Causes, Risks, Diagnosis & Treatment

Chronic knee pain is a common problem that can make it difficult to walk and carry out daily activities. It can be a long-term problem that can affect one or both knees. It can affect one part or all of the knee. The pain may be felt with bending, walking, or other movements. 

Chronic knee pain has a number of causes, including trauma and arthritis. It can cause inflammation and pain, and affect your mobility and independence. 

This article will cover chronic knee pain causes, symptoms, treatment, self-care, ways to find relief, and more. 

What Causes Chronic Knee Pain?

Knee pain affects around 25% of adults, and its prevalence has increased over 65% over the last 20 years. It can either be temporary or chronic. Temporary knee pain is usually the result of an injury to the knee, while chronic pain often has a long-term cause. 

A number of health conditions and diseases can result in chronic knee pain. Such conditions include: 

• Arthritis: Different types of arthritis, including osteoarthritis (OA), rheumatoid arthritis (RA), and gout, can lead to pain, inflammation, and joint damage.
• Tendinitis and bursitis: Tendinitis (tendon inflammation) can cause pain in the front of the knee, which is worse when climbing or taking stairs. Bursitis (inflammation of a bursa that cushions the joint) is caused by repeated overuse of the knee.
• Chondromalacia patella: Also known as runner’s knee, this condition causes a damaged cartilage (the smooth covering over the joints) under the kneecap.
• Patellar tendinosis: Also called jumper’s knee, this condition causes inflammation of the patellar tendon, the connection between the kneecap and shin bone.
• A meniscus tear or torn ligament: The meniscus is the shock-absorbing wedge that sits between the bone ends to cushion and support the knee joint. A meniscus tear is a tear in the cartilage of the knee. The knee can also experience tear in one of four ligaments, with the most common being the anterior cruciate ligament (ACL).
• Baker’s cyst: A baker’s cyst is a buildup of synovial (joint) fluid behind the knee. It can cause knee swelling, instability, clicking or popping noise with bending, joint stiffness, and limited range of motion.
• Bone cancer: Osteosarcoma, a type of bone cancer, often affects the knee.
• Trauma: Any injury to the knee that does not heal properly can lead to chronic knee pain.
• Knee infection: If bacteria contaminate synovial fluid that lubricates the knee, you may experience a septic or bacterial joint infection.

Knee pain, whether related to a health condition or an injury, can get worse without treatment. It can cause severe pain, further injury, difficulty with movement, joint deformity, poor mobility, and bone spurs (outgrowths of sharp bone at the end of a bone in the joint).

Who Is at Risk for Chronic Knee Pain?

You could be at risk for chronic knee pain if you are overweight or have obesity. According to a 2016 study, 19.5% of people with grade 2 obesity (body mass index of 35 to 39.9) have OA of the knee compared to 3.7% at a healthy weight. The additional weight puts extra pressure on the knees and can lead to inflammation, which can further exacerbate knee problems.

Additional risk factors for chronic knee pain are:

• Age: Knee pain, especially related to OA, is the highest among adults over age 50. 
• Overuse: Repetitive and excessive joint loading from bending can lead to chronic knee pain. High-impact sports, such as hockey and football, can lead to undue stress on the joints and increase the risk of chronic knee pain.
• Previous trauma: Prior injuries can lead to chronic knee pain, including OA knee pain. 
• Genetics: Researchers have identified specific genes associated with knee pain. Many gene studies suggest these gene variations are similar to those associated with severe knee OA.  

Other Symptoms of Chronic Knee Pain

The location and severity of knee pain will vary depending on what is causing your knee pain.

Common signs and symptoms of chronic knee pain may include:

• Knee pain that slowly develops over time
• Pain that is worse after sitting or getting up in the morning
• Pain that radiates beyond the kneecap
• Swelling and tenderness of part or all of the knee and surrounding areas
• Symptom flare-ups (periods where pain and other symptoms worsen), often after activity and exercise.
• Knee weakness or stiffness that limits your range of motion 
• Creaking or popping sounds in the knee 

Chronic knee pain can also affect your ability to carry out activities of daily living (ADLs). Being able to complete ADLs is vital to maintaining your independence. 

If you have chronic knee pain, the following ADLs might be affected:

• Mobility: Daily activities that involve walking, such as doing household chores or taking a stroll around your neighborhood, may be difficult.
• Sitting/standing: Getting up from a chair or out of bed can be painful with knee pain.
• Exercise: Knee pain can make it harder to exercise, which can lead to weight gain and additional health problems.
• Sleep: Chronic knee pain can make it harder to fall asleep and stay asleep.
• Personal hygiene: Knee pain can make it harder to shower, groom yourself, or even use the toilet because these activities require you to bend, squat, and keep your balance.
• Household chores: Cleaning, cooking, yard work, and grocery shopping all require you to walk, stand, or bend for long periods, and knee pain can cause you significant pain while you attempt to complete them.

