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Chronic Knee Pain: Causes and Treatment

By Dr. Clayton Hodges

Chronic knee pain is a common problem in both the young and older adult population. Often, knee pain is associated with knee injuries and/or arthritis. The good news is there are a variety of treatments for knee pain.

When the knee is unstable, meaning it’s lost its ligamentous stability, the knee undergoes abnormal motion. When that happens you can have meniscus tear, have cartilage wear out and tear or become thinner. This can be a problem if it becomes chronic and allows a person’s knee to have abnormal motion. This often results in people avoiding activities they would normally undertake, and even having discomfort or disability as far as normal activities such as stepping off a curb, going up steps or walking on uneven ground. 

ACL injuries are the most common ligament injuries that require surgery. These often involve non-contact injuries, in which someone plants their foot and twist their body in a way that twists their knee. Typically what you’ll see after an ACL injury is rapid swelling and inability to walk on it. Those signify serious injuries that should be tended to in a timely basis. 

Cartilage injuries may result from acute injury, such as an ACL tear. Common symptoms include persistent pain, swelling or fluid in the knee, locking or catching of the knee. In acute injuries, you may see swelling within the knee. Treatments for cartilage injuries include knee injections, bracing of the knee, physical therapy or surgery.

Tears in the meniscus also are a common knee injury and can happen with acute injury or it can happen over time. The meniscus functions as a shock absorber and helps distribute pressure evenly throughout the knee joint. When you’re missing part of your meniscus or it’s torn, that can cause symptoms and long term it can cause increased pressure on the cartilage which can cause the development of arthritis. Once you tear the meniscus, it’s not likely to heal on its own. 

Common symptoms of a tear in the meniscus include sharp pain with knee bending or twisting, and in severe cases the knee can lock or catch. Symptoms may improve with physical therapy, knee injections or non-steroidal anti-inflammatory drugs. If these measures fail, arthroscopic surgery may be considered to repair the meniscus, which preserves critical function and decreases the odds of arthritis occurring.

Knee arthritis also can cause knee pain and it is a huge problem worldwide, causing decreased quality of life, decreased economic income and myriad other problems. Symptoms of knee arthritis are pain that worsens with walking or as the day progresses, swelling, which may be constant or intermittent, stiffness on first use of the knee after sleep or arising from sitting, and in advanced cases, deformity of the knee. Wear of cartilage is the key factor of developing arthritis, so it’s important to prevent cartilage injuries or act early after a knee injury to restore cartilage. 

It is also important to decrease the load on your knees through activity modification, low impact exercise, braces and weight loss. Small changes in weight can have a huge impact on the load on your knees. Ten pounds of weight loss is 40 pounds of load off the knee. Decreasing the load on the knee is the most significant step many patients can take in improving their symptoms of knee arthritis. 

Depending on the severity of knee pain, there are many treatments available including physical therapy, non-steroidal anti-inflammatory drugs such as ibuprofen, bracing, injections, realigning the knee, partial or full knee replacement. To find out which treatment might be right for you, talk with your doctor.

Clayton Hodges, MD, is a board-certified orthopedic sports medicine surgeon at UT Health East Texas Orthopedic Institute.


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