How to figure out why your knee hurts
I started running again this spring. I began slowly, with intermittent walking. All was good until the day both my knees started complaining. A twinge of pain accompanied every footfall.
This new-to-me pain came from inside the knee, not below the kneecap, my usual sore spot. The other movement that gave me a flash of pain was the deep knee bend I did every morning to scoop the dog’s food.
I knew enough to stop doing the things that cause pain; I quit running and I leaned over on straight legs to reach the dog food. Other movements – walking, stairs – didn’t trigger the sharp pain, but my knees would get achy later in the day. Aspirin helped.
Self-treatment is appropriate for minor knee pain, according to two physicians, Nitin Damle and John Meigs. However, if there’s redness or if you have trouble with stability or walking, see a physician.
Another worry entered my mind – and that’s what sent me to the doctor. I live in an area, which harbours some of the highest rates of Lyme disease in the nation. My doctor accommodated me with a Lyme test, but she also examined me and asked a lot of questions.
General practitioners see a lot of people with knee pain, says Meigs. “It’s one of the most common complaints family physicians get.”
Faced with a painful knee, doctors will take a history: Did you injure yourself? Did you change your exercise regimen? “All can lead to inflammation of the knee,” says Damle.
Your doctor will examine the knee. “You might see fluid buildup, a decrease in the range of motion or difficulty bearing weight,” Damle says. These symptoms may indicate a serious injury such as a ligament tear, which may prompt an MRI scan and a referral to an orthopedic surgeon.
If you didn’t injure your knee outright, your doctor will look for other problems. Mild swelling and pain can arise from what are called overuse injuries. “Sometimes people take up jogging or walking or whatever, and they do a little too much too fast,” says Meigs.
I swear I didn’t do too much too fast. And yet, there are numerous structures in the knee that can become injured or inflamed. The most serious things are a fractured kneecap; a torn ACL (anterior cruciate ligament); and a torn meniscus, the cartilage cushion inside the knee. The more run-of-the-mill things are bursitis, a swelling of the small sacs of fluid that cushion the outside of the knee joint, and tendinitis, irritation and inflammation of the tendons that attach your leg muscles to your leg bones.
Runners, skiers and cyclists are all susceptible to bursitis and tendinitis. The treatment is straightforward: rest, ice, brace and anti-inflammatory medicine. That means you need to stop doing anything that causes pain, ice your knee (most helpful in the first two days after an injury), use athletic wrap or a knee brace to protect against a move that may reinjure the joint, and take pain killers.
My doctor told me that if I was negative for Lyme and the pain continued, I might consider seeing a specialist to check for osteoarthritis. The diagnosis becomes increasingly common with age; studies have found nearly 20 per cent of people older than 45 and more than a third of people older than 60 have osteoarthritis of the knee.
“Sustained pain in both knees in older adults: One does think osteoarthritis,” Damle says. An X-ray can help confirm osteoarthritis by documenting bony outgrowths and/or narrowing of the joint space.
A week after my doctor’s visit, another possibility presented itself. A friend told me she had taken her daughters – two tween gymnasts – to the pediatrician with knee pain. They were diagnosed with parvovirus, which in their case was not accompanied by the telltale rash or fever. “It’s going around,” my friend’s doctor reported, adding that the symptoms should go away in a week or two.
In an online search, I discovered a syndrome called viral arthritis, which often causes pain in the large joints, such as the knees, and can be triggered by parvovirus, even in adults, and a handful of other viruses including hepatitis (B and C), enterovirus and rubella. Perhaps I had a risk factor my doctor hadn’t asked about – living with a preadolescent child in a town where parvovirus was prevalent.
Bacteria can infect knees as well, Meigs says. “A hot knee will be red, swollen and tender,” he says, and warrants a doctor’s visit. Antibiotics can clear bacterial infections, but not viral ones. Those tend to clear with time.
Sure enough, my pain resolved in about two weeks. But did I have parvovirus? I cannot say.
The good news is that I started running again this week, and I am pain-free. If my pain reappears, I may look into specific stretching and strengthening exercises to help better support my knees while running and walking.
The Washington Post
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