How Chronic Knee Pain Is Diagnosed 

Depending on what is causing your chronic knee pain, your healthcare provider may use different diagnostic tools. These may include a physical examination, lab tests, and imaging tests.

Physical Examination 

During the physical exam, the healthcare provider will inspect the knee for swelling, tenderness, and warmth. They will also check to see how far you can move your lower leg in different directions. They may push on the joint to determine if there is any damage to the knee structure.

Lab Tests 

If your healthcare provider suspects an infection or an inflammatory condition, like RA, they may order blood tests, including:

Another type of lab test done to diagnose the cause of knee pain is a procedure called arthrocentesis. It involves using a needle inserted in the knee joint to remove fluid and send it to the lab for analysis. It is often done to look for crystals that indicate gout (a type of inflammatory arthritis) or evidence of a bacterial infection. 

Imaging 

Your healthcare provider may request imaging tests to look for certain types of joint damage to the knee:

• X-rays: X-rays can look for fractures and evidence of OA or other degenerative changes.
• Computerized tomography (CT) scan: A CT scan provides three-dimensional (3D) images to diagnose bone problems and fractures that are too small or hidden from X-rays.
• Magnetic resonance imaging (MRI): MRI creates 3D images of the inside of the knee to detect soft tissue injuries to the muscles, ligaments, tendons, and cartilage.
• Ultrasound: An ultrasound can produce real-time images of the soft structures of the knee, including the tendons, ligaments, muscles, blood vessels, and nerves of the knee and surrounding structures.

When to See a Healthcare Professional 

If you are experiencing chronic knee pain, you should see a healthcare professional for an accurate diagnosis. This is especially important if you: 

• Cannot bear weight on the knee or feel as if the knee is unstable or gives out on you
• Have notable knee swelling or a knee deformity 
• Are unable to extend or flex your knee
• Have fever with swelling, redness, and pain in the knee 
• Have pain in other joints in addition to the knee
• Have knee pain all the time
• Have knee pain that keeps you up at night

Treatment Options for Chronic Knee Pain

Treatment for chronic knee pain will depend on the underlying cause. For example, if your knee is swollen and inflamed due to OA, RA, or gout, treatments to bring down inflammation and halt disease processes can help manage your knee pain. 

In addition to treating an underlying problem, knee pain is treated conservatively (without surgery) or with surgery.

Conservative Treatments 

Conservative treats for chronic knee pain include:

• Physical therapy: Physical therapy can help to strengthen the muscles around the painful part of your knee, which reduces pain and helps to stabilize the knee. 
• Medications: Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen) or Aleve (naproxen) can reduce pain and swelling related to chronic knee pain. Many OTC oral and topical pain relief options are available, A healthcare provider can prescribe stronger ones if needed to manage symptoms. 
• Injections: Different types of injections can alleviate knee pain, and their effects can last for months. These include corticosteroid injections, hyaluronic acid injections, and platelet-rich plasma injections.
• Osteopathic knee traction: Knee traction is a type of manual therapy that pulls the knee joint to reduce pain and improve mobility. A healthcare provider performs knee traction with a device that keeps the alignment and length of the limb. Research shows it can be effective in treating cases of chronic inflammation, severe knee OA, and chronic jumper’s knee.

Surgery 

Surgery is a last resort option, but it is sometimes the most effective treatment for chronic knee pain. It is often considered when conservative therapies have failed.

Surgical options may include for chronic knee pain may include:

• Knee arthroscopy: This minimally invasive procedure allows a surgeon to repair injured tissue and bone or remove damage and inflammation. A lateral release is a type of knee arthroscopy used to align the kneecap. A knee arthroscopy may also be used to diagnose knee problems.
• Partial or total knee replacement: A partial knee replacement surgery replaces damaged parts of the knee with artificial parts made of metal or plastic. A total knee replacement replaces the entire knee with an artificial joint. 
• Meniscectomy or a meniscus repair/replacement: A meniscectomy removes a portion of the meniscus cartilage from the knee joint. A meniscus repair repairs the damaged meniscus, while a replacement places a donor graft (from a deceased person) for someone whose meniscus was removed.
• ACL reconstruction: ACL surgery reconstructs the ACL using a tendon graft from the person or a deceased donor.

Self-Care and Evidence-Based Home Remedies

In addition to using conservative treatments recommended by your healthcare provider, you can manage chronic knee pain at home through lifestyle changes, exercise, sleeping well, hot and cold therapies, and assistive devices.

Lifestyle Changes

Making healthy lifestyle choices can reduce the risk of chronic knee pain and improve symptoms in people with existing knee pain.

