Most Common Causes For Swelling In The Knee

Hi everyone! Welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David specialist, physical therapist over at El Paso Manual Physical Therapy. Today we're going to be talking about knee swelling, specifically the top five reasons for knee swelling.

If you're listening and you've ever had a swollen knee, or in the past you've dealt with swelling around your knee, whether it was just a onetime thing, because you twisted your knee, finding your banged it on something, or if it was a more chronic thing, where you get recurring swelling if you overdo it. We're going to talk about the top five reasons for that kind of knee swelling.

Here in the clinic, we often get people with knee problems. And almost always I can't think of a time recently when they didn't have swelling, but almost always they have swelling, and they've got swelling either on the inside on the front on the outside or the back of the knee or sometimes the entire knee around the knee joint. It's swollen, or sometimes it's on the muscle right above the knee joint as well. There are different places to get swelling, sometimes it's a little bit of swelling. And it's not a big deal.

At the time, it's quite a bit and especially with ladies that were more form fitting pants, they can feel the difference on one knee versus the other. Or with certain, like pantyhose or stockings, things like that. It'll feel different on the swollen knee versus the other. And then sometimes the knee swelling can get so bad that it affects how the knee works, then you won't straighten out or bend all the way. We'll go over and we'll go over the top five reasons that people get knee swelling.

Reason number one in meniscus injury.

Some people know about the meniscus, some don't. So I'm just going to explain to you what the meniscus is. If you think about the thigh bone, coming to meet the shin bone to form the knee joint, of course the kneecaps kind of sit in front of those two, there's a big layer of cushion that's made up of cartilage, right between the thigh bone and the shin bone. And that's called the meniscus, you actually have a pair of menisci, meniscus is in each knee. So you have what's called a medial and lateral or inner and an outer meniscus. They are c-shaped structures like this, and they are huge chunks of cartilage.

The concern with a meniscus injury is that because it's cartilage, it just heals slowly and potentially doesn't heal properly, if it's not helped properly was not treated properly. If you have a meniscus injury that can definitely cause swelling in the knee, and the way that that typically presents, the way that it shows up in an knee, is right where the knee bends, usually kind of behind the kneecap. It wraps around the sides of the kneecap. It's always wrapped around all the way to the back of the knee and it can hurt directly on the back of the knee.

That is a common presentation for swelling related to the meniscus. And this is a serious thing if you have swelling and it's like what I described, and it's related to the meniscus. You don't want to treat this lightly. Wearing a knee brace typically just doesn't help a whole lot. It may alleviate the pain but taking away the problem for the long term is not going to be helped by the knee brace. It typically requires being seen by an expert and getting expert advice and treatments on how to fix that knee problem.

Now if left untreated, if you keep getting recurring swelling because of the meniscus problem, you have the potential to face a meniscus tear and maybe even need surgery someday, which hopefully you can avoid at all costs. But it is possible to have a painless meniscus tear in other words. A tear that happened that isn't bothering you at all, because it's under control and your knee is working fine. You can have a painless meniscus tear.

Just think about that. If you have a meniscus problem right now, get it taken care of, go get some help right away. Don't wait too long. Injections won't fix it, that just takes away the pain for a temporary amount of time. And so does pain medications that you take by mouth. So, make sure to get professional help if you think that you have a meniscus related knee swelling problem.

Number two a ligament injury.

There are tons of ligaments in the knee. What a ligament is. It's what we call connective tissue, basically a structure that attaches a bone to a bone. So, going back to that example of thigh bone on the shin bone, you have a bunch of things that tie them together so that the bones don't just fall apart. Those are ligaments in the knee. You have some massive ligaments deep inside. The most famous one is called the ACL. The anterior cruciate ligament, there's also the PCL, the MC, and the LCL. There are some other ligaments as well, but those are the main ones that people typically injure.

What can happen to those ligaments is, they can get overstretched or even completely torn or partially torn, and you bet that causes swelling. Now, if you have an ACL tear, or sub tear, like a partial tear, or even just an irritation to that ACL ligament, then you can have some pretty significant swelling in the knee.

The way that looks is your knee blows up, typically it swells kind of evenly all around the knee where the joint is, where the thigh bone meets the knee bone, where the thigh bone meets the shin bone. You get swelling on the front of the knee, on the back of the knee, even on the sides of the knee, but typically in the front and back are where people feel at the most.

