Dear Doctor,

I’m a 27 year old. About six weeks ago I began having pain in my right knee. I can’t remember any specific injury that caused it, nor was I particularly active when it started. When sitting still or just walking, there is a mild ache or feeling of discomfort, but nothing serious.

When I run fast there is significant pain after the foot is taken off the ground for the next step. This pain is generally in the gap below the knee cap. There is also pain when there is any backward force placed on the straightened knee.

However, the thing that causes the most pain is when I cross the affected leg over the knee of the unaffected leg when sitting. This causes significant pain on the lateral aspect of my knee though rarely it is felt on the medial side as well. What is causing this?

Sandra

Dear Sandra,

Knee pain is a common problem both in the elderly and young, though for different reasons. In a young adult it can be due to tearing of the meniscus, for example, a cartilage providing support between the thigh and shinbone. Meniscus tear can occur due to activities that put sudden strain on the knee joint like playing football, basketball, lifting heavy weights, etcetera.

There is pain, particularly when the affected area is touched and swelling. Pain also occurs while lifting the knee to move. One may also experience a kind of locking sensation in the knee or inability of the knee to move in complete rotation, or a sensation of the knee not giving support.

Treatment consists of pain killer drugs to subside the pain, exercises to strengthen the leg muscles and surgery in severe cases or where symptoms are persistent.

Any activity that puts the knee joint on repeated stress like biking, cycling, playing football and similar games can cause what is known as, ”runner’s knee”. This occurs due to chronic irritation of the lining of the knee joint or of surrounding soft tissues, wear and tear of tendons and or cartilages. It is more common in women of middle age. Obesity aggravates this problem. Here, the pain commonly occurs when one is climbing stairs or sitting with legs crossed, kneeling down.

Diagnosis is made by blood tests and scans of the knee like a C.T scan and MRI. Treatment consists of cold ice compression and pain killers in case of severe pain, giving some rest to the knee for some days, compression of the knee by wearing elastic bandage while walking, putting a cushion or pillow below the knees while sitting and laying down is also useful.

Any kind of tear of ligaments or muscles surrounding the knee joint can also lead to pain and restricted movement of the knee joint. Arthritis of the knee or cartilage injury can result in painful fluid filled swelling (popliteal cyst) at the back of the knee, which causes painful and restricted movements.

Bacterial infection of the knee joint can cause a painful, fluctuant swelling of the knee joint, along with a fever. It responds very well to suitable antibiotics and anti-inflammatory drugs. Tuberculosis can affect the knee joint causing pain, swelling along with a fever, night sweats, loss of appetite, and more. One or more of these symptoms is cured by anti TB drugs.

Fibromyalgia, a condition where muscular pains occur due to mental stress, can cause knee pain as well. A good nutritious diet helps in keeping bones and joints healthy. Regular physical exercise, warming up exercises done before active sports and games help in keeping the joints supple and prevent wear and tear due to chronic use.

In case of unexplained knee pain as is your case, it is best to give ”rest” to the knee for a week or so, nonsteroidal anti-inflammatory drugs can be taken for five to seven days. After that, gradual movements can be started and range of movements can be increased gradually. Using a crepe or elastic bandage over the knee while walking or standing lends support to the knee, hence prevents or minimises pain and discomfort.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.