Which treatment is better for knee pain

Knee pain: This helps against the discomfort

Knee pain is mostly the result of joint damage that can affect different areas of the knee.
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Millions of people in Germany suffer from knee pain. Problems in the knee often significantly limit mobility, everyday activities and thus the quality of life of those affected. Due to the complex structure of the knee joint, the causes of knee pain are not always easy to find. However, once the trigger is discovered, there are numerous treatment options available.

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Here's how to protect your knees

Common causes of knee pain

There are very different causes for knee pain. Often, heavy strain and improper strain, for example during sport or at work, are the reason for damage to knee joint structures, as a result of which knee pain occurs. Sometimes the reasons for the pain can also be found outside the knee joint. This applies, for example, to certain (metabolic) diseases that also affect the knee joint and thus cause pain.

The following illnesses and injuries are possible causes:

  • Joint wear (osteoarthritis): The wear and tear of the protective articular cartilage that covers the bony halves of the joint is a normal symptom of old age; Almost everyone suffers from joint wear after a certain age. Certain factors can promote osteoarthritis, for example excessive strain or long-term poor posture.

  • Injuries / fractures the bony knee joint structures due to violent mechanical effects, such as in an accident. Here the kneecap and the thigh or lower leg in the knee joint area can be affected.

  • Dislocation of the knee or kneecap

  • Ligament and tendon injuries: Torn ligament, torn tendon

  • Meniscal injuries

Knee pain as a result of joint inflammation (arthritis)

Doctors differentiate - depending on the cause - different forms of joint inflammation:

  • Bacterial arthritis: This occurs, for example, when germs enter after a knee injury or knee operation.

  • Arthritis as a result of other infectious diseases (Post-infectious arthritis): One example is Lyme arthritis, which develops as a late sequela of Lyme disease. Lyme arthritis can develop years later after a person has been stung by a tick infected with Borrelia.

  • Reactive arthritis: It occurs after an infection that has affected the stomach, intestines, urinary tract or genital organs rather than the joints. Examples are a salmonella infection, gonorrhea (gonorrhea) or a chlamydial infection. A special form of reactive arthritis is Reiter's syndrome, which is also associated with eye infections.

Arthritis can also develop beyond infections with certain pathogens - namely as a result of certain underlying diseases. These include, for example:

  • Rheumatic diseases such as rheumatoid arthritis (rheumatism)

  • Joint wear (osteoarthritis)

  • Metabolic diseases such as gout or gout-like diseases (pseudogout)

  • Leg misalignments, for example bow or knock knees

  • Cartilage disease of the kneecap (Chondropathia patellae)

  • Disease of bony joint structures (osteochondrosis, osteonecrosis)

  • Runners knee (Iliotibiales band syndrome)

  • Inflammation of the bursitis (bursitis)

  • Bulging of the knee joint capsule (Baker's cyst)

  • Tendinitis (tendinitis)

  • Tumors

Sudden (acute), severe knee pain that is not related to the injury is often associated with the following causes:

  • Attack of gout

  • Overuse-related effusion (activated osteoarthritis)

  • Rheumatoid arthritis

  • Acute bacterial infection

  • Reactive arthritis

Knee pain: symptoms and localization

Over the course of life, the knee has to withstand considerable stress, for example when exercising or lifting heavy loads. The joint is specially designed for this. It consists of several components and structures that make it easy to move: the bony kneecap, the articular cartilage and a cartilage-like connecting link, the meniscus. The exact location and type of pain are important information for making a diagnosis.

A basic distinction is made between acute and chronic knee pain. The suddenly shooting complaints are often associated with a feeling of blockage or instability, and other complaints - for example reddening, swelling and overheating of the joint - are often added. Chronic knee pain develops over months or years, usually occurs during or after prolonged exercise and is also associated with swelling and overheating. Many sufferers report so-called initial pain: the pain initially gets better after a few steps, and then increases again after prolonged exposure.

Depending on the cause, the pain occurs in certain areas of the joint: Typical for a meniscus injury is knee pain on the inside or outside of the joint, and a Baker's cyst is often responsible for pain in the hollow of the knee. Front knee pain can have many different causes and is often grouped under the term patellofemoral pain syndrome or femoropatellar pain syndrome.

This is how the doctor makes the diagnosis

Severe or persistent knee pain should always be clarified by a doctor. In the worst case, there is a risk of destruction of the knee joint and loss of function - both processes are no longer reversible. Due to the complex structure of the knee joint and the many possible causes, the diagnosis of knee pain is in many cases a great challenge, even for the doctor.

