Understanding your chronic knee pain

It’s very easy to let the wonders of your working body go unnoticed until they start to give you problems. This is one of the reasons why recovering after injuries is so satisfying, because we have a new appreciation for a part of our body that we regained normal function of. Though this newly gained appreciation is unfortunately too often short lived. With this short introduction, we can now start to talk about our knees, one of the parts of our body that we take for granted our whole lives, but can’t ignore them once they start hurting.

Knee pain can cause a serious hit to the quality of our lives, because they affect our mobility to such a great extent. Someone who suffers from severe knee pain might even have to think twice before they get up from a chair to go to the bathroom. It also greatly lowers the amount of physical activity and exercise that you can do, and this sets off a whole chain of consequences that are detrimental to your health. This is why it’s so important to recognise knee pain as early as possible, and take all of the necessary steps to prevent it from progressing to the best of your ability.

Knees are complicated structures that include bones, cartilage, menisci, ligaments, muscles along with a number of other structures. Theoretically any of these structures can get injured or worn down throughout your life time. However in middle aged and older individuals, chronic knee pain usually points to worn down or injured cartilage, and that is what we are going to focus on. Although I mention middle aged and older, these problems can start earlier, even in children sometimes.

What is cartilage? 

Cartilage is a layer of tissue that lines the bones at the point of contact or friction with other bones. A good way to imagine your knee as you bend it, is to take a tennis ball or orange in your hand, with your palm up. Then rotate the ball as it sits on your hand. The friction you feel between the ball and your hand happens to your knees as you walk, with the only difference being your knees also carries the weight of your hand. The cartilage is there in order to make that friction smoother, and prevent damage to the bone and underlying structure. This is the main goal of the cartilage in your knees.

Where can it get injured?

There are 3 main compartments to your knees. There is the medial compartment, which is closest to your other leg, the lateral compartment is furthest from your other leg, and the patellofemoral compartment which is behind your knee cap. The two that are most often worn down are the patellofemoral compartment, and the medial one. Your patellofemoral compartment is used most as you walk up or down stairs, or get up from a chair. If those are the movements that bother you the most than this definitely raises the likelihood of this diagnosis.

How do I know?

A good way that the doctor can find out about the situation of your cartilage is with an X-ray. Cartilage is not seen on an X-ray however, so you can see the thickness of the cartilage in your knees by looking at the space between your femur bone (thigh) and your tibia (shin bone). It’s important however to make sure that you do this x-ray as you’re standing, because if you’re laying down the distance between the bones won’t give an accurate read of how much cartilage is between them. A narrowed space between them can suggest cartilage damage. Usually between the X-ray and the medical history the doctor should have sufficient information to make a diagnosis, but this is not always the case. The other good way of seeing your knee is through an MRI. MRIs are usually only done to determine if you need an operation or not, and unless you are severely suffering, damage to the cartilage is usually not an indication for operation. I say usually because there are specific cases in which this is not true, for example a young patient who has part of the cartilage break off, not a result of normal wear and tear. Another exception is very advanced damage in which a person is greatly suffering, they might be a candidate for total knee replacement surgery. However there are a number of steps that can be done between the start of damage and surgery, so try not to jump to conclusions.

How bad does it hurt?

One of the interesting things about a knee X-ray, is that the amount of subjective pain that an individual feels is not always correlated with the degree of damage seen on the X-ray. There are people who have completely lost the space between the femur and tibia, and you can see one bone sitting directly on the other, though the patient doesn’t complain of too much pain. Alternatively, there are patients who see a fair amount of space, though suffer immensely. This means that the pain that one feels is dependant on a number of things, not just the current state of their cartilage. This is great news, because it opens the door to treatments. One of the first treatment that is the most important, especially for younger patients is physiotherapy. The right exercises can strengthen leg muscles, create a proper motion which lowers the amount of pain, and in some cases can give the cartilage a chance to heal itself. Don’t dismiss this option!

There are a number of other treatment options that we won’t get into now, hopefully in future posts. But for now we hope that this post helped you understand a bit more about your chronic knee pain. Be sure to notify your physician early so that they can direct you towards a good physiotherapist, and explain more about the treatment options.

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