Knee Pain: Causes, Treatments, and When to Seek Help

Knee problems

Timeframe: Started in early February and continues to the present.
Physical condition: Occasionally exercises (about two to three times a week, sometimes less), no obvious injury sensations (such as strains or sprains).
Symptoms: Initially, there was pain in the right knee, occurring about once a day for a short duration, around a few minutes, mostly at night while lying in bed or sitting in a chair.
The pain would start suddenly, and sometimes rubbing the knee would help; the pain was more pronounced in the central indentation when the knee was bent (occasionally, there was pain on the side of the thigh, but it was uncertain if it was related).
Daily activities were not affected, and the pain was tolerable, so it was not given much attention.
However, a few days later, the left knee also started to hurt, though less frequently than the right, possibly once a day or not at all.
At this time, the right knee might hurt about twice a day, with the duration of pain increasing slightly.
Since there was no obvious injury, walking did not cause pain.
During this period, there were other health issues, leading to suspicion that the problem might be internal rather than related to the knees (having congenital anemia, accompanied by pain in the heart and various locations), so no orthopedic consultation was sought.
A few days later, the elbow suddenly hurt at night, feeling similar to the knee pain but more intense.
Rubbing it provided some relief, with the pain particularly sharp in the central groove when bent, lasting until morning.
After experiencing pain in three areas, I decided to visit an orthopedic clinic that afternoon.
If no issues were found, I planned to go to a larger hospital for blood tests.
After explaining the situation at the clinic, the doctor indicated that the knee issues were due to soft tissue injury and wear, with the right knee being more severe, and recommended rehabilitation.
The elbow was deemed fine, and topical medication was suggested.
After the consultation, I proceeded with rehabilitation, which consisted of two treatments: one involved applying two electrodes to the knee, and the other was a compression treatment similar to that used for hypertension (this was only done on the right knee), each lasting about fifteen minutes.
The first treatment went without issue, but during the second treatment, the pain in the knee and thigh intensified, with a feeling of numbness and stiffness in the entire leg, prompting me to stop the session.
Although I felt fine afterward, later that evening, the left knee began to hurt at certain angles while walking, resembling a sprain.
However, it was late, and after taking the medication prescribed by the doctor, I hoped to sleep it off.
During the night, I felt a cold, numb sensation in the entire leg (only confirmed in the left leg, but it occurred about three times, and I couldn't recall if the right leg was affected).
This sensation had never happened before, and I was unsure of its cause.
The next day, the feeling of a sprained left knee persisted, and the right knee also exhibited slight symptoms similar to the left, but less pronounced.
Both legs felt cold throughout the day, and the pain in the right knee lasted for one to two hours.
Questions: 1.
I previously had issues with soft tissue injuries, where pain would occur after using that area for a period (possibly 10 minutes to half an hour), but my knee pain mostly occurs when not in use.
What is the situation with my elbow? Is this truly a case of soft tissue damage? Can knee soft tissue damage manifest as pain only at night during rest, rather than during morning or afternoon activities? 2.
If it is not, I would like to see another doctor, but I am unsure if I should consult an orthopedic specialist.
Is this a joint issue, or could it be caused by something else? What type of specialist should I see? 3.
The situation during the rehabilitation sessions and subsequent events make me uncertain about continuing this rehabilitation.
This is my first experience with rehabilitation; is this situation normal? The sensation of cold in the legs occurs even when they feel warm, which I have never experienced before, and regarding the sprain, could this be a result of the rehabilitation, or is it coincidental?

