Knee pain – causes and therapy

Knee pain: an overview of possible causes and therapies

The knee joint is the largest joint in the human body and enables walking, running, jumping, standing and sitting, among other things. The swivel joint consists of bones, articular cartilage, tendons, ligaments, muscles and other joint structures that can be impaired or even destroyed by inflammation, injuries and signs of wear and tear.

The knee is exposed to great stress. Mostly people with deformities such as bowed legs or knock knees , obesity or persons occupationally much kneel such as tilers often have pain in the knee. These are often noticeable during certain sporting activities, when running, climbing stairs and / or going downhill. The pain intensity ranges from mild, temporary discomfort to severe, persistent pain that restricts walking or even makes it impossible.


  • Knee pain: an overview of possible causes and therapies
  • definition
  • Symptoms
  • Knee pain from injury
  • Overwork as a cause of knee pain
  • Pain in the knee from inflammation
  • Cartilage-bone damage as the cause
  • Pain in the knee area from metabolic diseases
  • Joint wear and tear as a cause of knee pain
  • Other causes
  • Risk factors
  • diagnosis
  • Treatment for knee pain
  • Naturopathic treatment for knee pain


In young people, knee pain is mostly due to injuries, while older people are more likely to experience signs of wear and tear (osteoarthritis). Mild, short-term knee problems often go away on their own. In the event of persistent complaints or injuries, e.g. after an accident, medical advice should be sought.

Knee pain is pain that occurs in the knee area. They can be located above, below, to the side, on or behind the kneecap, in the hollow of the knee or deep in the joint. The causes are varied and range from a slight overstrain to progressive degeneration of the knee joint. Both the articular cartilage and the surrounding structures such as ligaments and muscles can be affected.

Pain in the knee area often occurs as a result of injuries or joint wear. (Image: artstudio_pro /


The knee joint forms the connection between the lower leg (shinbone, tibia) and thigh (femur). The two crescent-shaped menisci (cartilage discs) in the knee joint act as a buffer between the two bones. In front, the bony kneecap (patella) lies on the knee joint, which is held together by ligaments such as the inner, lateral and cruciate ligaments as well as by muscles.

If one or more of these joint structures become diseased or damaged, pain and other complaints such as restricted mobility can occur. The pain can be felt as pressing, stabbing or pulling, depending on the cause. They can appear on, behind, below, above or to the side of the kneecap, in the hollow of the knee or inside the knee joint.

Those affected often feel it during certain sporting activities, when they run, climb stairs and / or go downhill. In some cases the pain radiates to the calf or thigh, and sometimes buttocks pain is also evident . If swelling occurs due to inflammation, the affected area is often red and overheated.

The duration and intensity of the complaints can vary greatly from case to case. Some sufferers only experience slight, temporary knee problems, while others have to struggle with persistent, massive pain that restricts walking or even makes it impossible.

Knee pain from injury

The most common causes include injuries. For example, impact accidents and falls can lead to fractures in the knee joint, such as fractures of the kneecap, the thigh rolls or the shin plateau. Such fractures usually have to be treated surgically by performing an osteosynthesis (surgical treatment of the fracture with implants). Affected bone parts are fixed with titanium or steel plates and so-called intramedullary nails or set screws. In addition, the joint surface, which is often indented in accidents, is often relined with the body’s own bone or ceramic material.

Fractures of the kneecap are rather rare, but heal well with simple fractures and appropriate care. In the case of transverse fractures, surgical intervention must be carried out, as otherwise serious complications such as failure to heal the fracture (pseudoarthrosis) can be expected due to the enormous strength of the quadriceps.

Accidental dislocations (dislocation) of the knee joint often limit its usability, as many ligaments tear. A dislocation of the kneecap (patellar dislocation) or patellar lateralization, in which the kneecap shifts laterally due to instability, are also possible.

