Knee pain

The pain under the knee can be caused by many reasons, since the knee joint is considered to be the most complex and largest joint of the human body and is exposed to stress almost daily, and sometimes to injuries, inflammations, and injuries.

Symptoms are pain under the knee, pain in the knee joint accounts for almost 30% of all complaints associated with musculoskeletal diseases and is most often found in people who are active, engaged in sporulation, including professional.

[1], [2], [3]

Causes of pain under the knee

Pain in the knee is caused by a change, damage to the cartilage, periarticular bag, tendons, muscles, the vascular system and are associated with various provocative factors, among which may be the following:

• Traumatic injuries as a result of intense physical exertion, non-compliance with the rules of warm-up before active, long workouts.
• Injuries caused by bruise, shock, accident, fall.
• The inflammatory process in the joint is osteoarthritis, gout, rheumatoid arthritis.
• The inflammatory process in the periarticular bag is bursitis.
• Becker cyst (popliteal neoplasm) caused by arthritis.
• Rheumatoid arthritis, systemic lupus erythematosus.
• Infectious process in the joint (psoriasis, venereal diseases).
• Offset the patella.
• Damage to the meniscus.
• Tendonitis (inflammation of the tendons).
• Tendinosis (tendon rupture).
• Schlätter's disease.
• Sprain, ligament rupture.
• Fracture of the kneecap.
• Chondramalacia patella (patella) - deformation, softening of the articular cartilage.
• Bone tumor.
• Overweight as a factor that provokes damage to the knee-hip joint.
• Osteochondrosis of the lumbosacral spine.
• Diseases of the hip joint.
• Cyclist's Knee Syndrome is a syndrome of the ileo-tibial ligament.
• Varicose veins

Despite all the diversity, the causes of pain under the knee are most often associated with inflammatory or traumatic damage to the tendons, as indicated by the localization of the pain symptom.

[4]

Pain in the leg below the knee

The zone of pain symptom below the knee in the diagnostic sense is quite specific, in contrast to pain in the joint itself. The most common pain in the leg below the knee, associated with diseases or injuries of the tendon-ligament apparatus.

Tendons are the textus connectivus or connective tissue of striated muscles, which is responsible for the compatibility and attachment of bone and muscle tissue. Tendons are very strong, but not capable of severe stretching, and this causes their sensitivity to inflammation, injury, stretching and tearing. In addition, pain in the leg below the knee may be associated with a serious condition - rupture of the meniscus, fracture of the patella, dislocation or inflammation of the periosteum (shinsplint).

Diseases of the knee tendons are typical problems of professional athletes, in rheumatology practice there are even definitions that describe the very specific symptoms and etiology of pain in the knee area: 

1. STIT - Runner Syndrome or Friction Syndrome or Tibial Tract.
2. Tendinitis of the patella - “jumper knee” (less often a basketball player).
3. Chronic tenosinovitis - "knee swimmer."

In addition, pain in the leg under the knee is often associated with varicose veins, which is manifested by pulsation, heaviness, and pulling sensations that increase with the static position of the body - standing, sitting.

How does the pain under the knee manifest?

The signs and symptoms of pain under the knee need to be differentiated for more accurate diagnosis.

Types and nature of pain symptom below the knee joint: 

• The aching, nagging pain, which most likely signals a developing inflammatory process in the joint - arthrosis, arthritis of rheumatoid etiology.
• Severe, sharp pain, characteristic of traumatic injury, rupture of ligament, tendon, as well as fracture.
• Acute pain below the knee can be a signal of damage to the meniscus or be reflected pain in the radicular syndrome (lumbar radiculopathy).

In addition to the painful symptom of the disease of the knee joint, they are accompanied by a decrease in functional mobility, stiffness, when extension, flexion of the leg is very difficult. Symptoms of pain under the knee, together with other clinical manifestations - redness of the skin, swelling, hematomas, unusual position or appearance of the knee are important diagnostic indicators that help the doctor accurately determine the root cause and prescribe an adequate treatment. There are certain conditions that cannot be treated on their own, as they can lead to serious complications and loss of motor function.

Signs, symptoms that require medical care: 

• If the pain below the knee is not intense, but does not go away within 3-5 days.
• If the pain increases during the day and is accompanied by fever, general malaise.
• If the pain symptom below the knee joint makes it impossible to step on the leg, immobilizes the person.
• When pain is accompanied by severe swelling of the joint.
• The painful symptom is acute, intolerable, the knee is deformed, the leg takes on an uncharacteristic appearance.
• If there is severe pain when going down or up.

