A number of things can go wrong with your knees. Early treatment is the best way to overcome the pain.
by Featured Provider Christopher Kim on Sunday, November 8, 2020
They say, “No pain, no gain.”
Sure, it’s a nice catchphrase with good meaning about the rewards of hard work. When it comes to exercise, medical experts agree: it’s bad advice.
“It’s not really true. Having that mentality and trying to push through your knee pain is just going to make things worse,” says Christopher Kim, MD, an orthopaedic surgeon who specializes in sports medicine. “Eventually, you get to the point of no return where it just doesn’t get better.”
Knee pain is a sign you have a knee injury.
As you get older, you lose a little spring in your step. Activities you dedicated your youth to like basketball or soccer can leave you with sore, achy knees after a weekend game. And newfound passions like running or cycling can cause nagging knee problems, too.
“A lot of it has to do with activity level. As we age, our activity level drops a little bit and our joints tend to get a little stiffer. And we change our routine,” Dr. Kim says.
It doesn’t matter if you’re a younger athlete, marathoner, triathlete or weekend warrior. The more active you are, the more risk you have of injury as the years go by. So if you feel even a tinge of knee pain, there’s likely an injury behind it.
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Older athletes and exercisers are prone to overuse injuries in the knee.
Chronic overuse injuries can afflict weekend warriors and regularly active people alike. There are a number of problems that can crop up, ranging from minor quad and hamstring strains to major foot and ankle injuries. In the knees, overuse often leads to patellar tendonitis — more commonly known as runner’s knee or jumper’s knee.
You might think that overuse knee injuries only occur in people who exercise vigorously or are in training. But they can happen just as easily if you’ve jumped off the couch for some exercise after a long layoff.
“Some people have been having pain for years and working through it. Usually, it’s something that happened recently that spurred the injury, like a change in your training regimen,” Dr. Kim says. “Ramping up activities too quickly can bring on that pain. And if you’ve rested for a little and then started up exercising again, it can also do it.”
The severity of runner’s knee varies, ranging from mild inflammation to serious tears in the tendon that warrant surgery. Most are in the first category and require exercise modifications to first relieve the symptom of knee pain and ultimately resolve the underlying patellar tendonitis.
Dr. Kim helps patients get to the bottom of it, looking at all the factors that could cause runner’s knee, like changes in footwear, running surface, training routine and type of activity.
“We have to talk about how to get the inflammation down and how we get the pain better so you can continue training,” he says. “Maybe we take a break and let things settle down. Or maybe we switch you to less painful activities or cross-training. Whatever the problem is, we work out a plan together.”
If you have a more serious knee injury, you’ll know it.
Sports can lead to any number of injuries. Unlike overuse knee injuries that occur when you push yourself more than your knee can handle, acute knee injuries happen in an incident — a fall, accident or twist of the knee. In most cases, you can pinpoint the moment when you got hurt and suffered one of the common acute knee injuries.
ACL, MCL and PCL Tears
You have four ligaments that help stabilize the knee: anterior cruciate ligament (ACL), medial collateral ligament (MCL), posterior cruciate ligament (PCL) and lateral collateral ligament (LCL). An accident or injury can result in a torn ligament, leading your knee to give out on you during activity.
A torn ACL is one of the most common knee injuries and almost always requires surgery to reconstruct the ligament. Because if the ACL is not intact, your knee can be unstable, which can result in other injuries and a quicker progression to arthritis.
MCL tears are also quite common, while PCL and LCL tears are less so and typically only occur as the result of other injuries. A torn PCL is most often a result from an impact — like a hard hit to the knee in football or your knee hitting the dashboard in a car accident.
“A lot of MCL tears heal without surgery — even the bad ones. Sometimes it's a matter of wearing a brace and doing therapy. A lot of PCL injuries can be treated without surgery too,” Dr. Kim says. “Even with a torn ACL, the pain and swelling will get better eventually and you’re able to walk just fine. The problem with the ACL is that your knee will keep giving out whenever you pivot or turn.”
The meniscus is a piece of fibrocartilage that acts as a shock absorber between the femur (your thigh bone) and the tibia (your shin bone). A meniscus tear is often the result of a twisting motion or deep squat and can happen at the same time as an ACL injury.
The older you are, the less likely a torn meniscus will heal. Instead of meniscus surgery to repair it, you may get a steroid injection and therapy to relieve your pain and regain function. If that doesn’t work, the meniscus can be trimmed or completely removed so that the damaged part no longer causes issues.
“There are a lot more things to consider when we’re talking about a torn meniscus. It’s a combination of age, healing potential, the complexity of the injury and the pattern of the tear,” Dr. Kim says. “If you’re on the younger side, your healing potential is much greater so we’re more likely to go in there and fix it.”
No matter your age or the treatment needed, you can still stay active with a missing or partial meniscus.
Dislocated Knee Cap
You can dislocate your knee cap (the patella) in both contact and non-contact situations. A dislocated patella is especially common in younger athletes and most often happens laterally, or on the outside of the knee. Because the bone moves out of place, it can also damage the surrounding ligaments or cause meniscus injuries.
The bigger concern when you dislocate your knee cap is with the patella itself. Pieces of the undersurface of the bone can chip off and become loose bodies floating around in your knee joint. Arthroscopic surgery is needed to remove the fragments. If there are no loose bodies to worry about, a couple weeks of rest and subsequent physical therapy followed by a gradual return to movement can get you back to activity in three to six weeks.
“The majority of the time with these acute injuries, you know something happened,” Dr. Kim says. “You hear or feel a pop. It’s very painful and the knee gets very swollen.”
You should always get your knee checked out for these three reasons.
Knee injuries have pretty obvious symptoms: a popping sound, visible swelling and pain. If you hear a pop, it’s probably an acute knee injury. And any kind of pain or swelling in the knee is reason to visit a sports medicine physician.
“Swelling is a very important sign. A swollen knee is a big clue that something happened, especially if you hear a pop or have pain,” Dr. Kim says. “Maybe it gets better. Maybe you won’t have problems. But it’s almost always an MRI to see if something’s going on.”
There’s no gain to be had by trying to push through the knee pain, he says. “It’s important to stop, rest, have it checked out early and just get rid of that ‘no pain, no gain’ mentality before you get to the point of no return with your knee pain.”