Do you have daily knee pain despite having no major trauma or precipitating event? Has physical therapy, rest and NSAIDs failed to provide relief? It is very frustrating and can keep you on the sidelines. To learn more please read below to answer the following questions: What are the different types of knee pain that are associated with bending and straightening? What are the eight most common causes of knee pain? What common conditions cause your knee to hurt when you bend it or straighten it? What treatment options are available? Let’s dig in.
My Knee Hurts When I Bend It And Straighten It!
Your knees bend countless times throughout the day. Running up the stairs, down the hall after kids, and getting into the car. You straighten the knee as you walk, descend stairs or get into and out of the car. Bending and straightening the knee are necessary for daily activities. Knee pain with bending or straightening may be a mild, transient irritation or may indicate a more significant problem. Learn more below and avoid further injury and dysfunction.
How The Pain In The Knee Appears When Bending or Straightening
Knee pain can vary significantly depending upon many factors including the actual source of the pain, the severity of the injury, general health, and level of activity. Let’s take a deeper look at the various types of knee pain.
Knee Pain in General
Knee pain can be intermittent or constant. It can be stable, improving, or escalating. It can be localized in a specific area or radiate down or up the leg. It can be dull, sharp, throbbing, aching, or burning. It can be associated with swelling and restriction in range of motion.
Pain with Joint Locking
Often times the knee will simply lock creating pain and immobility. You are walking one minute and the next the knee is stuck. The pain is abrupt and occurs when attempting to bend or straighten the knee. An injury to the meniscus or a loose body can cause this type of pain (1).
Pain Sensation Behind the Knee Cap
Pain can be localized behind the knee. Most often it is made worse with climbing and descending stairs. The pain can be dull or sharp and persists while descending from a hike. Knee pain behind the knee cap is typically due to misalignment of the knee, or cartilage loss.
Jolting Pain Behind The Knee
Pain in the back of the knee can stop you in your tracks making bending and straightening very difficult at times. The pain can be sharp and jolting or a dull ache. Possible causes of pain in the back of the knee include Baker’s cyst, hamstring tendon irritation or inflammation, ligament instability, and posterior horn meniscus injury (2)
Pain on the Outside of the Knee
Pain on the outside of the knee oftentimes is referred to as lateral knee pain. It can be caused by an injury or repetitive activity. The pain can be intermittent or constant. There are many causes of lateral knee pain which include osteoarthritis, meniscus injuries, ligament laxity, and iliotibial band dysfunction.
Pain on the Inside of the Knee
Pain localized on the inside of the knee is quite common. It can be constant or intermittent. Often it occurs at or slightly below the joint line. Common causes of medial knee pain include osteoarthritis, medial meniscus injury, and inflammation of the low leg tendons. The latter is called pes anserine bursitis.
Popping Sound
Audible popping sounds in your knee can be quite alarming. It can be abrupt in onset or occur gradually over time. In most cases, it is harmless and is the release of small bubbles in the joint or abnormal movement of ligaments and tendons over boney surfaces. If a popping sound is associated with pain and or swelling there is reason to be concerned. If persistent a consultation with your doctor is indicated.
Loss of Strength
Persistent loss of strength in the knee warrants concern. It can be gradual or abrupt in onset. It can be due to overuse but other causes include ligament instability, osteoarthritis, meniscus tears, and irritation or injury of the nerves in the low back. The well-established connection between low back dysfunction and knee pain has been discussed in a prior blog.
What Are The Eight Most Common Causes Of the Knee Pain?
Knee pain can arise from a number of conditions. It is important to understand where your knee pain is arising from. This will allow for the best treatment plan. The most common causes of knee pain include:
Cartilage Injury
Cartilage is a smooth coating on the end of your thigh and shin bone that allows smooth, painless movement of your knee. It is a flexible connective tissue that cushions your bones against the pressures and forces of daily living. Unfortunately, it is susceptible to injury and degeneration. The most common causes of cartilage damage are wear and tear, repetitive use, and trauma.
Ligament Injury
Ligaments are thick pieces of connective tissue that connect bone to bone. They provide important stability for a joint. Important ligaments in the knee include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament ( MCL), and lateral collateral ligament (LCL). Ligaments can be injured due to overuse, injury, aging, and medical conditions such as diabetes. Ligament injury can cause the knee to hurt when you bend or straighten it.
