Years of wear and tear can take a toll on your knees. If you have experienced pain dull, achy, or sharp knee pain while standing, chances are that your pain is being caused by one of three conditions:
- Patellofemoral syndrome
- Chronic degenerative meniscus tears
- Early osteoarthritis
If you have been an athlete in the past, the chances of your developing one of the three are even higher. These common conditions that often start off as a mere nuisance can turn into more serious conditions if they are not treated in a timely fashion.
Patellofemoral Syndrome (PFS)
Patellofemoral syndrome (PFS), also known as patellofemoral pain syndrome, is a painful knee condition that occurs when nerves at the front of the knee sense pain. It is also the most common cause of knee pain in the United States.?The causes of PFS are multifactorial and complex but most studies point to four major contributing factors:
- Misalignment of the lower extremity and/or patella
- Muscular imbalance of the lower extremity
Of the four contributing factors, overuse appears to be the most important.
Overactivity with a knee that has structural issues is especially troubling. Muscle imbalances?albeit muscles on one side of the knee being stronger or more flexible than the other?can lead to inflammation and pain.
The result of muscular imbalances is that the forces placed on the knee don?t travel through its normal channels, via the quadriceps and other muscles surrounding the kneecap and through the trochlear groove. This can lead to irritation of the nerves in the tendons, synovial tissues, and muscles surrounding the knee cap.
Who Is at Risk for PFS?
PFS often impacts athletes and those who engage in running, basketball, and other sports.
While the sharp, achy, or dull knee pain that occurs at the front of the knee is usually experienced during movement, over time the pain may persist even while standing. Strengthening the muscles around your hips and quadriceps and stretching your iliotibial band, hamstrings, and quadriceps can help relieve strain on your knee.
Chronic Degeneration of the Meniscus
The meniscus is a rubbery c-shaped piece of cartilage that cushions the knee. When the meniscus is torn abruptly it can cause your leg to lock up and impact your ability to walk, but more often than not the cartilage in your knee is damaged over time due to wear and tear. This is when standing knee pain can become a problem.
Chronic degeneration of the meniscus can occur from excessive standing or running. Acute meniscus tears are usually from sudden pivoting or twisting as seen in basketball or football. A torn meniscus normally produces localized pain that is worse during twisting and squatting motions.
Levels of Pain
Pain from a torn meniscus varies widely but some people are able to:
Others experience swelling and joint pain.
When the cartilage in your knee becomes frayed over time, small pieces get stuck in the joint. This can happen during the transition of sitting to standing or during movement. If your knee is locking or causing your gait to change it may be time to contact a healthcare professional.
As you get older, the cartilage in your knee may start to break down. The friction caused by the rubbing of your knee bones may cause:
- Meniscal damage
- Bone deformity
Although?osteoarthritis?is usually associated with old age many younger adults suffer from early osteoarthritis especially if you have suffered a serious knee injury in the past.
Osteoarthritis can make it difficult to walk or stand for long periods of time. Alleviating tension on your joints by periodically sitting or laying down or taking anti-inflammatory medication has been shown to temporarily relieve symptoms, but mitigating obesity and excess weight is a more effective long term solution.
The diagnosis of standing knee pain is usually made based on a detailed medical history and a physical examination. The questions that you will be asked will range from the medications you are using to questions about trauma to the knee, including previous surgeries, and activities of overuse.
Patellofemoral Syndrome (PFS)
PFS is considered a diagnosis of exclusion, which means your physical therapist, primary care doctor, orthopedist or another healthcare professional must rule out other conditions that it may mimic. If you describe that your knee is giving out or that you feel a catching sensation in the knee you may be asked to get an MRI as those might be signs of damage to the ligaments or cartilage in the knee.
Chronic Degenerative Meniscal Tear
If a healthcare professional suspects a meniscus tear they may listen for clicking or popping of the knee upon movement. A McMurray test, which involves bending and rotating your knee and listening for a pop or click, may be performed. The test is positive if a pop or click is heard.
If your medical history and clinical examination put you at high risk of having a meniscus tear, then you will be asked to get an MRI to look for loose cartilage in the knee. If the MRI is inconclusive, an arthroscopy can be performed to help detect the tear. Still, an MRI is the go-to imaging technique used to help diagnose meniscus tears.
If you are experiencing standing knee pain a healthcare professional will examine your knee for range of motion and signs of inflammation like warmth, redness, or swollen areas of the knee. They may also ask you about the medications you are taking and how the condition has affected your daily life. A primary care physician may even perform a joint aspiration to rule out conditions that mimic osteoarthritis like gout and rheumatoid arthritis.
Over time, bony spurs can develop due to the frequent rubbing of bone on bone. X-ray imaging can be used to view these degenerative changes. An MRI can be used to help detect bone sclerosis, subchondral cysts, and joint space narrowing.
Conservative treatment methods are usually used to treat the conditions that cause knee pain while standing.
The R.I.C.E. Method
The RICE Method of Rest, Ice, Compression, and Elevation involves:
- Resting?the leg
- Applying?ice?packs regularly
- Elevating?the knee above heart level.
The RICE protocol may be used immediately after injury and before you see a healthcare professional.
PFS, meniscus tears, and early osteoarthritis may all cause inflammation of the knee. Taking over-the-counter (OTC) anti-inflammatory medications such as acetaminophen and ibuprofen can help to reduce the pain and swelling. Of note, NSAIDs, specifically naproxen, have been shown to be especially effective in decreasing PFS pain and is the first-line treatment of osteoarthritis.
Physical therapy has been proven to help speed up the time of recovery from osteoarthritis, meniscus tears, and PFS. Physical therapy may include strengthening exercises, a stretching regimen, and massages. You may be surprised at how the implementation of a simple muscle strengthening regimen that focuses on weaknesses of muscle groups around the knee?like the hip abductors or quadriceps?may help alleviate symptoms.
Surgery is rarely used for PFS or osteoarthritis, but it may be used to repair a torn meniscus, although the chronic degenerative tears that cause standing knee pain rarely need surgery.
Early diagnosis and use of conservative treatment methods such as the use of anti-inflammatory medication, a knee brace, or a cortisone shot, have been shown to not only improve outcomes but also helps to avoid surgery like a knee replacement from osteoarthritis. A knee support brace or a cortisone shot may also be used to prolong the time to surgery even for those with a long withstanding injury.
Standing knee pain can be very debilitating and limit your activities. You may find that you are stopping activities that you previously enjoyed due to your pain. Chronic degenerative conditions, like osteoarthritis and meniscus tears, can lead to much more serious complications.
The combination of?early diagnosis and treatment and lifestyle changes such as reducing alcohol intake, quitting smoking, and maintaining a healthy weight may be all that you need to alleviate your pain and get back to doing the activities you love pain-free.