Knee Pain: Causes and Concerns for Joint Health

Knee pain?

Hello Dr.
Lee: For quite some time, I have been experiencing pain in both of my knees when squatting down or getting up, but I do not feel pain while walking.
Sometimes, it seems to hurt when I stand up after sitting for a long time.
What could be the reason for this? Could it be arthritis? I would appreciate your explanation, thank you!

Miss Lin, 20~29 year old female. Ask Date: 2007/07/19

Dr. Li Wenlin reply Orthopedics

Hello,
In response to your question, your condition is most commonly caused by slight valgus of the patella, which leads to cartilage softening beneath the patella due to wear against the femur.
This issue is particularly likely to occur when the knee is bent beyond ninety degrees and then straightened.
Therefore, you may not experience pain while walking on flat surfaces, but you might feel pain when squatting, going up and down stairs, or after sitting for a long time and then standing up (as the knee is bent beyond ninety degrees at that moment).
This is not arthritis, but some refer to it as pre-arthritis.

The treatment approach is to avoid bending the knee beyond ninety degrees, such as during squatting, stair climbing, wearing high heels, or walking too quickly.
If possible, you should strengthen your quadriceps.
Sit on a chair with your knee maintained at a ninety-degree angle (do not over-bend), then straighten your knee while simultaneously dorsiflexing your ankle.
At this point, you should feel the thigh muscles tightening and warming up.
Hold this position for five seconds, then lower your leg back to the ninety-degree bent position.
You can perform this exercise one hundred to two hundred times a day, in sets, rather than all at once.
This will help strengthen the quadriceps, theoretically preventing further wear of the cartilage beneath the patella.

If you continue to have issues, please consult an orthopedic specialist for an in-person evaluation and examination, which should yield more satisfactory results.

Wishing you all the best!

Reply Date: 2007/07/19

More Info

Knee pain can be a complex issue, often stemming from various underlying causes, and your symptoms suggest a few possibilities that warrant further exploration. The pain you experience when squatting or rising, but not while walking, could indicate several conditions, including patellofemoral pain syndrome, osteoarthritis, or even issues related to the cartilage or ligaments in the knee.

Possible Causes of Your Knee Pain
1. Patellofemoral Pain Syndrome (PFPS): This condition is characterized by pain around the kneecap (patella) and is often exacerbated by activities that put stress on the knee joint, such as squatting or climbing stairs. It is common among individuals who engage in repetitive activities or have muscle imbalances.

2. Osteoarthritis: This degenerative joint disease is common in older adults and can cause pain during movement, especially after periods of inactivity. The cartilage in the knee wears down over time, leading to pain and stiffness.

3. Cartilage Damage: Damage to the cartilage, such as a meniscus tear, can lead to pain during specific movements. This type of injury often occurs during sports or physical activities that involve twisting or heavy lifting.

4. Ligament Injuries: Injuries to the ligaments, such as the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL), can also cause pain, particularly during movements that stress the knee.

5. Tendinitis: Inflammation of the tendons around the knee, such as patellar tendinitis, can cause pain during activities that involve bending the knee.

Symptoms to Monitor
- Swelling: Look for any swelling around the knee joint, which could indicate inflammation.

- Stiffness: Notice if there is any stiffness after sitting for long periods, which may suggest arthritis or other joint issues.

- Pain Location: Pay attention to where the pain is located. Is it around the kneecap, on the sides of the knee, or deep within the joint?
- Range of Motion: Assess if you have any limitations in bending or straightening your knee.

Recommendations for Management
1. Rest and Activity Modification: Avoid activities that exacerbate your pain, such as squatting or climbing stairs. Allow your knee to rest and recover.

2. Ice Therapy: Applying ice to the knee can help reduce swelling and alleviate pain, especially after activities that trigger discomfort.

3. Physical Therapy: A physical therapist can design a rehabilitation program that focuses on strengthening the muscles around the knee, improving flexibility, and correcting any biomechanical issues.

4. Pain Relief Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.

5. Weight Management: If applicable, maintaining a healthy weight can reduce stress on the knee joints.

6. Consult a Specialist: If your symptoms persist or worsen, it is crucial to consult an orthopedic specialist. They may recommend imaging studies, such as X-rays or MRI, to assess the condition of your knee joint and determine the best course of treatment.

Conclusion
While your symptoms may not necessarily indicate arthritis, they do warrant a thorough evaluation to rule out any serious underlying conditions. Early intervention can help prevent further damage and improve your quality of life. If you experience persistent pain, swelling, or any changes in your knee's function, seeking medical advice is essential. Remember, understanding the root cause of your knee pain is key to effective treatment and management.

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