Absolutely, there's a loss of motion too. People can't fully bend or strain their knee. And if it's really bad, they might feel like they need to get on crutches for a while. While these types of ligament injuries are typically a result of some sporting accident, like football is a classic one, basketball, volleyball are classics as well. Car accidents, bike accidents, a bad fall can also cause an ACL injury, or some other ligament injury.

Those are all typical reasons for having a ligament injury. But it is possible to get a ligament injury slowly over time without ever having an accident happen. If that's the case, what you might feel are clicking sensations inside the knee, or feeling the knees going to give away, like you stand on it and you're not confident in your knee when you go to bend on it or kneel or stand on one leg. You just don't feel confident in that knee.

That's typically a sign that you have a loss of stability because your ligaments aren't 100%. So if you have those signs, the good news is, as long as it's not torn, you have an excellent shot at getting better without surgery. Medications in the short term might help to mask the pain but they are not going to fix that ligament. Typically, that needs to be braced with a knee brace. And you need some professional help to make sure that the knee brace is only used for a certain time period.

You don't want to be relying on the knee brace with a long term that's not good. And you want to make sure that you don't have anything that's fully torn, that may require some sort of procedure by a surgeon, or somebody professional that handles that kind of thing. But consult an expert if your ligament injury is not fully going away.

We see people ligament injuries all the time, and they get 100% better, it takes some management typically, if it's not too bad, but within a month or two, they get a lot better. If it's really bad, it could take three to four months. But it shouldn't be an ongoing problem that people have for many, many, many months or even years. If you think you've had a ligament problem for years. I strongly suggest you get some professional help to nip it in the bud, and make sure your knee gets back to normal as best as possible.

Left untreated, because you don't have the good stability in the knee, you can begin to irritate the meniscus, you can begin to develop arthritis over time. It's just not a good thing to leave. And it's not a good injury leaving your knee untreated because it will begin to cause other problems.

Number three, osteoarthritis or commonly known as arthritis.

There are different types of arthritis. People generally refer to osteoarthritis as arthritis. What that is, its changes usually age related, I think it's force related, is what I would call it. But it's changes to the surfaces of the joints. So where the bones meet together, if you think of the thigh bone and the shin bone, and then also the kneecap where it touches the thigh bone, where it moves the chain, there's changes to the surfaces of those bones that caused the surfaces to become not as smooth as you're supposed to be.

Joint surfaces should be very smooth, very lubricated so that all the motion can occur there freely without causing you any problems. But if you begin to lose a cartilage, if it wears down and you get what's called a bone on bone situation, or if the surfaces get bumpy because there's torn cartilage, or the bone is growing and appropriately like a bone spurs some extra bone growth under the cartilage, then you don't have a smooth surface anymore. Friction becomes a problem within the knee joint. That's the situation that begins to develop into arthritis.

This happens slowly over time, generally. So, people tend to develop arthritis symptoms as they pass 50 into their 60, 70s and beyond. And it progresses pretty far. People typically have a big loss of motion, they can’t bend their knee all the way or they can’t straighten the knee all the way. And sometimes it'll lock, it'll kind of stay in position because of those bumpy surfaces, it doesn't let it move properly.

What needs to happen is, we need to look at how the forces are going through the knee and then need to be normalized. Now that's a process that takes a while. Treating arthritis is not a quick thing. If you're out there and you have arthritis, you might benefit a lot from this program that we offer. It's called the 28 Day Knee Health And Wellness Boost Program.

You can find out more about in the description here. And that program teaches you how to begin to move better, if you have a knee arthritis problem, as well as a meniscus problem, a ligament problem, it helps out a lot of knee injuries. But especially if you've been dealing with a chronic knee arthritis problem, I strongly suggest you check out that program and consider starting it so that you can begin to fix your knee problem on your own at home.

If that program doesn't help you out, then I strongly suggest you go get professional help so that you're not in a tough situation later on in life, or that knee arthritis progress so far that you might be talking about a knee replacement with the surgeon.

Reason number four, a cartilage problem.

We talked earlier about the meniscus, that's a big chunk of cartilage, but we kind of separate that out from other cartilage in the knee. There is tons of cartilage in the knee. The most common cartilage injury that you get outside of the meniscus in the knee, is the cartilage on the back surface of the kneecap, on the patella. The kneecap sits directly against the thigh bone, and when you go to bend and straighten your knee, that kneecap travels over the end of the thigh bone. And there's cartilage on both surfaces on the kneecap and on the thigh bone, that needs to be there to allow free motion within of the kneecap against the thigh bone.

