Knee pain: causes and treatment without surgery

Knee pain is most often caused by osteoarthritis, an age-related meniscus tear or overload of the kneecap. Sometimes its source is not in the knee at all but in the hip joint. Most knee pain is managed without surgery: by strengthening the muscles, controlling weight and, if needed, with an injection.

Why does my knee hurt

The knee is the largest joint in the body, and it takes a heavy load when walking, on stairs and when squatting. The cause of knee pain often depends on age and on how the pain started.

Cause	Who it often affects	Typical sign
Osteoarthritis	Middle and older age	Pain that grows with load, short morning stiffness, grinding
Kneecap overload	Young and active people	Pain around the kneecap, on stairs and after sitting for a long time
Age-related meniscus tear	Middle and older age	Pain along the inner or outer edge of the joint, often without a clear injury
Ligament injury	Athletes and young people	A pop at the moment of injury, rapid swelling, the knee gives way
Bursitis	People who kneel a lot	Swelling in front of the kneecap, pain with pressure
Referred pain	Any age	The knee hurts, but the source is in the hip joint

Knee osteoarthritis is the gradual wear of the cartilage in the knee joint. It develops over years, and the pain grows gradually too. In osteoarthritis morning stiffness is usually short and eases within half an hour; if it lasts long and several joints swell, that points more to an inflammatory disease. On telling the two apart: osteoarthritis or arthritis.

My knee hurts, but the problem is in the hip joint

This case deserves a separate mention, because it is often missed. The nerves of the hip joint carry pain through the thigh down to the knee. The person complains about the knee, the knee X-ray is normal, and treatment does not help, because it is aimed where the problem is not.

That is why I always examine the hip joint as well when someone has knee pain. In detail: my knee hurts, but the problem is in the hip.

Meniscus tear: surgery is not always needed

The meniscus is a cartilage cushion in the knee that spreads load between the thigh bone and the shin bone. In young people it is usually torn by an injury, during a twist. In middle and older age a meniscus tear is often part of wear and shows on MRI even without pain.

With an age-related tear, exercise is the first choice, and many people need nothing more. Surgery is considered when the knee genuinely locks and cannot straighten, or when a young person has a tear after an injury that makes the knee unstable.

How knee pain is treated without surgery

What	What it does
Strengthening the front thigh muscle	The muscle protects the knee from load; this is one of the main parts of treatment
Hip muscle exercises	Correct the alignment of the knee when walking and on stairs
Weight control	Reduces the load on the knee with every step
Change in load	Temporarily reduces jumping, running on hard surfaces and deep squats
Medication	Controls pain and inflammation for a short time
Injection therapy	In some cases reduces pain and buys time for exercise

Treatment of knee pain most often rests on the thigh muscle. A weak muscle can no longer absorb load, which then goes straight to the joint; a strong muscle protects the knee like a shock absorber. So exercise is not an add-on to painkillers, it is the foundation of treatment.

With osteoarthritis, moderate walking, swimming and cycling help the joint and do not damage it. Complete rest, on the other hand, weakens muscle and increases pain over time. On the types of injection and what they can do: injection therapy. On excess weight and the joints: excess weight and your joints.

When does a knee need a surgeon

Only a small share of knee pain needs an operation. Most often these are situations like:

• osteoarthritis is advanced and severe pain limits daily life despite properly conducted non-surgical treatment;
• the knee genuinely locks and cannot straighten;
• after an injury the knee is unstable and gets in the way of an active person.

I do not operate on knees: I perform surgery only on the hip joint. In these cases I refer you to a knee surgeon and give you everything we found at the consultation to take with you.

When you should not wait

• the knee has suddenly swollen, turned red and feels hot, especially with a fever: this may be a joint infection;
• after an injury you cannot put weight on the leg, or the knee looks deformed;
• after an injury the knee swelled markedly within a few hours;
• pain behind the knee or in the calf comes with swelling of one leg: this may be a deep vein thrombosis and needs checking without delay.

Key points

• The most common causes of knee pain are osteoarthritis, kneecap overload and age-related meniscus tears.
• Knee pain sometimes comes from the hip joint.
• Strengthening the thigh and hip muscles is the foundation of treatment.
• An age-related meniscus tear does not always mean surgery.
• I do not operate on knees, and if surgery is needed, I refer you to a knee surgeon.

On joint pain in general: joint pain. If your knee has hurt for more than a week, book a consultation.