Knee Pain Diagnosis:
Part 1

Accurate knee pain diagnosis is vital in overcoming your knee pain and stopping it from coming back again.

You can’t accurately treat knee problems without knowing the underlying cause of the problem. For example, if the knee is swollen, you can treat the swelling, but if you don’t treat the underlying cause of the swelling, it will just keep coming back.

The best way to get an accurate knee pain diagnosis is to see your healthcare professional, but here is a guide to help you find out what your problem might be.  You can search by:

1) Specific symptoms: what are the main symptoms associated with your pain
2) Location of the pain: where exactly your knee pain is
3) How the pain started: the mechanism of injury eg sudden twisting or gradual onset

In part 1 here, we will concentrate on using specific knee injury symptoms to make a diagnosis. In part 2, we will look at using the location of the pain and how the pain started to make a knee pain diagnosis.

Specific Symptoms

One of the most important parts of diagnosing knee pain is thinking about the specific symptoms that accompany the knee pain. These tend to be the most defining features in knee pain diagnosis, as the presence or absence of them quickly rule conditions/injuries in or out.

1) Knee Makes Unusual Noises

A sudden popping noise at the time of injury usually indicates a ligament injury but sometimes indicates a cartilage tear.
Persistent clicking/grinding when the knee moves usually indicates an ongoing knee problem affecting the joint surfaces or how the bones are moving.

Visit the Noisy Knee Pain Diagnosis section to find out more about specific knee problems that cause strange noises

2) Pain When Kneeling

Kneeling puts pressure through the front of the knee and primarily aggravates 3 conditions:
Housemaids Knee: inflammation of the bursa (fluid filled sac) at the front of the knee. It is a common problem for people who spend long periods kneeling eg carpet layers
Osgood Schlatters: common in adolescents, particularly after a growth spurt. Tension on the tendon just below the kneecap damages the bone, often resulting in a hard lump on the front of the shin
Arthritis: changes in the bone caused by wear and tear or sometimes inflammation. Most common over the age of 50

3) Locking (knee gets stuck)

This happens when something gets wedged in the joint, stopping you moving the knee. You generally have to wiggle the knee around before it will then move.
The most common cause of locking is a Meniscus Tear, a tear in the cartilage that lines the joint. It can be caused by sudden twisting or a force through the knee, or can come on gradually due to wear and tear.
A less common cause of locking is Osteochondritis Dissecans, a condition where a poor blood supply causes small bits of bone and cartilage to break off at the joint

4) Running Knee Pain

Knee pain from running is hardly suprising when you think that forces up to 550% body weight go through the joint when running. Running knee pain is usually due to either training errors or poor biomechanics. Visit the knee pain from running section to find out how to prevent and treat this common problem

5) Knee Gives Way

This is when the knee buckles underneath you without you being able to control it.
The most common cause of this is a ligament injury, most commonly the ACL. It is usually caused by sudden twisting, a force through the knee or the knee bending backwards the wrong way. It may be accompanied by a popping sound, swelling and extreme pain. Only 20% of ACL tears are caused by direct contact.
Meniscus tears often make the knee feel unstable and can occasionally cause the knee to give way, but it is much less common

6) Pain When Sitting for Long Periods

It is not just activity which aggravates knee pain. Some conditions tend to get worse with prolonged inactivity eg office workers sitting for long periods – the pain may start while you are sitting or when you first get up. The most common causes are:
Runners Knee: a problem in how the kneecap moves that causes pain and stiffness at the front of the knee
Arthritis: changes in the bone caused by wear and tear or sometimes inflammation
Osgood Schlatters: common in adolescents, particularly after a growth spurt. Tight muscles irritate the bone causing pain just below the knee

7) Knee Pain Going Down Stairs

This usually indicates a problem with the knee cap, as the force going through the knee cap when you come down stairs is 3.5x bodyweight. Find out more about the most common causes of knee pain going down stairs to help diagnose knee pain.

8) Swelling

Virtually any knee problem may be accompanied by swelling, but different types of swelling lead to different knee pain diagnosis.
If the swelling comes up immediately or within the first 48hours, it usually indicates a ligament or cartilage injury.
If it comes on gradually with no specific cause, it usually indicates an underlying knee problem. Visit the knee swelling section to find out more on the most common causes of knee swelling. If there is moderate to severe swelling, you should see your doctor straight away.

9) Knee Stiffness in the Morning

Stiffness in the knee when you first wake up that settles once you’re moving about, is a classic feature of Osteoarthritis, which is most common in over 50’s. It is also sometimes caused by Runners Knee, which is a problem in how the kneecap moves. It causes pain and stiffness at the front of the knee

10) Bony Lump at Front of Knee

This is a classic sign of Osgood Schlatters, which is common in teenagers/young adults particularly after a growth spurt. Tension on the tendon just below the kneecap damages the bone, often resulting in a hard lump on the front of the shin

What Next?

Looking at knee injury symptoms is just one way of making a diagnosis. In Diagnosis: Part 2 we will look at how to diagnose knee pain from thinking about the location of the pain, and how the knee pain started.

If you want to know how to get rid of your pain, visit the knee pain treatment section for a variety of treatment options.

Remember, the only way to get an accurate knee pain diagnosis is to see your doctor/physical therapist and it is essential to understand what is causing your pain to be able to treat it.

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Updated 30th April 2013
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