Occasional Knee Pain: When to See an Orthopedist or Rehab Specialist

Intermittent severe pain behind the left knee, with the left leg unable to bend or squat normally?

Hello Doctor, I have been experiencing intermittent pain behind my left knee for over a year.
Initially, I thought it was a common injury, so I visited a general massage clinic.
While the treatment provided some relief, it did not address the underlying issue.
The massage therapist suggested that it could be due to cartilage degeneration or a problem with the cruciate ligaments.
However, I am not an active person and have not undergone any surgeries or other injuries.
Recently, I had an evaluation at a rehabilitation department in a regional hospital to check for any minor knee issues.
The doctor mentioned only slight edema, which should not be a concern.
Nevertheless, in the past month, I have been experiencing frequent discomfort in my left leg, with noticeable soreness and numbness while walking, as well as visible varicose veins.
My thigh feels numb, and I am unable to squat or stand up normally due to pain.
I also cannot run or walk comfortably.
Could you please advise whether I should consult an orthopedic specialist or continue with rehabilitation? Is there a solution to help me regain normal walking, running, and the ability to squat and stand up? Thank you, Doctor.

joe, 20~29 year old female. Ask Date: 2015/12/13

Dr. Hong Ximing reply Orthopedics

Based on the symptoms you described, it is not merely a case of ligament or joint discomfort.
It is advisable to seek an evaluation from a neurologist to clarify any symptoms that may be caused by neurological issues.

Reply Date: 2015/12/13

More Info

When dealing with occasional knee pain, especially if it has persisted for over a year and is accompanied by symptoms such as discomfort, numbness, and difficulty with movements like squatting or standing, it is crucial to approach the situation methodically. Based on your description, it seems that you have already sought some medical advice, but your symptoms have not fully resolved.
Given that you have experienced intermittent pain at the back of your knee, along with swelling and sensations of numbness in your thigh and leg, it is advisable to consult an orthopedic specialist. An orthopedic doctor specializes in the musculoskeletal system, which includes bones, joints, ligaments, tendons, and muscles. They can provide a more comprehensive evaluation of your knee's structural integrity and function.
Your symptoms could potentially be indicative of several conditions, such as degenerative changes in the cartilage (osteoarthritis), issues with the ligaments (like the cruciate ligaments), or even problems related to the meniscus. The fact that you have experienced swelling and discomfort suggests that there may be an underlying issue that requires further investigation. An orthopedic evaluation may include imaging studies such as X-rays or MRI to assess the condition of your knee joint, cartilage, and surrounding structures.

On the other hand, a rehabilitation specialist can also be beneficial, especially if your primary concern is regaining function and reducing pain through physical therapy. Rehabilitation specialists focus on restoring movement and function through exercises and other therapeutic modalities. They can help you develop a tailored exercise program to strengthen the muscles around your knee, improve flexibility, and enhance overall function.
In your case, since you have already been assessed for minor swelling and have been advised that it does not significantly impact your knee, it might be beneficial to first see an orthopedic specialist to rule out any serious underlying conditions. If they determine that your knee pain is due to soft tissue issues or minor degenerative changes, they may refer you to a rehabilitation specialist for physical therapy.

In terms of treatment options, there are several approaches that may help alleviate your symptoms and improve your knee function:
1. Physical Therapy: A physical therapist can guide you through exercises that strengthen the muscles around your knee, improve flexibility, and enhance stability. This is crucial, especially if you are experiencing weakness or atrophy in the muscles surrounding the knee.

2. Medication: Over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help manage pain and reduce inflammation. However, it is essential to use these medications as directed and consult with a healthcare provider if you have any underlying health conditions.

3. Activity Modification: Avoiding activities that exacerbate your pain, such as running or high-impact exercises, can help prevent further irritation of your knee. Instead, consider low-impact activities like swimming or cycling, which can maintain fitness without putting excessive strain on your knee.

4. Weight Management: If applicable, maintaining a healthy weight can reduce the stress on your knees, potentially alleviating pain and improving function.

5. Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and provide temporary relief.

6. Surgical Options: If conservative treatments fail and significant structural issues are identified, surgical intervention may be necessary. This could involve arthroscopy to repair damaged tissues or, in more severe cases, joint replacement.

In conclusion, while both orthopedic and rehabilitation specialists can play vital roles in your recovery, starting with an orthopedic evaluation seems prudent given the duration and nature of your symptoms. This will ensure that any significant issues are addressed early on, allowing you to pursue an effective treatment plan tailored to your needs.

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