At the beginning of the diagnosis there is always a doctor-patient conversation. The doctor asks the person concerned about their complaints and the medical history. This anamnesis often provides initial clues to the cause. The following points are important for the doctor:

  • Since when has the knee pain started?

  • How intense are they?

  • In what situations does the pain occur? At rest, when bending, under heavy load or at the beginning of a movement?

  • Where exactly can the pain be localized? On the inside or outside of the knee? At the front of the joint? Pain in the whole knee?

  • Are there times when the knee is particularly painful, for example in the morning?

  • Are there any other symptoms, for example joint stiffness, redness, swelling, overheating?

  • Are there any other known diseases and risk factors that could explain the pain? Examples are Lyme disease after a tick bite, heavy strain on the knee joint at work or during sports, injuries, accidents or previous knee surgery?

  • Are there any known underlying diseases such as rheumatism, gout or osteoarthritis?

  • What medications are being taken?

  • Are there any metabolic or rheumatic diseases in the family?

The doctor will do these physical examinations

During the physical examination for knee pain, the doctor takes a closer look at the painful knee joint. He looks for deformities, misalignments, effusions and signs of inflammation such as swelling, redness or overheating. In addition, the doctor tests whether the knee joint hurts under pressure and checks its mobility. In addition, he also examines the other joints to get clues about certain diseases as the cause, for example rheumatoid arthritis or gout.

Depending on the findings, further examinations sometimes follow. These include, for example:

  • Blood tests to determine inflammation levels, rheumatoid factors or uric acid levels (if gout is suspected)

  • X-ray examination of the painful knee joint (routine)

  • Magnetic resonance imaging (MRI = magnetic resonance imaging)

  • Computed tomography (CT)

  • Joint puncture and examination of the synovial fluid

  • Joint ultrasound (joint sonography)

  • Arthroscopy

  • Bone scintigraphy (special bone examination)

Treatments that will help with knee pain

Treatment depends on the specific cause. A knee injury, for example from a sports accident, is treated differently than rheumatoid arthritis or the metabolic disease gout. In many cases, for example with an uncomplicated torn ligament, a temporary immobilization of the knee joint with subsequent strengthening through physiotherapeutic measures (physiotherapy) is sufficient.

Medication for knee pain

Knee pain can be treated briefly with pain relievers. These are available as tablets, stick-on pain plasters and as ointments or gels that are applied locally to the knee. Some medications not only relieve pain, but also have anti-inflammatory and decongestant effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used. Examples of active ingredients from this group are ibuprofen, diclofenac or naproxen.

In some cases, joint irrigations and joint injections with cortisone or pain relievers help. In this way, inflammation and pain can be combated directly on site. Doctors treat infections of the knee joint with antibiotics that target and eliminate bacteria. For osteoarthritis, doctors can inject cartilage-building preparations, such as hyaluronic acid. For some people, this is a way to relieve knee pain. If specific underlying diseases are the trigger, doctors first treat them. This applies to rheumatoid arthritis or gout, for example.

Complementary treatments for knee pain

The pain can also be treated with the following measures:

  • Electrotherapy: Application of a weak stimulation current

  • Heating or cooling applications

  • Exercise baths

  • Massages

  • Movement training

  • physical therapy (Physiotherapy)

  • Orthopedic aids: Doctors often use bandages, splints or orthotics after sports injuries in which the ligaments, tendons, kneecap or meniscus have been affected. They fix, stabilize and relieve the affected knee joint. Such aids can be customized. Special insoles, for example, help with misalignments of the legs that cause long-term knee pain.

  • nutrition: People with metabolic diseases such as gout, but also rheumatoid arthritis, can sometimes change their diet to get their knee pain under control.

Operations against knee pain

Surgery is sometimes needed to effectively treat the cause of the pain or to prevent the joint damage from progressing. Doctors now carry out many operations gently as part of an arthroscopy. Examples are the removal of the meniscus, inflamed joint lining (synovectomy) or other tissue components from the joint. In advanced osteoarthritis, doctors sometimes have to partially or even completely replace the knee joint.

Prevention: this is how you can prevent knee pain

The wear and tear of the knee joint is a typical symptom of old age that cannot be prevented. Nevertheless, the sensitive knee joint can be protected and knee pain prevented:

  • Walking is much gentler than jogging. For all regular runners, cushioning shoes are a must.

  • Anyone who crouches more often (for example when gardening) should invest in knee pads or a stool.

  • Regular stretching and stabilization exercises strengthen the muscles around the knee joint.

  • Those who reduce excess weight also relieve their knees.

  • Knock knees or bow legs as well as other misalignments should be corrected with adapted shoes or insoles.

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