Understanding Knee Pain When Bending
Knee pain when bending is very common and can originate from a variety of sources. The knee is a complex joint made up of bones, muscles, ligaments, tendons, and fluid-filled sacs called bursae. Any injury, overuse, or disease affecting one of these structures can cause knee pain.
Some of the most common causes of knee pain when bending include:
Knee Bursitis
Bursae are fluid-filled sacs that provide cushioning between bones and soft tissues like muscles, tendons, and skin. When bursae become inflamed, it's called bursitis. There are several bursae around the knee that can become irritated and inflamed.
Pes anserine bursitis affects the inner knee and causes pain when bending or kneeling. Prepatellar bursitis, also called housemaid's knee, causes pain and swelling in the front of the knee. And infrapatellar bursitis, or clergyman's knee, leads to pain below the kneecap when bending the knee or kneeling.
Tendonitis
Tendons attach muscles to bones, and they can become inflamed or irritated with overuse. Two common types of tendonitis around the knee include patellar tendonitis (jumper's knee) and iliotibial band tendonitis (runner's knee).
Jumper's knee causes pain below the kneecap that worsens when bending the knee, like when jumping or going up and down stairs. Runner's knee leads to outer knee pain that flares up after activities like running or biking.
Arthritis
Arthritis occurs when the cartilage that cushions the joint wears down over time, leading to pain, swelling, and stiffness. Osteoarthritis is common in the knees, especially in older adults, and causes knee pain that gets worse with activity like bending or prolonged walking.
Rheumatoid arthritis and other inflammatory types of arthritis can also affect the knee joint and cause pain and swelling.
Meniscus Tears
The menisci are two C-shaped discs of cartilage that provide cushioning and stability in the knee joint. Twisting injuries and wear and tear can cause meniscus tears, which often cause knee pain when bending fully or squatting.
Patellofemoral Pain Syndrome
Sometimes called runner's knee, this condition causes dull, aching pain around and under the kneecap. It results from issues like poor tracking of the kneecap in the groove of the femur or weak thigh muscles. Pain gets worse when bending the knee, like when going up and down stairs.
Dislocated Kneecap
A kneecap dislocation occurs when the patella pops out of place, usually from a direct blow or twist. It causes immediate, severe pain and a visibly displaced kneecap. Bending the knee is difficult or impossible until the kneecap returns to its normal position.
When to See a Doctor
Occasional knee pain with bending that goes away fairly quickly probably isn't cause for concern. But see your doctor if you experience:
- Persistent or worsening knee pain when bending
- Swelling around the knee joint
- Feeling like the knee will "give out"
- Significant knee stiffness, limited motion, or inability to fully straighten the knee
- Severe knee pain that comes on suddenly after an injury
Seeking timely medical care is crucial to get an accurate diagnosis and proper treatment to relieve your symptoms.
Examining Knee Pain Causes
During the appointment, the doctor will discuss your symptoms and medical history. They'll examine your knee for signs of swelling, tenderness, or deformities. You'll need to describe exactly where it hurts and what makes the pain worse.
The doctor may also order imaging tests like:
- X-rays to see bone alignment and look for arthritis
- MRI to examine soft tissues like ligaments, tendons, and cartilage
- CT scan to further evaluate bone structure
Blood tests can help diagnose inflammatory forms of arthritis. The doctor may also recommend aspirating fluid from the knee joint for analysis.
Common Knee Pain Treatments
Treatment will depend on the underlying cause of your knee pain. Some options may include:
Rest and Ice
Taking a break from activities that aggravate your knee allows healing. Ice helps ease swelling and pain. Your doctor may recommend resting your knee for a period of time and icing for 15-20 minutes several times per day.
Compression
Wearing a knee brace or bandage can provide compression to help reduce swelling.
Elevation
Keeping your leg elevated above the level of your heart helps decrease swelling and discomfort.
Medications
Over-the-counter nonsteroidal anti-inflammatory drugs like ibuprofen help relieve knee pain and swelling. For more severe arthritis pain, prescription medications may be needed.
Physical Therapy
Specific knee and leg strengthening exercises can improve stability and function. Stretching and range-of-motion exercises also help.
