back of lower leg).

The muscles are supported by Ligaments which hold your bones together and these are therefore integral to stabilising the knee. Your Ligaments include the ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament) and LCL (lateral collateral ligament).

To further add shock absorption and stability to the knee is the cartilage or Meniscus.

The knee joint also includes the Patella or knee cap and this joins the front of the knee inside the patella tendon. The knee is able to allow bending, straightening and some element of twist.

 

►	Why do I have Knee pain?

Knee pain can be caused by a number of structures around the knee. An understanding of the location of pain, the aggravating movements and the time of onset of the symptoms can help make a diagnosis. Pain can be present as the result of trauma leading to damage to one of the numerous structures around the knee, however this is not always the case. Pain can be present in the absence of structural damage and can be termed persistent pain.

As there are a number of possible causes of knee pain, a thorough examination by a healthcare professional may be required to make an accurate diagnosis.

 

►	How can I help myself?

There are a number of things that you can do to help manage your pain before seeking help from a medical professional. Below are some ways that you may wish to try to help manage your knee pain.

 

I have just injured myself …

If you have suffered an acute knee injury you may be suffering with pain, swelling and bruising. In this instance the best treatment is;

• Rest – Whilst it is important to keep the knee and leg moving it is also important to have a period of relative rest from strenuous activity. This may mean avoiding standing, walking (commuting / shopping / gardening / house work), driving and stairs.
  
   
• Ice – Using a cold pack around the area of pain and swelling can help manage your symptoms.
  
   
• Compression – Using a Neoprene sports bandage can help manage the swelling.
  
   
• Elevation – when resting, keeping the leg supported but elevated so the foot is above the groin level can help manage the swelling.
  
   

It may be appropriate to manage your symptoms with appropriate pain relief. You can discuss what medication is most appropriate for you with a pharmacist at your local pharmacy. If these medications do not provide adequate relief then you may need to see a GP to discuss prescription pain medications.

 

I have had a problem for over 3 months that is not getting better …

If symptoms persist for more than 3 months this still does not mean that there is damage to the structures in the knee. We know that there are a number of reasons as to why pain can persist for longer than three months without structural damage. If this is the case then there are ways to manage the symptoms:

• Commence gentle exercise – this could be specific for the leg or general cardiovascular exercise. The NHS recommends 150 minutes of moderate aerobic exercise and 2 to 3 days of strengthening exercise per week for people between the ages of 19 and 64 years of age. Muscles and joints need regular movement to remain healthy.
  
   
• Pain medication – Pharmacists at a local pharmacy will be able to advise you on over the counter pain medications that will be most appropriate to you. If these do not provide adequate relief then you may need to speak with a GP to discuss prescription medications.

 

►	When should I seek medical attention?

If you have sustained a trauma to the knee which is accompanied by locking in one place, giving way, twisting with sudden swelling, or inability to put your body weight through the knee in standing, high levels of pain and a reduced ability to move the knee then the injury may warrant further investigations and a trip to the local walk-in-centre or A & E may be required.

If knee pain and restriction of activities of daily living continue to be problematic then a review with your local general practitioner may be required to discuss future management options.

 

►	What treatments are available?

Often the first line of treatment is through self-help – (see section How can I help myself? For more details)

Medical treatment will vary depending on your symptoms and likely diagnosis. Often your general practitioner will refer you directly to physiotherapy where exercise therapy, manual therapy and taping may be of benefit.

Occasionally a review with an Extended Scope Practitioner or Orthopaedic Consultant is required which may lead to further treatment options such as Injections or surgery.

 

►	How do I get help?

If you wish to seek further advice and help in the diagnosis and management of your knee pain then you will need to make an appointment to see your GP. Your GP can then make a decision with you about what would be the next steps going forward in managing your pain. At this time your GP may consider sending you for investigations including x-ray, or they may wish to refer you to the Surrey Integrated Musculoskeletal service at Ashford & St Peter’s Hospitals, or to a physiotherapist.

 

►	Helpful Links

There are a number of websites that you may find useful regarding taking care of your knees:

 

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Videos

Patient Decision Aid: Knee Replacement

• View the introduction
• View the main video