Knee Pain: Causes and what to do

The knee is affected in many sports injuries and injuries in everyday life. This can cause for example, bone fractures, ligament strains and tears, a cruciate ligament tear or meniscus injuries can occur. Osteoarthritis (of the knee) can occur within the natural aging process, but also as a late consequence of the above-mentioned injuries.

The main causes of knee pain are generally:

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

Often, degenerative changes of the knee joints are found already from the age of about 35 years. Such a degenerative change can have different causes: malalignment (deviations of the normal knee joint axis, e.g. bowlegs or knock knees) and overloading, injuries and vascular diseases, and as a consequence of joint diseases (such as rheumatism). However, studies also show that a degenerative change of the knee joints can be present without any symptoms, i.e. the affected persons do not feel any pain although they have signs of wear and tear on the knee joints. In the case of painful changes in the area of the knee joints, stabbing or pulling pains after longer periods of rest are typical, such as a morning start-up pain. If there are permanent complaints in the knee joint or if they increase over time, regular exercise and training is 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.

To prevent it from getting that far, timely measures are important that can also be carried out by the affected person. These include muscle strengthening through targeted exercises and, if necessary, the additional wearing of supportive braces.

The 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 lifetime. 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, complaints occur due to, for example, muscular imbalances without there being 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 we load and use it in everyday life, i.e. despite a lifelong load on these joints, the majority of people have no complaints in their knee joints. The reasons why some people develop pain due to osteoarthritis of the knee joints and others do not, is not yet conclusively understood. However, like back pain it is also the case with the large joints of the human body that it is 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.