Meniscus Injury
The meniscus is a c shaped shock absorber sandwiched between the thigh bone (femur) and shin bone (tibia). It is composed of fibrocartilage and serves to absorb the forces of daily living in addition to providing stability to the knee (4). There are two menisci per knee: one on the inside (medial) and one on the outside (lateral). Meniscus tears are the most common injury. The can be degenerative in nature or as a result of acute injuries. There are many different types of knee meniscus tears which include radial, horizontal, incomplete, flap, buck handle, and complex. Meniscus tears can cause swelling and dysfunction. Meniscus tears can also cause the knee to hurt when you bend or straighten it.
Tendon Injury
Tendons are thick pieces of connective tissue that connect muscle to bone. They serve to stabilize and move a given joint. There are many tendons in the knee which include the patellar and distal quadriceps tendon. Tendons are susceptible to injury due to overuse, muscle imbalance, trauma, medications such as certain antibiotics, and medical conditions.
Imbalance
Proper knee function requires that all the muscles, tendons, ligaments, and nerves work together in a synchronized and harmonic fashion. When the system breaks down, knee pain, swelling and dysfunction can occur.
Nerve Injury
Nerves provide important information to the muscles, tendons, and ligaments in the knee. Without this information, the knee can not properly function. Nerve injury can occur locally as is the case with peroneal nerve injuries. Nerve dysfunction can also occur due to problems in the low back such as disc herniation, disc protrusion, spinal stenosis, and lumbar disc slippage. A previous blog has discussed knee pain due to nerve irritation.
Bone Injury
There are three principal bones in the knee: patella, femur, and tibia. Bone can become injured due to trauma. Acute injuries can lead to bone swelling also known as subchondral edema. Long-term bone injury can result in bone death also referred to as avascular necrosis. Both injuries can cause significant knee pain that oftentimes is most intense at night. At the Centeno-Schultz Clinic, these boney injuries have been successfully treated with an injection of PRP and bone marrow concentrate into the bone (intraosseous). A previous blog discusses it application and success.
Referred Pain
Referred pain is pain that is perceived or felt in an area different than where the actual tissue damage is occurring. The classic example is that of a patient who is experiencing a heart attack. That patient may feel arm pain however the actual tissue damage is occurring in their heart. An example of referred pain in the knee is an irritation of the L3 nerve in the low back. A patient may have no back pain but have pain in the front portion of their knee which is the result of low back nerve irritation.
Common Conditions That Cause Pain When Bending or Straightening Knee
Pain when bending or straightening the knee can sideline you for the weekend or for months at a time. There are many different causes of knee pain. It is important that you identify the specific cause of your pain so that a specific treatment plan can be created. There are 5 major conditions that can affect how the functions like difficulties in bending or straightening the knee:
Knee Arthritis
Arthritis is a medical condition with swelling, tenderness, and stiffness in the knee. There are many different types of arthritis with osteoarthritis being the most common. It affects millions of patients worldwide. Osteoarthritis is a degenerative joint disease where the cartilage that protects the joint wears down over time. The result is knee pain when bending or straightening it.
Bursitis
A bursa is a fluid-filled sac that allows tendons, ligaments, and muscles to easily glide on boney areas. There are multiple bursae in the knee that allow for pain-free motion. Bursitis is inflammation of these fluid-filled sacs. Bursitis can cause significant knee pain and limit bending and straightening of the knee.
Ligament Injuries
Ligaments are the duct tape that keep your knee joint together and stable. Trauma and repetitive wear and tear can result in injury or degeneration or tearing of knee ligaments. Common athletic injuries witnessed virtually every weekend include ACL tears. The Centeno-Schultz Clinic pioneered a safe alternative to surgery utilizing your own bone marrow concentrate which contains your stem cells. To learn more please click on the video below.
Jumper’s Knee
Jumper’s knee is inflammation of the patellar tendon. It is a very common overuse disorder in athletes who participate in sports that require jumping such as volleyball and basketball. The prevalence varies but can be as high as 22.8% in elite athletes (5). Pain is typically localized on or immediately below the knee cap. Risk factors for a jumper’s knee include body weight, leg length differences, arch of foot height and quadriceps, and hamstring flexibility (6).
Meniscus Injuries
Meniscus injuries are a common injury with an incidence of 60 per 100,000 individuals (7). Risk factors include age (older than 60 years), gender (males), work-related squatting and kneeling, and climbing stairs (8). Meniscus tears can cause a number of different symptoms including pain along the joint line, swelling, clicking, locking, and “giving way” of the knee. It can also cause knee pain when bending and straightening your knee.