Sports accidents are usually the cause of a cruciate ligament tear. (Image: Syda Productions /

The most common ligament tears in the knee joint include cruciate ligament tears as well as inner or outer ligament tears. A cruciate ligament rupture is often the result of sports accidents, for example when playing soccer, skiing or playing handball. The so-called flexion-valgus external rotation position results in a cruciate ligament tear , in which the knee is involuntarily bent, in the knock-kneed position and turned outwards, while the lower leg remains stationary.

Cruciate ligament ruptures are accompanied by ruptured blood vessels that lead to bleeding into the knee joint. Accidents can also tear the kneecap tendon or the thigh extensor tendon.

Injuries to the meniscus also often lead to knee discomfort. A meniscus rupture (meniscus tear), a meniscus squeezing, an anomaly such as the disc meniscus or degenerative changes to the meniscus can occur.

Overwork as a cause of knee pain

Overloading can irritate the bones, cartilage, muscles, tendons and ligaments, which can lead to inflammation. In the patellar tip syndrome, for example, there is chronic overload disease of the kneecap extensor apparatus at the bone-tendon junction of the patellar tip.

The syndrome, also known as “Jumper’s knee”, shows symptoms similar to that of the “tennis elbow” and is often perceived as very painful. Overstressing the kneecap tendon leads to hardening and calcium deposits in the tendon attachment to the kneecap. Athletes who play athletics or ball sports often suffer from patellar tip syndrome.

With the so-called chondromalacia patellae, those affected also sometimes have severe knee pain. The disease, which is also known as “runner’s knee” in English, leads to a softening and degeneration of the cartilage on the underside of the kneecap. Young and active people are particularly affected. The symptoms often occur on the front of the knee or in the form of kneecap pain .

Overuse, particularly high forces on the cartilage, functional disorders of the thigh muscles, trauma, chronic wear and tear as well as inflammation of the knee joint, the knock-kneel position, elevated kneecap or weak ligaments lead to chondromalacia patellae.

The pain syndrome, known as “runner’s knee” in German-speaking countries, is a malignancy and overload disease, the so-called iliotibial band syndrome, which also causes knee problems. They arise because the iliotibial band (tendon plate that runs on the outside of the thigh to the shin) rubs over the bones of the knee joint. The irritation leads to inflammation of the tissue.

The so-called Plica syndrome can result from chronic knee overload and often affects racing cyclists. (Image: nokturnal /

The so-called plica syndrome also often leads to knee pain, in which enlargements and thickenings or folds (plica) of the synovium swell due to inflammation and form painful entrapment in the joint. The folds can appear above and below the kneecap, on the sides and towards the middle of the joint, causing pain behind the kneecap and swelling and even cartilage damage. Strength athletes and cyclists are often affected. In addition, an earlier injury can also lead to plica syndrome.

Pain in the knee from inflammation

Inflammation of the knee joint often leads to discomfort. Arthritis (joint inflammation) can have different causes. Rheumatoid arthritis is one of the most common forms of arthritis . The disease is triggered by a malfunction of the immune system, so that one’s own joints and tissues are attacked and destroyed. That is why rheumatoid arthritis is classified as an autoimmune disease. It usually shows itself symmetrically through swelling of both knee joints, typical are still morning stiffness of the joints and movement-dependent pain.

Other causes of inflammation can be, for example, irritation (e.g. in the runner’s knee). In addition, infections caused by viruses or bacteria can lead to inflammation in the knee area. These include the infectious diseases rubella, rubella, hepatitis B, hepatitis C, HIV and mumps. Bacteria that can trigger inflammation in the knee joint include staphylococci, streptococci, salmonella, campylobacter and borrelia. Fungi, such as the Candida genus, can also cause inflammation.

Pain in the knee is often caused by what is known as bursitis, an inflammation of the bursa. In the knee, for example, there are bursae on the side, on or below the kneecap or as a connection with the interior of the joint. The inner bursa is primarily injured when there is a break. The bursae lying in front of and below the kneecap are often inflamed due to the high pressure they are subjected to. For example, tilers are more often affected by chronic bursitis. But falls and impact accidents or an inflamed wound can cause bursitis.

