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After having reconstructive knee surgery to repair my ACL I did not know what I would be able to do. I have always been very active and I was scared I would not be able to run or ski. Well I just got back from a ski trip and it was a great success. I couldn’t even tell that I’d had surgery on my knee. Your hard work, encourage, and guidance through the rehab process was key to my recovery. I appreciate your help more than I can say! I will definitely refer my friends and family to you.


Denver, NC







Knee Pain

The knee is a relatively simple joint, however it performs a complicated task. The knee needs to function properly to provide flexible mobility while bearing considerable weight. While walking down the street, our knees bear three to five times our body weight. When climbing stairs, that force can multiply to seven times our body weight. The compact structures, bone and cartilage, of the knee bear the weight and the joint is supported by muscles and ligaments.

Most people have had a minor knee problem at one time or another. Most of the time our body movements do not cause problems. Knee symptoms develop from everyday wear and tear, overuse, or injury. Knee problems and injuries occur most frequently during sports or recreational activities, work-related tasks, or home projects.

The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The knee joint is really two joints: the patello-femoral joint, where the large bone of the upper leg connects with the knee cap; and the tibio-femoral joint, where the upper leg bone hinges with the large bone of the lower leg. These bones are held in place by passive restraints called ligaments. The joint is further supported by muscle tissue. When conditioned and strengthened, these muscles apply forces that help stabilize the joint. The menisci are pads of cartilage that help to stabilize the bones and provide shock absorbency.

The surface of the bones inside the knee joint is covered by articular cartilage. The articular cartilage absorbs shock and provides a smooth, gliding surface for joint movement. Although a knee problem is often caused by an injury to one or more of these structures, it may have another cause. Some people are more likely to develop knee problems than others. Many jobs, sports and recreation activities, getting older, or having a disease such as osteoporosis or arthritis increase the chances of having a knee problem.

Sudden (acute) injuries

Injuries are the most common cause of knee problems. Sudden (acute) injuries may be caused by a direct blow to the knee or from abnormal twisting, bending the knee, or falling on the knee. Pain, bruising, or swelling may be severe and develop within minutes of the injury. Nerves or blood vessels may be pinched or damaged during the injury. The knee or lower leg may feel numb, weak, or cold; tingle; or look pale or blue. Acute injuries include:

• Sprains, strains, or other injuries to the ligaments and tendons that connect and support the kneecap.

• A tear in the rubbery cushions of the knee joint (meniscus).

• Ligament tears. The medial collateral ligament (MCL) is the most commonly injured ligament of the knee.

• Breaks (fracture) of the kneecap, lower portion of the femur, or upper part of the tibia or fibula. Knee fractures are most commonly caused by abnormal force, such as a falling on the knee, a severe twisting motion, severe force that bends the knee, or when the knee forcefully hits an object.

• Kneecap dislocation. This type of dislocation occurs more frequently in 13- to 18-year-old girls. Pieces of bone or tissue (loose bodies) from a fracture or dislocation may get caught in the joint and interfere with movement.

Overuse injuries

Overuse injuries occur with repetitive activities or repeated or prolonged pressure on the knee. Activities such as stair climbing, bicycle riding, jogging, or jumping stress joints and other tissues and can lead to irritation and inflammation. Overuse injuries include:

• Inflammation of the small sacs of fluid that cushion and lubricate the knee (bursitis).

• Inflammation of the tendons (tendinitis) or small tears in the tendons (tendinosis).

• Thickening or folding of the knee ligaments (Plica syndrome).

• Pain in the front of the knee from overuse, injury, excess weight, or problems in the kneecap (patellofemoral pain syndrome).

• Irritation and inflammation of the band of fibrous tissue that runs down the outside of the thigh (iliotibial band syndrome).

Conditions that may cause knee problems

Problems not directly related to an injury or overuse may occur in or around the knee.

• Osteoarthritis (degenerative joint disease) may cause knee pain that is worse in the morning and improves during the day. It often develops at the site of a previous injury. Other types of arthritis, such as rheumatoid arthritis, gout, and lupus, also can cause knee pain, swelling, and stiffness.

• Osgood-Schlatter disease causes pain, swelling, and tenderness in the front of the knee below the kneecap. It is especially common in boys ages 11 to 15.

• A popliteal (or Baker's) cyst causes swelling in the back of the knee.

• Infection in the skin (cellulitis), joint (infectious arthritis), bone (osteomyelitis), or bursa (septic bursitis) can cause pain and decreased knee movement.

• A problem elsewhere in the body, such as a pinched nerve or a problem in the hip, can sometimes cause knee pain.

• Osteochondritis dissecans causes pain and decreased movement when a piece of bone or cartilage or both inside the knee joint loses blood supply and dies.

Treatment of Knee Pain

Treatment for a knee problem or injury may include first aid measures, rest, bracing, physical therapy, medicine, and in some cases surgery. Treatment depends on the location, type, and severity of the injury as well as your age, health condition, and activity level (such as work, sports, or hobbies). Unfortunately, there is no quick cure for a knee injury. Physical therapy plays a key role in treating and rehabilitating the knee.

An evaluation of the trunk and lower extremity to identify the predisposing factors that are causing knee pain. The evaluation will look at muscle strength, flexibility, coordination, joint mobility and stabilziation, and balance. A treatment plan is then developed to suit a person's individual condition. The treatment program will focus on achieving normal motion and increasing lower extremity muscular performance and strength. A second component of the treatment plan involves activities leading to a gradual return of normal activities.


Your knee’s tolerance for stressful activities will decrease with age and loss of conditioning. So, stresses that would not have caused injury last year could hurt your knee today. A decrease in your level of activity over a period of time will also contribute to the vulnerability of your knees. An exercise program designed by your physical therapist, and applying some good common sense, can be your best protection from injury.


Prevention tips

• Don't carry objects that are too heavy. Use a step stool. Do not stand on chairs or other unsteady objects.

• Wear knee guards during sports or recreational activities, such as roller-skating or soccer.

• Stretch before and after physical exercise, sports, or recreational activities to warm up your muscles.

• Use the correct techniques or positions during activities so that you do not strain your muscles.

• Use equipment appropriate to your size, strength, and ability. Avoid repeated movements that can cause injury. In daily routines or hobbies, look at activities in which you make repeated knee movements.

• Consider taking lessons to learn the proper technique for sports. Have a trainer or person who is familiar with sports equipment check your equipment to see if it is well suited for your level of ability, body size, and body strength.

• If you feel that certain activities at your workplace are causing pain or soreness from overuse, call your human resources department for information on other ways of doing your job or to talk about using different equipment.

• Keep your knees and the muscles that support them strong and flexible.

• Avoid activities that stress your knees, such as deep knee bends or downhill running.

• Wear shoes with good arch supports.

• Do not wear high-heeled shoes.

• Replace running shoes every 300 to 500 miles (480 to 800 kilometers).