Baker’s Cyst
A baker’s cyst is a fluid-filled sac located on the backside of your knee. Its size can vary from small to large creating tightness and a bulge in the back of your knee. Most importantly it is an indication that you have a problem that warrants attention. A baker’s cyst is an increase in fluid in the knee due to an underlying injury. Examples of issues that can cause a Baker’s cyst includes osteoarthritis, meniscus tear, ligament tear, instability, and gout.
Runner’s Knee
Runner’s knee is a clinical condition that involves pain around or behind the kneecap, also known as the patella.. It is typically an overuse injury. This is not exclusive to runners and can affect non-athletes as well. Knee cap pain can arise from several different conditions including loss of cartilage behind the knee (patellofemoral syndrome), poor tracking of the patella, iliotibial band (ITB) syndrome, and quadriceps weakness.
ACL Tears
The Anterior Cruciate Ligament (ACL) is one of four major ligaments in the knee. It is an important stabilizer of the knee and prevents the shin bone (tibia) from sliding in front of the thigh bone (femur).
The ACL is susceptible to injury. It is most likely to be injured during activity or by impact.
A torn ACL is a common injury for athletes at all levels, but it is most common for people who are active or who experience impact injuries to the knee.
ACL injuries can happen to anyone of any age, condition, or ability, and it can be injured in many ways. Examples include abruptly changing direction, slowing down while running, landing incorrectly, or getting struck by someone or some object.
Bone spurs, also known as osteophytes, are abnormal growths that can form along any bony surface in the body. They most frequently occur where tendons and ligaments attach to the bone. As a result, they are more commonly seen in large mobile joints that support weight, such as the hips, spine, ankles, or knees.
Surprisingly, most bone spurs are relatively benign but are a clinical sign of instability in the area. Research demonstrates that if a ligament has laxity, the constant strain at the insertion into the bone will elevate the surface of the bone, creating additional bone formation – this is known as a traction osteophyte.
Calcific tendonitis, also known as calcifying tendonitis, is a condition characterized by the formation of calcium deposits in a tendon, most commonly in the rotator cuff tendons of the shoulder. These deposits are not due to injury or trauma but rather occur spontaneously. Tendons, the thick connective tissues that link muscles to bones, aren’t usually calcified. However, in calcific tendonitis, calcium builds up in these tissues, which can result in inflammation and severe pain. This condition tends to occur more commonly in adults between 30 and 60 years old, and it’s more prevalent in women than in men.
Chondromalacia is the knee usually causes pain, typically around the kneecap or deep in the kneecap. You can also have some grinding sensations or crepitus which are sounds and noises coming from around the knee with certain motions. Typically, pain and grinding sensations are worse with bending the knee, especially for prolonged periods of time, kneeling on the knee, walking downstairs, or running downhill. Standing after prolonged sitting or an immobility period where the knee is bent can cause some discomfort as well. Some people may experience swelling, others may experience locking or catching in the knee, feeling the knee wants to give out, or a feeling of weakness….
Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity. It most commonly affects the skin, joints, and blood vessels. Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…
Also known as “IT Band Syndrome” also known as “ITB Syndrome,” iliotibial band syndrome is a painful medical condition that affects the lateral hip, leg, and knee. It can affect individuals of all ages and most often is caused by repetitive activities like running, cycling, hiking, and walking.
Your iliotibial band is a thick band of connective tissue that runs from the outside of your hip down to the outside aspect of your knee. Its principal function is to stabilize the hip and knee. If it becomes tight and dysfunctional, you may experience pain along with this band of tissue due to strain or inflammation. You may also experience pain, limited range of motion in…
In the human body, a joint is simply where 2 ends of bone come together. At the ends of these bones, there is a thick substance called “Hyaline Cartilage” that lines the ends. Hyaline cartilage is extremely slippery which allows the two ends of the bone to slide on top of each other. Then there is a capsule that connects the two ends filled with “synovial fluid” that acts as a further lubricant to make it more slippery!
Arthritis in the knee is defined by loss of the hyaline cartilage plus other changes that happen to the bone such as additional bone being laid down (bone spurs/osteophytes). The cartilage layer is worn down to the point of exposing the underlying bone they cover…
What is an LCL Sprain?
