Knee Pain: Causes, Symptoms, and Recommended Tests

Knee pain

Hello Dr.
Hong: I just graduated from university and I regularly run marathons and ride my bike.
A year ago, I noticed that I experience pain in my right knee when cycling uphill, but I don't feel pain when riding on flat surfaces or while running.
Sometimes, when standing or walking, my knee feels uncomfortable and slightly painful, but it usually resolves quickly.
Recently, I've noticed that if I stand for about 10 to 20 minutes, I start to feel pain and need to sit down for relief.
However, if I stand up again, the pain returns.
I also experience pain when putting weight on my right leg while going up and down stairs.
A traditional Chinese medicine practitioner mentioned that I might have injured my cartilage.
Could you please explain what this might be? What kind of examinations should I undergo? Thank you!

Mr. Chen, 20~29 year old female. Ask Date: 2006/09/15

Dr. Hong Ximing reply Orthopedics

Hello, knee joint pain caused by running or cycling is a common complication.
Due to the frequent movement of the patella, it can lead to patellar cartilage softening.
The most direct approach is, of course, to rest for a period of time, avoiding jogging and substituting it with walking on flat surfaces to allow the injured cartilage sufficient time to recover (approximately 3-6 months).
Avoid direct pressure on the patella (such as going up and down hills or sitting for too long).
Wishing you a speedy recovery.

Reply Date: 2006/09/15

More Info

Knee pain can be a complex issue, especially for someone like you who is active in sports such as marathon running and cycling. Your symptoms suggest that there may be underlying issues related to the knee joint, particularly involving the cartilage, which is a common concern for athletes. Let's break down the potential causes, symptoms, and recommended tests for your condition.

Causes of Knee Pain
1. Patellofemoral Pain Syndrome (PFPS): This condition is often seen in runners and cyclists. It occurs when the kneecap (patella) does not track properly in the groove of the thigh bone (femur), leading to pain, especially during activities that put stress on the knee, such as climbing stairs or cycling uphill.

2. Chondromalacia Patella: This is a softening and breakdown of the cartilage on the underside of the kneecap. It can cause pain during activities that involve bending the knee, such as cycling or running.

3. Meniscus Tear: The meniscus is a C-shaped cartilage that cushions the knee joint. A tear can occur due to twisting motions or heavy loading, leading to pain, swelling, and sometimes a locking sensation in the knee.

4. Patellar Tendonitis: Also known as "jumper's knee," this condition results from overuse and can cause pain just below the kneecap, particularly during activities that involve jumping or running.

5. Osteoarthritis: Although more common in older adults, early signs of osteoarthritis can develop in younger athletes, especially if there is a history of knee injuries.

Symptoms to Monitor
- Pain during specific activities (e.g., cycling uphill, standing for prolonged periods).

- Swelling or stiffness in the knee joint.

- A feeling of instability or "giving way" in the knee.

- A grinding or popping sensation when moving the knee.

Recommended Tests
To accurately diagnose the cause of your knee pain, several tests may be recommended:
1. Physical Examination: A thorough examination by an orthopedic specialist will assess your range of motion, strength, and any areas of tenderness.

2. X-rays: These can help rule out fractures or significant joint degeneration.

3. MRI (Magnetic Resonance Imaging): This imaging test is particularly useful for visualizing soft tissues, including cartilage, ligaments, and menisci. It can help identify any tears or degeneration.

4. Ultrasound: This can be used to assess soft tissue injuries and inflammation around the knee.

5. Blood Tests: While not always necessary, blood tests can help rule out inflammatory conditions such as rheumatoid arthritis.

Management and Treatment
Once a diagnosis is established, treatment options may include:
- Rest and Activity Modification: Avoiding activities that exacerbate the pain, such as cycling uphill or prolonged standing.

- Physical Therapy: A physical therapist can design a rehabilitation program to strengthen the muscles around the knee, improve flexibility, and correct any biomechanical issues.

- Ice and Compression: Applying ice to the knee after activities can help reduce swelling and pain.

- Medications: Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) can help manage pain and inflammation.

- Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation.

- Surgery: If conservative treatments fail and there is significant damage to the cartilage or other structures, surgical options may be considered.

Conclusion
Given your active lifestyle and the specific nature of your symptoms, it is crucial to seek a comprehensive evaluation from an orthopedic specialist. They can provide a tailored treatment plan based on the underlying cause of your knee pain. Early intervention can help prevent further damage and ensure you can continue your athletic pursuits.

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