Knee Brace
Wearing a supportive knee brace can improve alignment and take pressure off areas causing pain. Braces also limit unwanted knee motion.
Corticosteroid Injections
Cortisone injections delivered directly into the knee joint or bursa can powerfully reduce inflammation and provide pain relief. However, results are temporary.
Surgery
If conservative treatments fail, surgery may be needed to trim damaged cartilage, repair ligaments, or replace the joint. Common knee surgeries include arthroscopy, ligament reconstruction, and partial or total knee replacement.
Preventing Knee Pain
You can reduce your chances of developing knee pain and injury by:
- Maintaining a healthy weight to avoid putting extra stress on the knees
- Wearing supportive and well-cushioned shoes
- Using proper form when exercising
- Stretching the legs, hips, and knees before and after physical activity
- Strengthening the leg and hip muscles through exercise
- Taking breaks when participating in repetitive tasks that involve lots of bending
- Replacing worn out athletic shoes regularly
Seeing a physical therapist can also be helpful to identify areas of weakness and prescribe specific strengthening exercises tailored to your needs.
When to See an Orthopedist
If home treatments and initial medical management aren't improving your knee pain, your doctor may recommend consulting an orthopedic specialist. Orthopedists complete extensive training in diagnosing and treating injuries and diseases of the musculoskeletal system.
Orthopedists can order more specialized tests like a CT or MRI scan to fully evaluate the structures causing your knee pain. They may provide more aggressive treatment options like steroid injections, viscosupplementation with lubricating knee gel, prescription anti-inflammatories, or surgery.
Seeing an orthopedic specialist is particularly important if you experience any of the following:
- Inability to bear weight on the leg
- Locking, clicking, or popping in the knee joint
- Weakness, numbness, or pain radiating down the leg
- Significant injury to the knee like a ligament tear
- Failed conservative treatment for knee arthritis
Knee pain can significantly impact your mobility and quality of life. An orthopedic specialist has the advanced training necessary to accurately assess the cause of your knee pain and discuss all treatment options available, including surgery if needed.
When Knee Pain May Indicate Arthritis
If you have knee pain that gets worse with activity and seems to come and go with the weather, arthritis may be the cause. Arthritis leads to inflammation and gradual deterioration of the cartilage that cushions the knee joint.
As the smooth cartilage surface wears down, the bones begin to rub together. This causes pain and stiffness, especially with bending, prolonged use, or weight-bearing activities. Arthritis-related knee pain is also typically worse in the morning or after sitting for long periods.
Osteoarthritis is the most common form of knee arthritis, but rheumatoid arthritis and post-traumatic arthritis after an injury can also affect the knees. Having a family history of arthritis, previous knee injury, or being overweight increases the risk.
Diagnosing Knee Arthritis
An orthopedic doctor can confirm a diagnosis of knee arthritis. They'll examine the joint for swelling, tenderness, fluid, and limited motion. Imaging tests like x-rays, CT or MRI scans may be ordered to look at cartilage loss and bone spur formation.
Blood tests can help diagnose inflammatory forms of arthritis like rheumatoid arthritis. The doctor may also remove a sample of fluid from the knee joint to analyze.
Treating Arthritic Knee Pain
While there is no cure for arthritis, many treatments can help manage the pain and improve knee function. Options may include:
- Weight loss to reduce stress on the knees
- Pain relievers like NSAIDs, cortisone injections, or hyaluronic acid gel injections
- Physical therapy exercises to strengthen muscles around the knee for added stability and support
- Assistive devices like a cane, knee brace, or shoe orthotics
- Surgery such as arthroscopic clean-up, osteotomy, partial knee replacement, or total knee replacement
An orthopedic knee specialist can determine the best options for controlling your arthritic knee pain and improving joint function.
When Meniscus Tears Cause Knee Pain
The menisci are two rubbery discs of cartilage in the knee joint that cushion impact and improve stability. They frequently become torn from sudden twisting injuries or wear and tear as we age.