That cartilage can get worn down and cause that bone on bone situation. And let me just go into that for a second, because I want to make sure that your mind picture your perception of what bone on bone is, is accurate because sometimes people go visit the physician or their orthopedic surgeon, and as soon as the doctor says, “You got a bone on bone in your knee”, what I see as a physical therapist patients come in here to tell me that their perception is that there is zero cartilage left, there's nothing there, and your knee needs to be replaced. And that's just not the case.

In rare circumstances. The cartilage is massively lost throughout the entire joint, but it is extremely rare. I mean, you're talking one in a million. What is way more likely is that there's a spot a tiny spot, maybe like a pinhead at most like an eraser head of a pencil that is missing some cartilage. And the bone is now being exposed because of cartilage is so gone there. But well, we've been able to do here in the clinic.

We do it all the time with patients that have that bone on bone situation, because we can change the way they are moving, change the way that they are putting forces to their knees. We look at muscle imbalances, we're looking at all kinds of other things. And when they begin to move better, and have better strength and muscles that were lacking it for decades, they take pressure off that spot that's bone on bone, and begin to put it where it's supposed to be within the knee joint, where the cartilage is thickest, and they feel better and they move better. And they begin to recover from that bone on bone situation naturally without medications, injections or surgery.

Cartilage problems can be a huge reason for swelling in the knee. The way that it'll look, if you have swelling related to cartilage, on the kneecap specifically, you'll feel swelling right around the kneecap, that's the most common presentation, it'll be tender. If you press the kneecap down and you put some light pressure on it against your thigh bone, that feels terrible. So. if you try that out in yourself, just do it very carefully. As soon as you have a small increase in in pain or discomfort, you can be pretty certain that there's a cartilage problem behind your kneecap.

Reason number five swelling in your knee a muscle strain.

There are tons of muscles that are right above the knee, and then some below the knee, mainly on the back of the leg in the upper calf area. It is possible to strain those muscles to basically overdo some activity. Maybe in an instant, like if you took a bad step and caught yourself, or if you exercise, like if you run or bike or maybe even just walk too much.

If you're not used to walking as much as you did that one time, it is possible to get a muscle strain. Now that will typically cause lots of intense soreness at the muscle where it hurts and some swelling usually on the muscle itself. So that's easier to manage. Muscle thankfully heal pretty quick with a question that I would ask, if you get repetitive swelling in a muscle, is there something wrong with the way that you're moving potentially, or an imbalance of muscle strength around your knee, possibly even up into the hip or down into the foot.

If you get recurring swelling and it's in the muscle, like in the thigh muscles, the quads or in the calf muscle, there's something not right about the way that you're moving. And that means you have an imbalance of strength somewhere. Here, I would talk to an expert about getting that addressed. If it's just a onetime deal, you swell once that time you went hiking, then I wouldn't worry about it too much.

As long as you're not going to be regularly hiking, and it's not getting better, you're not getting stronger or better in shape to tolerate doing that hike. But if you do the same hike and you're just getting worse, you're swelling more each time, it's not a good situation. Get some professional help for that. A brace typically doesn't help for that much. You have to make sure that you switch the way that you're walking or change the strength around your knee to fix that situation.

Thank you so much for listening to our podcasts on the top five reasons for knee swelling. I hope that this information was beneficial for you. If you are in the El Paso area and you are thinking that we might be able to help you with your knee swelling and knee pain problem, I strongly encourage you to visit our website at www.EPmanualPT.com and try out some of the free resources we have on there. We have an eBook that you can download instantly, we will send it to your email that has tips for knee pain problems.

You can also go to our blog on the same website, just click the blog tab at the top of the website, and you'll find tons of blogs that we have written that go over different knee problems and why they might be there, what you can do about them. Some of them have exercises and other things you can try, home remedies and all they're all of course, expert produced tips and resources. And you might be able to find something that you can do at home before having to reach out to anybody.

But if you do feel like you'd want some professional help so you can make this problem go away faster, get under control faster, and hopefully avoid surgery, injections ,and having to rely pain medication so that you can be active again, be normal, get back to your usual exercise routine or you're taking care of your house, or your yard work, or your gardening, whatever might be that you love to do. But spending time with family with kids with grandkids, you can go to a website to learn more about how to get in touch with us. Or you can call us directly at 915-503-1314 and we'll be happy to begin a conversation about your knee problem and see if it's the type of knee problem that we can help out. Thanks so much and have a wonderful day. Bye

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