A strain or tear to the lateral collateral ligament (LCL) is known as an LCL injury. The LCL is a band of tissue that runs along the outer side of your knee. It aids in keeping the bones together while you walk, ensuring that your knee joint remains stable.
How you feel and what type of treatment you’ll require depends on how severely your LCL has been stretched or torn. If it’s only a minor sprain, self-care at home might help. However, if it’s a significant tear or sprain, you may need physical therapy, an injection-based procedure, or surgery….
A strain or tear to the lateral collateral ligament (LCL) is known as an LCL injury. The LCL is a band of tissue that runs along the outer side of your knee. It aids in keeping the bones together while you walk, ensuring that your knee joint remains stable.
How you feel and what type of treatment you’ll require depends on how severely your LCL has been stretched or torn. If it’s only a minor sprain, self-care at home might help. However, if it’s a significant tear, you may need physical therapy, an injection-based procedure, or surgery. Orthopedists categorize LCL tears into 3 grades…
The medial collateral ligament AKA MCL is a thick, strong band of connective tissue on the inside portion of your knee. It connects the top part of the tibia (shin) to the bottom part of the femur (thigh). This is a vital ligament that works along the lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL) to bring stability, structure, and movement to the knee. The MCL provides support and stability for the inside (medial) aspect of the knee. MCL sprains are a common injury in sports such as football, hockey, and skiing. The ligament can…
The medial collateral ligament AKA MCL is a thick, strong band of connective tissue on the inside portion of your knee. It connects the top part of the tibia (shin) to the bottom part of the femur (thigh). This is a vital ligament that works along the lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL) to bring stability, structure, and movement to the knee. The MCL provides support and stability for the inside (medial) aspect of the knee. MCL tears are a common injury in sports such as football, hockey, and skiing. The ligament can…
The meniscus is a c-shaped piece of cartilage in the knee that functions as an important shock absorber. It is sandwiched between the thigh and shin bone. There are two menisci per knee. One on the inside portion of the knee (medial) one on the outside aspect (lateral).
The knee meniscus is susceptible to injury. The most common injury is a tear in the meniscus. Not all meniscus tears however cause pain. When symptomatic a meniscus tear can cause pain, swelling, and restriction in range of motion.
Tears in the knee meniscus can arise from trauma or degeneration. There are many different types of meniscus tears based upon locations….
The Patellar tendon is the thick connective tissue that starts at the base of the kneecap (Patella) and extends down to the shin. The is an extension of the Quadriceps tendon (1). The Quadricep is the large thick muscle that is often referred to as our thigh. The Patellar tendon works together with the Quadriceps muscle to straighten (extend) the knee. It is easy to touch your Patellar tendon as it is immediately below the knee cap. There are many different causes of Patellar tendon tears. Patellar tendon tears are a common sport injury but can also occur from overuse or a motor vehicle injury…
What is the Patellar Tendon? A tendon is a piece of connective tissue that connects muscle to bone. It serves to move the bone or a given joint. The patellar tendon is a major tendon in the knee. It is located at the bottom of the kneecap (patella) and stretches down to the shin. The patellar tendon enables you to extend your knee, kick, run, and jump. What is Patellar Tendinitis?
Patellar tendinitis is an irritation and inflammation of the tendon that connects your kneecap (patella) to your shinbone. Patellar tendinitis, also known as jumper’s knee, can affect anyone. The most common symptom is pain at the shin or lowest part of the kneecap…
Patellofemoral pain syndrome (PFS), also called runner’s knee or retropatellar pain syndrome, is a significant cause of pain in the front of the knee. The pain is usually experienced behind or around the patella (kneecap) when the knee is bent or fully loaded. This post discusses everything you need to know about patellofemoral pain syndrome.