Lin, 20~29 year old female. Ask Date: 2021/03/01

Dr. Chen Bochen reply Orthopedics

1.
I previously had issues with soft tissue injuries, where pain would occur after using that area for a period of time (possibly 10 minutes to half an hour).
However, my knee pain mostly occurs when I am not using it.
I'm not sure about the condition of my elbow.
Is my situation really a problem with soft tissue damage? Is it possible for knee soft tissue damage to not show symptoms during morning and afternoon activities, but instead cause pain at night while resting? >>> It is quite common for soft tissue pain to occur during rest, especially at night (due to a decrease in physiological corticosteroids).
2.
If it’s not the case, I would like to see another doctor, but I'm not sure if I should visit an orthopedic specialist.
Is this situation related to a joint issue, or could it be caused by something else? Which specialty should I see? >>> You can see either an orthopedic specialist or a rehabilitation specialist, but it is recommended to stick with one physician for continuity of care, as it takes several visits for the doctor to gradually understand your condition.
3.
The situation with my rehabilitation therapy and what happened afterward makes me uncertain about whether to continue.
This is my first time undergoing rehabilitation; is this situation normal? My legs feel cold even though they are warm, which has never happened before.
Is this related to the sprain that led me to seek rehabilitation, or is it just a coincidence? >>> You can try a few more sessions to see how it goes.
If discomfort persists, you should discuss it with your physician and physical therapist.
If there are no contraindications, it is recommended that you take anti-inflammatory medication for a week along with rest to see if it helps.

Reply Date: 2021/03/01

More Info

Knee pain can be a complex issue, often resulting from a variety of causes, including soft tissue injuries, joint degeneration, or even systemic health problems. Based on your description, it seems you are experiencing intermittent pain in both knees and your elbow, with symptoms that worsen during rest, particularly at night. Let's break down your concerns and provide some insights into potential causes, treatments, and when to seek further medical help.

1. Understanding Your Symptoms
Your experience of knee pain primarily occurring during periods of inactivity, such as when lying down or sitting, could suggest a few possibilities:
- Patellofemoral Pain Syndrome (PFPS): This condition is characterized by pain around the kneecap, often exacerbated by activities that put stress on the knee joint, such as climbing stairs or sitting for long periods. The pain can sometimes be felt more acutely when the knee is bent, which aligns with your description of pain during certain movements.

- Soft Tissue Injury: Given your history of soft tissue injuries, it's plausible that you may have some residual effects from previous injuries. Soft tissue injuries can lead to inflammation and pain that may not always be present during activity but can flare up during rest or after prolonged inactivity.

- Tendinitis or Bursitis: Inflammation of the tendons or bursae around the knee can also cause pain that is more pronounced during certain positions or movements.

2. Seeking Appropriate Medical Attention
If you suspect that your knee pain is not solely due to soft tissue injury, it would be prudent to consult with a healthcare professional who specializes in musculoskeletal issues. Here are some recommendations:
- Orthopedic Specialist: Since you have already seen an orthopedic doctor, it may be beneficial to seek a second opinion from another orthopedic specialist, especially if your symptoms persist or worsen. They can perform a thorough examination and may recommend imaging studies like X-rays or MRI to assess the condition of your joints and surrounding tissues.

- Rheumatologist: Given your mention of systemic issues, such as congenital anemia and pain in multiple joints, consulting a rheumatologist might be worthwhile. They can evaluate for underlying inflammatory or autoimmune conditions that could be contributing to your symptoms.

3. Rehabilitation and Recovery
Regarding your experience with rehabilitation, it’s not uncommon for patients to feel discomfort during their initial therapy sessions, especially if they are not accustomed to the exercises or modalities being used. However, the increase in pain and the sensation of coldness in your legs are concerning and warrant further investigation. Here are some points to consider:
- Communication with Your Therapist: It’s essential to communicate any discomfort or unusual sensations to your physical therapist. They can adjust your treatment plan to better suit your needs and ensure that you are not exacerbating any underlying issues.

- Monitoring Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any activities that seem to trigger or alleviate them. This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

- Rest and Ice: If you experience increased pain after therapy, consider resting the affected area and applying ice to reduce inflammation. This can help manage symptoms and prevent further irritation.

Conclusion
In summary, your knee pain, especially if it is accompanied by sensations of coldness and discomfort in other joints, should be thoroughly evaluated by a healthcare professional. It’s crucial to determine whether the pain is due to soft tissue injuries, joint issues, or potentially systemic conditions. Continuing with rehabilitation is important, but adjustments may be necessary based on your response to treatment. Always prioritize open communication with your healthcare providers to ensure the best possible outcomes for your health.

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