People who are affected by so-called chronic internal knee diseases also often suffer from Baker’s cyst , a fluid-filled bulge in the hollow of the knee. The causes include rheumatoid arthritis and chronic meniscus damage. If the knee is injured or damaged, inflammatory processes increase the formation of synovial fluid. As a result, the internal joint pressure increases, making the surrounding connective tissue slack. A fluid-filled cyst develops, the Baker’s cyst.

Rheumatoid arthritis is characterized by inflammatory processes that cause massive pain in the affected joint. (Image: designua /

Cartilage-bone damage as the cause

Another disease that affects boys between the ages of 10 and 14, but also athletes, is Osgood-Schlatter’s disease . In growth disorders, pieces of bone become detached due to irritation of the kneecap tendon (patellar tendon) on the anterior tibia and can die, resulting in what is known as aseptic osteonecrosis. This is a dead area of ​​bone at the base of the kneecap ligament (patellar tendon) below the kneecap.

The causes are assumed to be micro-injuries or overstrain caused by training, a reduced load capacity of the shin during the hormonal changes in puberty , obesity and local circulatory disorders .

Sinding-Larsen-Johansson disease occurs primarily in male adolescents and athletes. The painful inflammatory reaction at the origin of the patellar tendon at the tip of the kneecap can cause a piece of bone to detach from the kneecap and die. Sinding-Larsen-Johansson’s disease is caused by overload.

Knee pain in children and adolescents can also be due to Panner’s disease (osteochondrosis dissecans). Bone necrosis mainly affects boys between the ages of six and ten. This leads to the formation of a so-called joint mouse, a free cartilage-bone part, the cause of which can be traced back to circulatory disorders, overload or an unknown trigger. The free joint body can settle into the joint and cause severe entrapment, damage to the cartilage and, later, arthritis.

Another cause in young children (and less often in adolescents) is Blount’s disease. Affected suffer from a deformation of the lower leg bone due to a growth disorder of the medial growth plate.

Chondropathia patellae is a disease of the cartilage on the back of the kneecap. Typical complaints include pain when climbing stairs, when getting up after long periods of sitting and when squatting down. The articular cartilage on the back of the kneecap is subject to degenerative changes that only become painful when the degeneration has progressed so far that the kneecap below it is also affected. If the thigh bone is involved, it is referred to as the patellofemoral pain syndrome. See also knee joint pain .

Metabolic disorders can lead to deformation and damage to the knee joints. (Image: artstudio_pro /

Pain in the knee area from metabolic diseases

The cause can be an acute attack of gout . Uric acid crystals that have not been broken down are deposited in the joints and internal organs, among other things, and can cause severe pain. Uric acid occurs as a metabolic product even in healthy people. However, it is normally sufficiently broken down by the metabolism.

Metabolic disorders can lead to the formation of uric acid build-up, which can result in deformation and damage to the joints. The formation and deposition of pyrophosphate crystals, which can also lead to severe joint pain, is called pseudogout.

People who have hemophilia have knee pain due to bleeding in the joint. The first bleeding in a joint (initial bleeding) is often caused by an accident. Enzymes are released through the synovial membrane (membrana synovialis), through which the blood in the joint is broken down. This is why the synovia (joint fluid), which is more permeated with blood vessels, increases in large effusions. The result is a cycle of bleeding and inflammation.

Other metabolic diseases that can lead to knee pain include hemochromatosis ( iron storage disease ) and hypercholesterolemia.

Joint wear and tear as a cause of knee pain

Wear and tear in the knee joint (osteoarthritis of the knee) can lead to severe knee problems. This can completely destroy the cartilage in the joint. Previous injuries such as a cruciate ligament tear or meniscus damage are often the trigger. As the wear and tear progresses, the patient can no longer move his joint without experiencing pain.

In the worst case, the knee joint stiffens. That is why therapies for osteoarthritis of the knee are not only aimed at relieving those affected from the symptoms, but also at maintaining the mobility of the joint. This may require surgery and even an artificial knee joint. With early treatment, wear and tear can be stopped in most cases.