The Posterior Cruciate Ligament is one of the paired ligaments in the middle of the knee. It is made up of 2 separate bundles: The two bundles of the PCL, and the ALB (anterior lateral bundle), and the PMB (posterior medial bundle), function synergistically to provide stability. The PCL functions as one of the main stabilizers of the knee joint and serves primarily to resist excessive posterior translation of the tibia relative to the femur. The PCL also acts as a secondary stabilizer of the knee preventing excessive rotation specifically between 90° and 120° of knee flexion. A PCL sprain happens when force is applied beyond…
The Posterior Cruciate Ligament (PCL) is a paired ligament in the middle of the knee. It is made up of two separate bundles: ALB (anterior lateral bundle) and PMB (posterior medial bundle). These bundles work synergistically to provide stability. The PCL plays an important stabilizing role in the knee joint by resisting excessive posterior translation of the tibia relative to the femur. Between 90 and 120 degrees of knee flexion, it serves as secondary support for preventing excessive rotation. PCL tears happen when force is applied beyond what the PCL tensile strength is capable of resisting. The tensile strength of the PCL is well documented…
Knee pain located at the lower inside of the knee can be caused by Pes Anserine Bursitis, which is irritation of the tendons that run on the inside aspect of the knee. Commonly mistaken for arthritic pain, meniscal pain, and sometimes nerve pain from the low back! Don’t be misdiagnosed, and let’s dive in below to get a better understanding of Pes Anserine Bursitis. The Pes Anserine Bursa is a bursa that surrounds 3 tendons of the leg. A bursa is a thin, slippery, sac-like film that contains a small amount of fluid. A bursa is found between bones and soft tissues in and around joints…
The meniscus is an important fibro-cartilage structure within the knee that absorbs shock and provides cushioning. It has a semicircular ‘C’ shape and sits between the femur (thigh bone) and the tibia (lower leg bone).
The meniscus protects the two bony structures from weight, shock, and shear forces. Each knee contains two menisci, one on the outside (lateral) and one inside (medial).
Common Treatments for Knee Pain When Bending and Straightening
Specific treatment will depend upon the specific type of knee injury and its severity. Not all knee injuries are treated the same. Establishing a proper diagnosis is essential so that treatment and rehabilitation are tailored for your specific condition. When appropriate conservative care should be the first line of treatment. Common treatment options include:
Physical Therapy
Physical therapy is a cornerstone in the treatment of most knee injuries. Therapy will focus on increasing strength, stability, and range of motion.
Steroid Injections
When physical therapy, rest, and other conservative treatments fail to provide significant benefits some patients are referred for a steroid injection. Steroids are powerful anti-inflammatory agents which can reduce swelling and pain. Unfortunately, they are toxic to most orthopedic tissue and have been demonstrated to damage cartilage, tendons, and ligaments (8). Steroids can cause tendon rupture (9). For this reason, steroids should be avoided.
Surgery
Surgery is increasingly popular for knee injuries. There are many different types of surgeries. Meniscus “repair” surgery is one of the most common and is poorly understood by most patients. It is recommended to patients who have sustained a tear in the meniscus. Rarely is the meniscus repaired? Rather a portion of the meniscus is simply cut out. This has a profound long-term impact on the knee including:
Increased incidence of knee arthritis
Recurrent meniscus tears
2 1/2 times more likley to get a knee replacement.
Most importantly a 2013 study demonstrated that meniscus surgery results could not beat physical therapy (9)
To understand meniscus surgery, its consequences, and alternatives please click on the video below.
Regenerative Options
The Physicians at the Centeno-Schultz Clinic in Broomfield and Denver, Colorado are experts in the treatment of knee injuries. Treatment options include the use of PRP or Bone Marrow Concentrate. PRP is rich in growth factors that can decrease inflammation and increase blood flow both of which can accelerate healing. Bone Marrow Concentrate contains your stem cells which are the body’s powerhouses of healing. All injections are performed under ultrasound guidance and or x-ray guidance. This ensures accurate placement of the PRP or Bone Marrow Concentrate into the area of knee damage.
In Conclusion
We bend and straighten our knees hundreds of times a day.
There are various types of knee pain that can present in different areas. Examples include behind the kneecap, on the inside, on the outside, and in the back of the knee.
The eight most common causes of knee pain are:
Cartilage Injury
Ligament Injury
Tendon Injury
Imbalance
Nerve Injury
Bone Injury
Referred Pain
Common conditions that cause knee pain when bending and straightening are:
7.Bhan K. Meniscal Tears: Current Understanding, Diagnosis, and Management. Cureus. 2020;12(6):e8590. Published 2020 Jun 13. doi:10.7759/cureus.8590.
8.Snoeker BA, Bakker EW, Kegel CA, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther. 2013 Jun;43(6):352-67. doi: 10.2519/jospt.2013.4295. Epub 2013 Apr 29. PMID: 23628788.
9. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis [published correction appears in N Engl J Med. 2013 Aug 15;369(7):683]. N Engl J Med. 2013;368(18):1675–1684. doi:10.1056/NEJMoa1301408
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