Knee Pain: Causes, Concerns, and Treatment Options

Knee pain

Hello, Doctor.
A year ago, due to work requirements, I had to stand up and squat continuously, increasing from 3 hours a day to 9 hours a day.
After a week of this, I woke up one day to find my left leg numb.
I could walk, but when sitting in a chair, I couldn't lift my foot or bend it onto the chair.
At the same time, I couldn't raise or press down my foot, and I was almost unable to use my left leg from the thigh to the foot individually.
On the day I noticed this, I worked another 9-hour shift, then rested for 4 days.
During the rest period, I walked with a limp; my left leg was not as smooth as my right leg.
After that, I worked for another two days and finished that job.
At this point, my left leg was still a bit limp but not as noticeably as before.
I then took a new job where I stood for 8 hours a day for 2 months.
About a month after the initial incident, the issues with my left leg disappeared, and I could move normally again—walking, running, jumping, and bending without any pain.

However, 7 months after the initial incident, while riding a bicycle one day, I suddenly felt pain in my left knee, specifically in the middle inside of the knee.
After that, I rarely rode my bike.
Three months ago, I frequently used a stepper at home, doing about 1000 steps a day.
After about a month, my knee started to hurt a bit, so I bought a knee brace and occasionally did one or two hundred steps.
A month ago, I went hiking with my family for two hours.
About halfway through, my knee started to feel uncomfortable, and during the last part, which involved descending stairs, I felt significant pain in the middle inside of my knee.

Two weeks ago, during the Lunar New Year, I went back to my hometown and hiked again.
On the way up, I tried to use my thigh muscles as much as possible, and going down was also on stairs.
After two hours, the pain was milder than the last time.
Over the past three to four days, when sitting and bending my leg, I felt noticeable pain in the middle inside of my knee.
However, at other times, the pain is around the front of the knee (above and below the rounded middle part).
It feels like pain on the surface of the bone.
After self-massaging, the pain lessens or even disappears, but it returns a few hours later.
All of this pertains to my left knee; my right knee hardly ever hurts.

After the New Year, when I returned from my hometown, my knee didn't hurt until the rainy, humid, and cold weather began.
I'm very worried that it might be rheumatoid arthritis.
I'm currently very scared and haven't dared to do any exercise since the New Year, only normal daily activities like walking and going up and down stairs (one or two floors).

Since childhood, my knee joints have made sounds when squatting.
I often went to temples with my mother, and at 20, I loved playing table tennis, playing about 1 to 2 hours daily, occasionally up to 6 hours in a day for about a year.
Later, I learned to dance, attending classes for 1 to 2 hours a week for about six months.
Due to my university being built on a hillside, I had to climb stairs (about 18 floors high) for four years to attend classes.

What is wrong with my knee? Is it rheumatoid arthritis? Osteoarthritis? Patellar chondromalacia? Patellofemoral pain syndrome? Is using glucosamine liquid (chondroitin) suitable for maintenance? Could you please recommend appropriate examinations and suitable hospitals in Taoyuan and Taipei? Thank you!

Liu Xiaojie, 20~29 year old female. Ask Date: 2011/02/13

Dr. Shi Guozheng reply Orthopedics

Rheumatoid arthritis typically occurs symmetrically on both sides of the body and is characterized by redness, swelling, warmth, and pain.
It can also affect other joints.
Based on your description, it seems more like an overuse injury.
I recommend that you consult an orthopedic physician for an evaluation and to receive appropriate treatment.
The specific medication required will need to be determined after a proper diagnosis.

Reply Date: 2011/02/13

More Info

Knee pain can be a complex issue, especially when it arises from a combination of factors such as overuse, previous injuries, and underlying conditions. Based on your description, it seems that your knee pain may be related to several potential causes, including patellofemoral pain syndrome, early signs of osteoarthritis, or even issues related to the cartilage in the knee joint.

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, such as climbing stairs, squatting, or sitting for prolonged periods. Given your history of extensive stair climbing and physical activity, PFPS could be a likely cause.

2. Osteoarthritis: This degenerative joint disease is common in individuals who have a history of joint stress or injury. The wear and tear on the cartilage can lead to pain, stiffness, and swelling, especially after periods of inactivity or after engaging in physical activities.

3. Chondromalacia Patella: This condition involves the softening and breakdown of the cartilage on the underside of the kneecap, leading to pain and discomfort. It is often associated with activities that involve repetitive knee bending.

4. Rheumatoid Arthritis: While less likely given your symptoms, it’s important to consider inflammatory conditions, especially if you are experiencing joint stiffness or swelling.

5. Tendinitis or Bursitis: Inflammation of the tendons or bursae around the knee can also cause pain, particularly after physical activity.

Recommendations for Diagnosis and Treatment
1. Medical Evaluation: It is crucial to consult with an orthopedic specialist or a rheumatologist who can perform a thorough evaluation. This may include:
- Physical Examination: Assessing the range of motion, strength, and stability of the knee.

- Imaging Studies: X-rays can help rule out fractures or significant joint degeneration, while an MRI can provide detailed images of soft tissues, including cartilage and ligaments.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and reduce pain. A physical therapist can design a program tailored to your specific needs.

3. Activity Modification: It’s essential to modify your activities to avoid exacerbating the pain. This may include reducing high-impact activities like running or stair climbing and incorporating low-impact exercises such as swimming or cycling.

4. Pain Management: Over-the-counter pain relievers such as NSAIDs (ibuprofen or naproxen) can help manage pain and inflammation. However, consult with a healthcare provider before starting any medication.

5. Glucosamine and Chondroitin Supplements: These supplements are often used for joint health and may provide some relief for osteoarthritis symptoms. However, the evidence is mixed, and it’s best to discuss this with your doctor.

6. Knee Bracing: Using a knee brace or support can provide stability and reduce pain during activities.

When to Seek Immediate Help
If you experience significant swelling, inability to bear weight on the knee, or if the pain worsens, it is essential to seek immediate medical attention.

Recommended Facilities
In terms of medical facilities, both Taipei and Taoyuan have reputable hospitals and clinics specializing in orthopedics and rheumatology. Some well-regarded options include:
- Taipei Veterans General Hospital: Known for its orthopedic department.

- National Taiwan University Hospital: Offers comprehensive orthopedic services.

- Taoyuan General Hospital: Provides a range of orthopedic treatments and rehabilitation services.

Conclusion
Your knee pain may stem from a combination of overuse and potential underlying conditions. A thorough evaluation by a healthcare professional is essential for an accurate diagnosis and effective treatment plan. In the meantime, consider modifying your activities, engaging in physical therapy, and managing pain with appropriate medications. Remember, early intervention can significantly improve outcomes and help you return to your regular activities.

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