Chronic Knee Pain Causes and Treatment

Chronic knee pain, which affects one in four Americans, can be debilitating and limit your function and mobility. Chronic knee pain involves ongoing pain, swelling, and sensitivity in the knee that lasts more than 4-6 months and can result from a traumatic injury that healed incorrectly or from medical conditions like osteoarthritis. Physical therapy can help you manage chronic knee pain long-term without the need for surgery to reduce pain and improve your mobility and function.

Common Causes of Chronic Knee Pain 

Over 25% of Americans suffer from chronic knee pain of varying severity. Chronic knee pain is defined as pain that lasts more than four to six months and can involve ongoing discomfort in the knee, such as swelling, sensitivity, an achy, creaky feeling in the knee, a dull throb in the knee as you move, or a sharp shooting pain.

Chronic knee pain can result from a traumatic injury or a medical condition. Traumatic causes of chronic knee pain include a fall or blow directly on the knee, causing a dislocated kneecap or fracture; twisting or pivoting the knee sharply when the foot is firmly planted, causing a tear in the ligament or meniscus; or from repetitive movements that inflame knee ligaments and tendons, leading to tendonitis and eventually a tear over time. If these acute injuries do not receive proper care and heal correctly, chronic knee pain can result.

However, chronic knee pain is most often caused by medical conditions. As we age, our bodies can become more vulnerable to degenerative disorders that can contribute to knee pain. Chronic knee pain due to medical conditions can include:

• Osteoarthritis: pain, inflammation, and joint degeneration due to deterioration and wearing away of the cartilage that protects your bones due to age

• Tendinitis: inflammation, swelling, and pain in the tendons of the knee that worsens when climbing, taking stairs, or walking up an incline due to overuse

• Bursitis: inflammation and swelling of the bursae of the knee due to repeated overuse of the knee (Bursae are fluid-filled sacs that cushion the bones of the knee)

• Chondromalacia patella: damaged cartilage under the kneecap

• Gout: arthritis caused by a buildup of uric acid

• Baker’s cyst: a buildup of synovial fluid that lubricates the joint behind the knee, causing a cyst

• Rheumatoid arthritis: a chronic autoimmune inflammatory disorder that causes painful swelling of joints and can lead to joint deformity due to the immune system attacking the joints

• Obesity: excess weight can significantly increase chronic knee pain. The knee is a major weight-bearing joint, supporting the weight of the upper body, hips, and thighs, while maintaining flexibility by which you run, walk, and sit. However, when walking on a level surface, the knee absorbs 1.5-2 times your body weight. When going up and down stairs or when moving into a deep bend, the knee can absorb as much as 4-5 times your body weight.

There are a number of factors that can exacerbate chronic knee pain:

• Previous injuries to the structures of the knee that cause bleeding and swelling. When not treated properly, this can lead to lingering pain.

• Sprains or strains of the knee due to sports activity

• Overuse due to repetitive knee motions without sufficient rest

• Infection of the knee

• Bad posture and form when doing physical activity that places undue stress on the knee

• Improper stretching of the muscles of the leg and knee

• Not warming up or cooling down before or after physical activity 

Treatment for Chronic Knee Pain

Physical therapy can help you manage chronic knee pain long-term to reduce pain and improve your mobility and function without the need for surgery. The sooner you start physical therapy for chronic knee pain, the quicker your recovery time, the fewer complications to other parts of the body, and the better your lifelong knee health!

At the start of treatment, the physical therapist conducts an evaluation of your knee function, assessing knee range of motion, strength, posture, balance, gait, and type and severity of your pain. Chronic knee pain is a symptom of an underlying issue, so the goal of the therapist is to uncover the root cause of your chronic knee pain to manage your pain more effectively. Treatment is tailored to your specific condition and physical therapy goals.

Physical therapy treatment for chronic knee pain can include:

• Modalities to manage pain and swelling such as ice, heat, and ultrasound

• Manual therapy soft tissue and joint mobilizations to relieve pain and improve the knee’s range of motion and mobility

• Low-impact aerobic exercise to improve cardiovascular fitness, walking ability, and agility.  Exercise can include cycling, using an elliptical trainer, or swimming over 20-30 minutes to increase heart rate and improve muscular endurance.

• Targeted strengthening of the muscles of the knee, quadriceps, and hamstrings to relieve pressure on the knee. The therapist may also target hip, back, and core muscles for strengthening to minimize stress on the knee joint.

• Gait and movement retraining for optimal alignment and movement quality to minimize pressure on the knee, including simulating daily activities

• Aquatic therapy in our warm water therapy pool for greater ease of movement while relieving pressure on the knee joint and easing pain and swelling.

Surgery is a last resort for chronic knee pain and is done after conservative treatment has failed. Surgery can involve repairing a torn ligament or damaged cartilage, or a partial or total knee replacement, in which damaged parts of the knee are replaced with artificial parts made of metal.

Are you experiencing chronic knee pain? Work with our physical therapists to manage your knee pain and restore function!