Meniscus tears often cause knee pain when bending fully, squatting, kneeling, or going up and down stairs. Other symptoms may include:
- Swelling and stiffness in the knee joint- Feeling like the knee will "give out"
- Catching, popping, or locking sensations
- Difficulty fully straightening the knee
Diagnosing a Meniscus Tear
An orthopedic doctor can diagnose a meniscus tear. They'll perform a physical exam looking for swelling, tenderness, and limited range of motion. Special tests like the McMurray test also help indicate a meniscus tear.
Imaging studies like MRI provide the most accurate view of the menisci to identify tears. X-rays may be done to rule out other problems like arthritis or fractures.
Treating Meniscus Tears
Some small or stable tears may get better with rest, ice, anti-inflammatories, and physical therapy. But most torn menisci require arthroscopic knee surgery to trim or repair the damage.
During arthroscopy, the surgeon inserts a tiny camera into the knee joint to view the meniscus. Small tears are simply trimmed and smoothed out. Larger tears may be sutured back together if the remaining meniscus is healthy.
Recovering from meniscus surgery takes several weeks but can very effectively reduce knee pain from a torn meniscus. Physical therapy then helps strengthen the knee and restore full function.
Warning Signs to See a Doctor
In most cases, knee pain is not a medical emergency. But some specific symptoms should prompt urgent evaluation to avoid complications like permanent joint damage.
See your doctor right away if you experience:
- Sudden onset of severe knee pain - This may indicate a torn ligament, tendon, or meniscus that needs prompt treatment.
- Significant swelling around the knee joint - Large effusions can cause stiffness and pain.
- Inability to bear weight or severe pain with weight-bearing - This suggests a major strain, sprain, fracture or ligament tear.
- The knee locking or catching when moving - Locking indicates a loose body or tear in the knee.
- Popping or crunching noises - Loud noises can mean cartilage, meniscus, or ligament damage.
- Knee instability or giving out - This may result from ligament, cartilage, or meniscus injury.
Severe knee injuries require immediate examination. Getting proper treatment fast improves healing and prevents chronic issues like arthritis down the road.
Preventing Future Knee Pain
Once any existing knee problems have been properly addressed, there are things you can do to prevent future knee pain:
- Maintain a healthy weight to reduce knee joint stress.
- Avoid high-impact activities like running on hard surfaces.
- Wear supportive shoes with adequate cushioning.
- Strengthen leg and core muscles through regular exercise.
- Always warm up and stretch thoroughly before physical activity.
- Use proper form when working out to avoid injury.
- Take frequent breaks if you have a job that requires lots of bending and squatting.
- Wear knee pads if you spend time kneeling.
Some types of knee pain can't be prevented. But protecting your knees from strain and practicing good joint care makes coping with knee problems much easier.
When to Consider Knee Replacement Surgery
For those with severe, debilitating knee arthritis pain that hasn't responded to other therapies, knee replacement surgery may be the best option. Knee replacement surgically resurfaces damaged cartilage and bone to create a smooth gliding joint.
Candidates for knee replacement surgery include those with:
- Bone-on-bone osteoarthritis or rheumatoid arthritis
- Intense knee pain even at rest or at night
- Stiffness and loss of knee mobility
- Joint deformity
- Failed conservative treatments
- Difficulty with daily activities due to knee pain
Younger, more active patients are increasingly opting for knee replacement to regain their activity levels. New implant materials allow knee replacements to last 20-25 years in some cases.
Knee Replacement Procedures
There are several different knee replacement procedures depending on how much of the joint requires replacement:
- Total knee replacement - Resurfaces all three compartments of the knee, suitable for combined medial, lateral and patellofemoral arthritis.
- Partial knee replacement - Only replaces one or two compartments of the knee.
- Bicompartmental knee replacement - Resurfaces two of the three knee compartments.
- Patellofemoral knee replacement - Specific to arthritis under and around the kneecap.
Your orthopedic surgeon will determine the best surgical option based on your knee anatomy and arthritis pattern.
Recovering from Knee Replacement
After surgery, patients begin physical therapy to help regain knee flexibility and strength. Most people can walk with assistance and perform basic daily tasks within a few weeks.
Complete recovery takes about 3-6 months. Long term, knee replacements provide excellent pain relief, vastly improved joint function, and a greatly enhanced quality of life.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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