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Knee pain

Do you suffer from knee pain?

In Germany, almost one person in eight is affected by knee pain. Are you one of them?

With every step, every leg movement and even when resting – the knee joint is subjected to varying strain every day that can often amount to several times a person’s body weight. Studies have shown that, when climbing the stairs, the knee joint is subjected to three times a person’s body weight.1 When squatting or kneeling, a contact pressure of 80 to 100% of the body weight is exerted on the patella. Furthermore, joint forces of about 400% can be generated in the area of the patella when getting up.2

Knee pain is always a warning. The knee is one of the body’s joints most prone to injuries. Despite its size, it’s very vulnerable. That's why symptoms of knee problems should always be taken seriously. If they are ignored for a long time, treated too late or incorrectly, subsequent damage to the knee joint can be caused that can result in severe and ongoing problems. If you have persistent knee pain, you should consult a doctor to diagnose and treat the cause early. So get active today! Support your knee to prevent pain. 

1Source: Duda et al. 2011, "AE-Manual der Endoprothetik" (AE manual of endoprosthetics), 
2Source: Glitsch et al. 2009, "Belastung des Kniegelenks beim Knien und Hocken" (Strain on the knee joint when kneeling and squatting)

The knee

The pivotal point of our mobility

The knee joint (articulatio genus) is the largest joint in the human body. It ensures stability when standing, cushions the body weight and is part of practically all movements. Most of the time, we only notice how much the knee does when pain occurs that restricts movement.
This hinge joint allows the knee to perform movements in two directions: flexion or extension of the leg, but also the option of turning the lower leg slightly outwards or inwards when the leg is bent. The structure of the knee joint is highly complex, which means it is very vulnerable and prone to injuries.

Knee anatomy and functions

Bony structure

Three bones join in the knee: the two longest bones in the human body, the thigh bone (femur) and the shin bone (tibia), as well as the kneecap (patella).

These three bones form two joints: the patellofemoral joint (articulatio femoropatellaris) between the thigh and the patella, as well as the femorotibial joint (articulatio femorotibialis) between the thigh and the tibial plateau (caput tibiae). Where the femur and tibia meet, they have cylindrical joint bodies covered with cartilage. These allow the low-friction rolling-gliding motion of the knee joint, and therefore a smooth gait.

Based on its bony structure, the knee itself is very unstable. It is therefore secured with tendons, ligaments, muscles and cartilage structures. This provides the joint with the required stability in all directions and enables upright standing and walking. 

Anatomy of the knee, lateral view

 

Right knee, lateral view

  • Kneecap (patella)
    The kneecap has a triangular shape, slightly convex at the front, and it protects the front of the knee joint. It is the insertion point of the thigh muscle (quadriceps femoris) and, similar to a pulley, it is responsible for the thigh muscles’ ideal transmission of forces to the lower leg. In this way, the patella makes bending and stretching of the leg easier and additionally guides the patellar tendon.
     
  • The back of the knee (fossa poplitea)
    Important blood vessels and nerves run through the popliteal fossa, supplying the lower leg.
  • Menisci
    Because the joint bodies of the femur and tibia do not directly fit into each other, cartilage structures, the menisci, lie between them. On the one hand, the menisci (medial and lateral menisci) extend the contact area of the two joint surfaces. On the other hand, they function as shock absorbers. The fibrous cartilage disks can cushion severe impact, compensate for heavy loads on the knee joint and evenly distribute the strain of weight. This provides additional protection to the joint surfaces.

 

  • Bursae
    The bursae are elasticated, mobile pads filled with fluid. They lie between moving muscles, tendons and bones to reduce friction and pressure.
  • Menisci
    Because the joint bodies of the femur and tibia do not directly fit into each other, cartilage structures, the menisci, lie between them. On the one hand, the menisci (medial and lateral menisci) extend the contact area of the two joint surfaces. On the other hand, they function as shock absorbers. The fibrous cartilage disks can cushion severe impact, compensate for heavy loads on the knee joint and evenly distribute the strain of weight. This provides additional protection to the joint surfaces.

 

  • Bursae
    The bursae are elasticated, mobile pads filled with fluid. They lie between moving muscles, tendons and bones to reduce friction and pressure.

Ligaments and tendons

In addition to the menisci, the knee is protected by complex and firm ligament structures. Together with tendons, they are responsible for the exact guidance of the knee joint, and stabilise it in combination with the muscles. They consist of firm connective tissue fibres and feature hardly any blood vessels or nerves. This means their capacity for regeneration is limited.

