Knee pain

How common it is

Knee osteoarthritis is common enough to have its own national clinical care standard. It is more common in women than men and, although it may affect people of all ages, its prevalence increases sharply from the age of 45. ^[1]

Not all knee pain is arthritic. Knee pain can come on suddenly or over time, and it becomes more common as you get older. ^[2] Many people come to us with a knee that has been niggling for months, often alongside a back or hip with its own history.

What can be behind it

The knee is a hinge between two long levers, the thigh and the shin, so it takes load from both ends. Injury related causes include damage to the bone, cartilage, ligaments, tendons or muscles, and bursitis, which is swelling of the fluid filled sacs that cushion the knee. ^[2] Pain around the kneecap, where it runs over the end of the thigh bone, is another common pattern. ^[2]

The hip and lower back can also refer pain into the thigh and knee, which is why a knee examination here does not stop at the knee. In my clinical experience, restricted movement at the hip is often worth looking at when the knee below it is sore.

• Arthritic change in the knee joint
• Irritation around the kneecap
• Strain of a ligament, tendon or cartilage after an injury
• Referral from the hip or the lower back

How we assess it

We examine the knee, the hip and the lower back in the same visit. Movement and load testing of the knee, the kneecap and the tendons around it, then hip rotation and a lumbar examination to see whether your familiar pain can be reproduced from above.

The national standard says imaging is not routinely used to diagnose knee osteoarthritis, and that when it is clinically warranted, X-ray is the first-line imaging. ^[1] We follow that, and explain why before taking any. A knee that is badly swollen or has changed shape, a red and hot knee with a fever, or pain after a major injury needs an emergency department, ^[2] and a knee you cannot put weight on, or that locks or gives way, is a referral to your doctor rather than something we adjust. ^[2]

What care looks like

Where the examination implicates the hip, pelvis or lower back, that is where adjustments are aimed. Where the knee joint itself is the source, care may include gentle work on the knee and the muscles around it, but it is combined with exercise rather than standing in for it.

The standard says a person with knee osteoarthritis should be advised that being active can help manage knee pain and improve function, with exercise advice tailored to their priorities. ^[1] Where the picture calls for medical management or a surgical opinion, we say so and write to your doctor.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.