Other causes

Furthermore, knee and leg pain can occur with growing pains, an overmovable joint, chronic fatigue syndrome, fibromyalgia and tumors . Due to the multitude of possible causes, these explanations only represent a selection of the more common triggers. In principle, a doctor should be consulted in the event of persistent or recurring complaints.

Those who work on their knees a lot have an increased risk of knee problems. (Image: Ingo Bartussek /

Risk factors

Risk factors include activities that are performed while kneeling or crouching, such as laying tiles or parquet, and sports that can strain the knee, such as running or skiing. However, the main risk factor for pain in the knee area is overweight due to the increased stress on the joints and a lack of exercise.


Since the causes range from brief overload to accidents and metabolic diseases, a differentiated diagnosis is important. The doctor will first ask questions about possible accidents and previous illnesses. The exact location of the pain is also important in order to track down the cause. The doctor will carry out various movement tests so that any restriction of movement – if any – can be determined.

The external examination of the knee can provide information about swelling and redness. Depending on the case, further examinations such as x-rays, blood tests, for example for inflammation values, ultrasound examinations (sonographies), magnetic resonance imaging (MRT), joint punctures for joint effusions, and arthroscopies (knee mirror images) are necessary.

Treatment for knee pain

Treatment depends on the cause of the problem. While short-term, acute complaints often subside on their own, persistent and / or recurring pain in the knee requires therapy. Anti-inflammatory pain relievers are often prescribed. In addition, joint injections and joint irrigation with cortisone-containing agents are used if necessary. Local analgesics can also be administered to the joint.

Whether exercise or rest is sensible depends on the diagnosis. Often, good results are obtained with physical therapy. In addition, special muscle training for strengthening and stretching, certain sports such as swimming or cycling, heat or cold therapy, water and bath therapy, ultrasound therapy or orthopedic bandages, shoe heels or crutches can help.

Knee problems can often be brought under control with individually tailored physiotherapy. (Image: contrastwerkstatt /

If these therapies do not provide relief, surgery may be necessary. In most cases, the operation is carried out by means of arthroscopy (knee joint mirroring). If the degeneration of the knee joint is very advanced, an artificial joint can be used.

In addition to adequate, adequate exercise, a balanced diet is also advisable as a preventive measure. In this way, bones and cartilage are supplied with all important nutrients. At the same time, the composition and amount of synovial fluid is positively influenced, which ensures reduced friction between the joint partners. If the knee is moved, it mixes the synovial fluid and “oils” it at the same time, so that the cartilage is also nourished.

Naturopathic treatment for knee pain

From the perspective of naturopathy, knee pain is always viewed in the context of other body structures. For example, the nerve (femoral nerve), which is responsible for supplying the knee, runs from the lumbar spine between two muscle parts of the hip flexor (Iliopsoas muscle). However, this muscle is often shortened from sitting for long periods of time during office work and lack of exercise. If pain occurs after getting up or without mechanical stress and there is no conventional medical explanation, the symptoms in osteopathy are often viewed as the result of a pinching of this nerve.

Acupuncture has long been used in Europe as part of traditional Chinese medicine (TCM) to relieve symptoms . Thin needles are placed at certain points along meridians (paths in which the life energy “Qi” flows).

The procedure in which these points are heated is called moxibustion, the massage of the points acupressure . Acupuncture can provide relief, especially for knee osteoarthritis. This is proven by scientific studies.

A therapy with leeches , which are placed on the skin, can be promising. The leeches give off many health-promoting substances with their salvia. For example, the enzymes cause the blood vessels to widen, inhibit blood clotting and have an anti-inflammatory and analgesic effect.

Other methods used in naturopathy are cupping , in which cupping glasses are drawn along the muscle paths, and Ayurveda therapy , which consists of a combination of massages, external applications with herbal oils and sachets, a special diet and yoga exercises.

The Phytotherapy , discuss various medicinal plants used, is also frequently a component of the natural treatment of knee pain.


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