Anatomy of the knee, frontal view

 

Right knee, proximal view

  • Collateral ligaments (lig. collaterale)
    In order to prevent movement in a sideways direction, the knee joint is stabilised by the medial and lateral collateral ligaments.

 

  • Cruciate ligaments (lig. cruciata genus)
    The cruciate ligaments, on the inside of the joint, are particularly important for the stabilisation of the knee joint. They stop the femur and tibia from shifting forwards or backwards and limit rotation.

 

  • Patellar tendon (lig. patellae)
    The patellar tendon links the lower leg with the kneecap and ensures that it is guided precisely. It also connects the large anterior thigh muscles with the tibia via the kneecap.

Causes of knee pain

Knee injuries and conditions

About 10 million people in Germany regularly suffer from knee pain. This pain has many causes.

Triggers can include: 

  • acute injuries caused by an accident, such as broken bones, capsular injuries, injuries to the ligaments, menisci and cartilage. The number of knee injuries constitutes about a quarter of all sports injuries and it is constantly increasing due to a lack of physical fitness.
  • Inflammation and rheumatoid conditions, such as arthritis, rheumatism, inflammation of the bursa, Baker’s cyst and Morbus Bechterew, are the most common causes of knee pain.
  • Metabolic disorders or blood disorders, such as gout, pseudo gout, haemochromatosis or haemophilia, can also trigger knee problems.
  • Wear and degenerative conditions, such as meniscus damage and osteoarthritis of the knee, usually result in chronic problems without ongoing treatment.
  • Excessive strain and misalignments, such as a high-riding patella, patellar lateralisation, knock knees or bandy legs, are causes of patellofemoral pain syndrome, patella tip syndrome (also known as jumper’s knee), Osgood-Schlatter disease and the well-known runner’s knee.
  • Congenital factors and auto-immune disorders, such as chronic polyarthritis, lupus erythematodes, osteochondrosis, patellar dysplasia or Ehlers-Danlos syndrome are possible triggers of knee pain.

Externally, knee pain may manifest with swelling, reddening or bruising. Pulling or piercing pain is then sometimes felt with every step. 

The areas where pain occurs most obviously can give an initial indication as to the cause.

The following overview is arranged by pain localisation and is designed only as an initial source of information and non-binding guide. 

To obtain a definitive diagnosis and appropriate treatment, medical advice is essential! 


Localisation: where does knee pain occur? 

Anterior knee pain (patella) 


If the pain is mainly concentrated in the area of the patella, the front of the thigh and lower leg, as well as the patellar tendon insertion below the patella, this is referred to as anterior knee pain. When the pain occurred for the first time or which situations trigger it can provide an indication of the cause of the condition.

In which situation does pain occur? 


Posterior knee pain (back of the knee) 


Pain at the back of the knee can have various causes. The situation in which pain occurs for the first time or repeatedly can provide an indication of a certain condition.

In which situation does pain occur? 


Knee pain on the inside of the knee joint

If the pain primarily occurs on the inside of the knee joint, in the surrounding soft tissue, the medial collateral ligament as well as the inner thigh and lower leg, this is referred to as medial knee pain. When the pain occurred for the first time or in which situations it is very noticeable, can provide an indication of the cause of the condition.

In which situation does pain occur? 


Knee pain on the outside of the knee joint

If the pain primarily occurs on the outside of the knee joint, in the surrounding soft tissue, the lateral collateral ligament as well as the outer thigh and lower leg, this is referred to as lateral knee pain. The situation in which pain occurs for the first time or repeatedly can provide an indication of a certain condition.

In which situation does pain occur? 


Pain in the entire knee 

In these cases, no precise localisation of the pain is possible. It affects the entire knee and may even radiate into the surrounding areas. When pain occurred for the first time or when it primarily occurs can provide an indication of the condition.

In which situation does pain occur? 


What options are there to treat knee pain?

Supports and orthoses for relief and stabilisation 

Juzo offers a comprehensive range of specialised medical aids for numerous different indications.

Knee supports

Knee supports stabilise the knee joint in cases of sprains or strains, after surgery or for particular misalignments. Thanks to a combination of different innovative and sophisticated knitting techniques, Juzo knee supports provide an excellent fit. The highly functional materials wick moisture away from the body particularly quickly. This provides you with maximum wearing comfort, the perfect fit and ideal freedom of movement.

