Knee pain: when should I see a specialist?

Knee pain refers to discomfort or soreness experienced in or around the knee joint, often caused by injury, overuse, or underlying medical conditions, impacting mobility and daily activities. Renowned consultant orthopaedic surgeon Mr Jonathan Miles discusses the condition, including the causes, diagnosis and what measures can take themselves to manage the pain.

What causes knee pain, and when should someone seek medical advice for it?

 The knee is one of the most complex joints, whether in nature or man-made. There are numerous causes of knee pain, including overloading, wear and tear, damage to soft tissues in and around the knee, or trauma.

If you experience knee pain for a day or two, it's generally okay to rest, use anti-inflammatories, and apply ice. However, if the pain persists beyond that, it may be time to seek medical advice. For chronic pain, if it interferes with daily activities, isn't well-controlled with painkillers, or occurs at rest or nighttime, you should go and see a knee specialist to explore treatment options.

How is knee pain diagnosed, and what tests are typically used to determine the cause?

The most crucial step in diagnosing knee pain is having a knee surgeon or specialist ask you detailed questions about your symptoms and medical history. This process, known as taking a history, can provide about 70 percent of the information needed for a diagnosis. A thorough physical examination is also essential, with the surgeon spending several minutes closely inspecting your knee.

The most common initial test is an X-ray, which helps identify signs of trauma, fractures, or severe arthritis. Following that, an MRI scan is often conducted for more detailed, three-dimensional images. An MRI can reveal arthritis, damage to the meniscus, tendons, and ligaments, as well as provide insight into the quality of the bone and any inflamed soft tissues around the knee.

What treatments are available for knee pain, and how are they chosen based on the underlying condition?

There are several treatment options available for knee pain. For acute, self-limiting pain, anti-inflammatories, rest, and ice can be effective. If there are specific concerns about degeneration or tears, an MRI scan can provide guidance. For instance, a torn meniscus can be treated by removing the torn piece or repairing larger tears.

If the anterior cruciate ligament (ACL) is damaged, it can be reconstructed. For osteoarthritis, the primary treatments are either conservative methods or surgical interventions. Conservative treatments might include weight loss or physiotherapy to adjust the forces around the knee. Various injections can reduce inflammation and provide pain relief for several months.

When necessary, joint replacement is an option. A partial knee replacement can be done if only one compartment is worn out. If more than one compartment is affected, a total knee replacement may be needed. This procedure can be enhanced with robotic assistance to ensure precise reconstruction and proper alignment of the knee's soft tissues with the new implant.

What self-care measures or lifestyle changes can help manage knee pain at home?

You can do quite a lot to help with your own knee pain. It can be very useful to take some time to identify the triggers. For example, if you do well with low-impact sports but high-impact sports cause significant pain, you might need to reassess your participation in high-impact activities.

If your knees are imbalanced, it can be beneficial to address this with the help of a personal trainer, physiotherapist, or through exercises at the gym. Many people have slightly weaker quadriceps compared to hamstrings, and tighter hamstrings compared to quadriceps. Correcting this imbalance can alleviate a lot of knee pain, especially around the front of the knee and kneecap.

Weight loss can also be very helpful. For overweight patients, losing weight can significantly reduce knee pain. Regarding supplements, there hasn't been much definitive evidence of their effectiveness. Although many studies have been conducted on turmeric, hyaluronic acid, and other supplements, we are still in a "wait and see" phase rather than being able to make solid recommendations.

If you are suffering from knee pain and would like to book a consultation with Mr Miles, you can do so by visiting his Top Doctors profile today