Research shows that obesity and chronic knee pain go hand in hand, with excess weight contributing to joint load and increasing the risk for knee OA. Losing excess weight can significantly reduce stress on knee joints, alleviate pain, and prevent fractures and further damage.

Additional ways to manage chronic knee pain are by reducing your alcohol intake and not smoking. Alcohol use and smoking have been linked to knee pain and OA.

Exercise

A major mistake that people with chronic knee pain make is avoiding movement. Research has continually found that regular exercise has numerous protective advantages for knee health.

It can prevent cartilage degeneration, inhibit inflammation, and prevent bone loss. It can also improve pain, stiffness, joint dysfunction, and muscle weakness in people with knee OA. 

For people with chronic knee pain, low-impact exercise can reduce stress on joints and improve joint health. Such exercises include:

• Aquatic exercise: Research on aquatic exercise shows it can have a positive effect on pain, knee extension, muscle strength, and walking ability in people with knee OA.
• Walking: Walking can offer a total cardiovascular activity that can reduce chronic knee pain.
• Exercise equipment: Some exercise machines, including elliptical machines and stationary bikes, can allow knee-friendly exercises.

Sleeping

Knee pain can affect your sleep, but there are things you can do to improve knee pain and get a more restful sleep.

These include:

• Keeping to consistent sleep and wake times
• Having a daily bedtime ritual 
• Exercising regularly but avoiding exercise too close to bedtime
• Limiting caffeine and alcohol too close to bedtime
• Keeping daytime naps short
• Using your bedroom for sleep and intimacy only
• Not using electronics or watching TV in bed 
• Sleeping on a supportive mattress

Heat and Cold Therapies 

Heal therapy using a hot water bottle or a heating pad can improve knee pain and reduce stiffness. Cold therapy with a commercial ice pack or a simple bag of ice can alleviate pain, inflammation, and swelling. 

Assistive Devices 

A number of assistive devices can help manage chronic knee pain and prevent further damage to the knee joint. They can also help manage knee stiffness and pain, improve mobility, and help you stay independent. 

Examples of assistive devices to manage knee pain are:

• A leg brace to help support the knee, reduce pain, and improve stability
• Shoe inserts to support the foot’s arch and redistribute weight to protect the knee and reduce pain
• A cane to take weight off the knee and reduce pain
• Reaching devices to access objects without putting stress on the knee joints
• Grab bars to reduce stress on the knees when getting up from a seated position

CAM Therapies

Complementary and alternative medicine (CAM) therapies are medical practices that are not part of conventional medicine. They may include natural therapies, mind-body practices, and body therapies to promote healing.

CAM therapies that have been found to be helpful for managing knee pain include acupuncture, yoga, tai chi, and massage. These can be used alone or in combination with other therapies to manage your chronic knee pain. 

Can You Prevent Chronic Knee Pain?

It is possible to prevent some, but not all, causes of chronic knee pain.

Ways to do this include:

• Maintaining a healthy weight 
• Being active
• Warming up and stretching before exercising 
• Wearing comfortable footwear appropriate for activities and sports, and shoe inserts or orthotics when needed
• Using proper techniques when lifting and carrying objects
• Using mobility aids if knee pain affects your walking or causes an unsteady gait (how you walk)

If you are experiencing knee troubles, including stiffness and pain, let a healthcare provider know. They can examine your knees and create a treatment plan that reduces the potential for chronic knee pain.

What Is the Long-Term Outlook?

Some causes of knee pain, like arthritis, can be lifelong because the structure of the knee is damaged. Without surgery or other extensive treatments, you will continue to have swelling, pain, and stiffness.

However, as long as you can manage pain, prevent flares, and reduce other knee symptoms, your outlook can be positive. Knee surgery can also be helpful for repairing joint and cartilage damage and reducing or eliminating pain and other symptoms. 

Summary

Chronic knee pain can cause long-term pain, swelling, and stiffness in one or both knees. The cause of knee pain will determine any additional symptoms a person might have. Many conditions can contribute to knee pain, including an injury or arthritis. 

Chronic knee pain can affect your mobility and independence. Treatments include self-care management with exercise, maintaining a healthy weight, wearing supportive shoes, and using assistive devices.

OTC NSAIDs and other pain relievers can help manage pain and other knee pain symptoms. A healthcare provider can prescribe more potent pain relievers and other medications to manage inflammation if needed.

Surgery is considered as a last resort and is reserved for cases of severe pain or damage to bones and joints. You may be able to prevent chronic knee pain by maintaining a healthy weight, staying active, using mobility aids, and wearing supportive shoes. 

The outlook for chronic knee pain can be positive if symptoms can be managed or surgery is done to repair a damaged knee.