JuzoFlex Genu Xtra knee support

Knee orthoses 

Knee orthoses allow an even more effective influence on movement than is possible with flexible knee supports. Rigid elements help to relieve, stabilise and guide the injured knee joint. Knee orthoses also make it possible to allow movement only within a specific individually defined range, or to completely immobilise the joint. Orthoses can be adapted to treatment requirements as needed and thus help to achieve the desired outcome.

JuzoPro Genu Soft knee orthosis

Medication to combat knee pain 

If pain occurs only temporarily, it can be treated with pain medication for a limited time. Some drugs counteract inflammation and swelling. Pain medication is available in the form of tablets, as pain plasters, creams or cooling gels. The cause of the pain should always be clarified by a doctor first though.


Physical therapy in cases of knee pain

Physical therapy is an essential component of a comprehensive treatment concept in cases of knee pain. Physical therapy includes active as well as passive exercises in cases of knee pain. This means movements that patients perform themselves as well as exercises and stretches where the physical therapist guides and controls the movements. In addition to acute cases, physical therapy is also used for prevention and rehabilitation.


Heat treatment and cryotherapy in cases of knee pain

Whether heat or cooling is more beneficial in cases of knee pain will depend on the individual cause, but the general rule applies that acute pain and inflammation are usually alleviated more effectively by cooling the affected area. The cold also reduces swelling and inhibits inflammation. Ice or cooling compresses should be wrapped in a thin towel and never be applied directly to the skin to prevent frostbite. In cases of chronic conditions, such as osteoarthritis, heat is more beneficial because improved circulation more quickly removes metabolic waste and products that cause pain. 


What you can do yourself in cases of knee pain

Everyday tips for stable knees

To ensure comprehensive treatment of your knee pain, you should get active.

Regular exercise
Healthy legs with strong, stretched muscles, ligaments and fasciae are less prone to knee problems and pain. Therefore, regularly train the co-ordination of your legs and your leg muscles with sports that are gentle on your knees, and carry out specific exercises to strengthen the knees.

Exercise vs strain 
Movement is crucial for a healthy knee joint. Make sure, however, that your movements are gentle. Avoid excessive, one-sided and, in particular, constant strain. 

Carrying heavy loads
Do not carry heavy loads on one side only and ensure your carrying method is gentle on your knees, by using a backpack, for example. 

Appropriate footwear 
Footwear has a significant impact on healthy knees. Your shoes should therefore have cushioning soles. High heels can lead to problems and should therefore only be worn for a limited time. Orthopaedic foot orthoses can compensate for misalignments.

A healthy diet 
A healthy diet is absolutely essential. Every additional pound also puts extra strain on your knees. Make sure your dietary fibre intake is sufficient, and cut down on sugar and fat as much as possible. 

Female runner wearing the JuzoPro Patella Xtec Plus knee orthosis

Exercises for strengthening the knees

We have put together a few exercises for you that help to strengthen your legs and therefore your knees or to support recovery after an injury. They are easy to do and you can incorporate them into your daily routine for the best results. If you are suffering from an acute injury, please consult your doctor first to find out which exercises are suitable for you. 

 Repeat the stretch twice for each leg.

  • Stand on one leg. The knee of the supporting leg is slightly bent.
  • Using one hand, pull the foot of your other leg up behind you towards your bottom.
  • Hold on to your foot with both hands.
  • Hold this position for about 20 seconds, then change legs.

 

Please note: your back must remain straight during this exercise. 

Man stretching his leg

Lunge

Man doing a lunge

Do 12 lunges and repeat this exercise three times. 

  • Stand with your legs hip-distance apart, keeping your upper body straight.
  • Tense your abdominal muscles.
  • Take one long step forwards.
  • Your lower leg and thigh of the front leg must be at a right angle.
  • The back leg lowers and stops just before touching the ground.
  • Hold this position briefly, then return to the start point.
  • Change legs after each lunge.

 

Please note: your back must remain straight during this exercise.


Squat

Do 12 squats and repeat this strengthening exercise three times. 

  • Stand up straight with your legs a little wider than hip-distance apart.
  • Distribute your weight equally on both legs.
  • Slightly bend your legs and push your bottom back.
  • Squat only so far that your knees remain behind your toes.
  • Hold this position briefly, then straighten your body again.

 

Please note: keep your back straight during this strengthening exercise and tense your abdominal muscles. 

Man doing a squat