Knee Pain: Symptoms, Treatment, and Rehabilitation Options

Knee pain

Hello Dr.
Chen: My knee was injured several years ago, and now every time the weather changes, it acts like a weather station.
My knee experiences a dull ache, and I have to push on it with my hand to feel more comfortable.
Additionally, there is a soft area in the center that feels like a bone is moving, and when I kneel down, I experience a sharp, aching pain.
What symptoms could this be, and how should I treat it and proceed with rehabilitation?

NINI, 30~39 year old female. Ask Date: 2004/08/10

Dr. Chen Xianchang reply Rehabilitation

(1) Based on your description, there may be a tear in the knee meniscus.
(2) You should visit a large hospital (regional hospital or medical center) to see the rehabilitation department for an ultrasound or MRI to confirm the location, and avoid undergoing arthroscopy initially.
(3) If there is moderate to severe cartilage damage, arthroscopic repair should be performed first (managed by orthopedics), followed by rehabilitation.
(4) If there is a minor cartilage injury, the focus should be on rehabilitation, which may include shortwave therapy, ultrasound, laser therapy, interferential current therapy, and exercise therapy.

Reply Date: 2004/08/10

More Info

Knee pain can be a complex issue, often resulting from a variety of underlying causes, including previous injuries, degenerative changes, or inflammatory conditions. Based on your description, it seems you are experiencing symptoms that could be related to several conditions, such as patellofemoral pain syndrome, osteoarthritis, or even issues related to the cartilage or ligaments in the knee.

Symptoms and Possible Causes
1. Weather Sensitivity: The fact that your knee pain worsens with changes in weather is not uncommon. Many individuals with joint issues report increased pain during cold or damp weather, which may be due to changes in barometric pressure affecting the joint tissues.

2. Soft Sensation and Instability: The "soft" feeling you describe in the central part of your knee, along with the sensation of the bone moving, could indicate issues with the patellar tracking or instability. This might be due to weakened muscles around the knee, particularly the quadriceps, or could suggest cartilage damage.

3. Pain When Kneeling: Experiencing sharp pain when kneeling could indicate irritation of the patellar tendon or bursitis, which is inflammation of the fluid-filled sacs that cushion the knee joint.

Treatment Options
1. Rest and Activity Modification: Initially, it’s crucial to rest the knee and avoid activities that exacerbate the pain, such as kneeling, squatting, or climbing stairs.
2. Physical Therapy: Engaging in a structured physical therapy program can be highly beneficial. A physical therapist can guide you through exercises aimed at strengthening the quadriceps and hamstrings, improving flexibility, and enhancing overall knee stability. This may include:
- Strengthening Exercises: Focus on the quadriceps, hamstrings, and hip muscles.

- Stretching: Gentle stretching of the muscles around the knee to improve flexibility.

- Balance and Proprioception Training: Exercises that improve your balance can help stabilize the knee.

3. Pain Management: Over-the-counter pain relievers such as acetaminophen or topical analgesics can help manage pain. If you have allergies to NSAIDs, discuss alternative medications with your healthcare provider.

4. Ice and Heat Therapy: Applying ice to the knee after activities can reduce inflammation and pain. Heat therapy may also be beneficial before activities to relax the muscles.

5. Bracing: A knee brace may provide additional support and stability, especially during activities that put stress on the knee. However, if wearing a brace causes discomfort, it may be best to avoid it.

6. Injections: In some cases, corticosteroid injections may be considered to reduce inflammation, particularly if conservative treatments are not effective.

Rehabilitation
Rehabilitation is a critical component of recovery from knee pain. It typically involves a gradual return to activity, ensuring that you do not rush the process. Here are some rehabilitation strategies:
- Gradual Increase in Activity: Start with low-impact activities such as swimming or cycling, which are easier on the knees.

- Monitoring Symptoms: Keep track of your pain levels and any changes in symptoms as you progress through rehabilitation.

- Long-term Maintenance: Once you have regained strength and function, continue with a maintenance program that includes regular exercise to keep the muscles around the knee strong and flexible.

When to Seek Further Evaluation
If your symptoms persist despite conservative management, or if you experience significant swelling, instability, or inability to bear weight on the knee, it is essential to seek further evaluation from an orthopedic specialist. Imaging studies, such as X-rays or MRI, may be necessary to assess for structural damage or other underlying conditions.

In conclusion, knee pain can significantly impact your daily life, but with appropriate treatment and rehabilitation, many individuals can achieve relief and return to their normal activities. Always consult with a healthcare professional for personalized advice and treatment options tailored to your specific condition.

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