Acute Injury:
Chronic Knee Conditions
The nerves that provide sensation to the knee come from the lower back and also
provide hip, leg, and ankle sensation.
Pain from a deeper injury(called referred
pain) can be passed along the nerve to be felt on the surface of the knee. Knee pain,
therefore, can arise from the knee itself or be referred from conditions of the hip,
ankle, or lower back. All of the following sources of knee pain below arise from the
knee joint itself.

In general,
knee pain is either immediate (acute) or long-term (chronic). Acute
knee pains can be caused by an acute injury or infection. Chronic knee pain is often
caused by injuries or
inflammation (such as arthritis) but can also be caused by
infection. Chronic knee pain rarely goes away without treatment, and is not always
attributable to one incident. It’s most often the result of several micro traumas to
the knee over time.
Arthritis of the knee is an inflammatory disorder of the knee joint that is
often painful. Arthritis has many causes.

Osteoarthritis (OA) is caused by degeneration of cartilage in the knee. In its
extreme form, the menisci (cartilage) will be completely eroded,and the
femur will rub on the tibia, bone on bone. Osteoarthritis causes a chronically
painful knee that is often more painful with activity.

Rheumatoid arthritis (RA) is a connective tissue disease of the
whole body that affects many joints often including the knee. People who
have this disease often have family members who suffer from it as well.
In addition to
knee pain, rheumatoid arthritis may produce morning
stiffness and pain in other joints.

Bursitis is a result of trauma, infection, or crystalline deposits, to the
various bursae of the knee. The knee becomes painful and often swollen. A
particularly common bursitis is
prepatellar bursitis. This type of bursitis
occurs in people who work on their knees.

Patellofemoral syndrome is when the patella rubs against the inner or outer
femur rather than tracking straight down the middle. As a result the knee
joint becomes inflamed causing pain that is
worse with activity or
prolonged sitting. The condition typically occurs in elderly people

Tendonitis (inflammation of the tendon) of the quadriceps tendon at the
upper point of the patella, where it inserts onto patella or tendonitis of the
patellar tendon either at the lower point of the patella, or at the place where it
inserts on the tibia is termed jumper's knee. Jumper's knee is
so named because it is typically seen in basketball players, volleyball
players, and people doing other jumping sports.

Osgood-Schlatter disease occurs in adolescent athletes where repetitive
extension of the knee causes inflammation and injury of the tibial tubercle
(the bony protrusion at the top of the shin, just below the kneecap).
Children suffering from this syndrome report pain at the tibial tubercle. This
pain is typically worse when extending the leg. The tibial tubercle is tender to
touch and over time begins to protrude more because the chronic
inflammation stimulates the bone to grow. Osgood-Schlatter disease is a
self-limited condition that usually resolves as the tibial tubercle stops growing
with the end of adolescence (at about age 17 years in males and age 15 years
in females).

Iliotibial Band Syndrome A fibrous ligament, called the iliotibial band, extends
from the outside of the pelvic bone to the outside of the tibia. When this band
is tight it may rub against the bottom outer portion of the femur (the lateral
femoral condyle). Distance runners typically suffer from this condition.
These runners complain of outside knee pain usually at the lateral femoral
condyle. Early on, the pain will typically come on 10 minutes to 15 minutes
into a run and improve with rest.

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Injuries to the knee may be sprain/strains, ligament or tendon tears, meniscal tears
and dislocated kneecap (patella).

An anterior cruciate ligament (
ACL) injury
is a common sports injury generally
caused by a hard stop or a violent twisting   
of the knee. If you tear your ACL, you                                                          
may hear a pop. You will also
notice your knee give way or become
unstable and feel extreme pain. This will,
almost always, be followed by marked
knee swelling over the next couple of
hours. The posterior cruciate ligament
(PCL) is stronger than the ACL and much
less commonly torn.

Both the quadriceps and patellar tendons
may rupture partially or completely. A
quadriceps tendon rupture typically
occurs in recreational athletes
than 40 years.
A patellar tendon rupture
typically occurs in younger people who
have had previous tendonitis or steroid
injections to the knee. Rupture of either
the quadriceps or patellar tendon causes
pain (especially when trying to straighten
the knee). The patella is also often out of
place either upward or downward.

Injuries to the meniscus are typically traumatic
injuries but can also be due to overuse. Often,
a piece of the meniscus will tear off and float
in the knee joint. Meniscal injuries may cause
the knee to lock in a particular position, or
either click or grind through its range of
motion. Meniscal injuries may also cause the
knee to give way. Swelling typically
accompanies these symptoms although the
swelling is much less severe than with an ACL

Dislocated kneecap (patella) is a common injury caused by direct trauma or
forceful straightening of the leg, such as an injury that happens when serving in
volleyball or tennis. Kneecap dislocation is more common in women, the
obese, knock-kneed people, and in those with high-riding kneecaps and will usually
dislocate laterally (outside). If you have this injury you may have difficulty bending
your knee. This injury often causes damage to the
cartilage on the back of the patella.
Chronic Knee Center of San Diego
Performing Non-Surgical Knee Procedures
Rudy A. Reyes, D.C.
Knee Pain
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