[5]

Knee pain when flexing

The pain in the joint itself, the pain under the knee during flexion is connected with the fact that the muscles of the knee joint work in two directions - concentric and eccentric. Flexion is an eccentric contraction of the muscular system. A pain symptom may be due to poor preparation, insufficient warming up, and warm-up before exercise, when sharp movements are made. Rarely, the cause of pain during eccentration (flexion) is prolonged static tension of muscles, ligaments and tendons (stagnation). In addition, when subjected to stress, the patella squeezes the inflamed articular surface, which makes it difficult for the knee to slip smoothly and causes a painful symptom. As a rule, in such cases, pain under the knee when bent is associated with gonarthrosis - the inflammatory process of the knee. Painful sensations are dull, permanent, if you do not diagnose them in time and do not begin to heal, arthrosis of the knee can lead to serious deformation of the joint structure, damage to the cartilage tissue and a condition in which it is difficult, and sometimes impossible to fully straighten the legs. A typical gait on the half-bent legs appears, characteristic of gonarthrosis in the advanced stage.

[6], [7]

Knee pain in front

The front of the knee joint, pain under the knee in front is most often triggered by the following functional disorders, diseases: 

• Weakness of the medial head (caput mediale) of the extensor, which provokes pressure on the lateral parts of the patella and disrupts its movement. If atony of the head and mechanical pressure becomes chronic, softening develops, deformation - chondromalacia of the patella.
• Instability of the patella, its displacement as a result of constant rotation of the tibia. Most often, such a violation is associated with sports.
• Tendonitis, which manifests as pain in the knee, pain under the knee in front. A painful symptom may be exacerbated by physical exertion, climbing or descending the stairs.

Knee pain from behind

The causes that provoke pain under the knee from behind are well studied in the clinical sense and are usually caused by damage to the meniscuses or sprains or torn ligaments. In addition, the pain symptom, localized behind the knee, indicates a tumor - Becker cyst. The cyst forms in the inflamed tendon-ligamentous apparatus of the knee, in the popliteal fossa due to a long, chronic inflammatory process in the mucous bag - arthrosis. There is accumulated exudate, which, gathering, bulges inside. This not only interferes with normal movement, but also causes transient, tingling pains first, then numbness. In the deepening of the knee joint is clearly palpable education, painful to the touch. The Becker cyst is diagnosed by X-ray and the injection of a contrast agent into the soft tissue. In the initial stage, pain under the knee from behind is treated with conservative methods, in severe, neglected cases, puncturing is required, in which exudate is pumped out of the cavity, a corticosteroid drug is injected. Surgery is also possible, when a cyst grows to a large size and contains pus. In addition, after the relief of a painful symptom, basic treatment of the inflammatory process in the joint itself and in the body as a whole is necessary.

Pulling pain under the knee

Pulling pain under the knee is associated with arthritis or degenerative processes in the meniscus. The zone of the inner part of the knee is considered a projection of the medialis (medial), the inner meniscus, as well as the inner collateral ligament. A characteristic symptom of damage to the medial meniscus is a pulling pain under the knee when descending from an elevation, a ladder. As a rule, X-ray examinations at the initial stage of the process do not show cartilage degeneration; therefore, during persistent, prolonged pain, arthroscopy is prescribed, which helps to establish and confirm precisely the deformation of the inner meniskos - the cartilaginous joint pad. Also, the pulling pain under the knee may be due to osteochondrosis of the lumbar spine or a more banal cause - flatfoot. Also, painful sensations at the bottom of the knee joint are characteristic of venous stasis - varicose veins, which develops in office workers who are forced to sit more than 7-8 hours in the same position, such symptoms are characteristic of drivers who spend most of their time behind the wheel. In these situations, regular warm-ups, preventive massages and check-ups are shown.

Arthritis, which provokes the pulling nature of pain under the knee, is most common in the elderly, as this process is associated with age-related changes in the bone and muscle tissues.

Pain under the knee when walking

A common cause of persistent pain under the knee is progressive gonarthrosis. This is especially true for people older than 40-45 years, in whom, according to statistics, a deforming lesion of the knee joint in 30% provokes pain under the knee when walking. The symptom can develop in one knee or be felt in both legs.

The onset of the disease is asymptomatic, a person practically does not feel discomfort, only transient aching pain can signal the development of arthrosis, but, as a rule, they are “written off” to overwork, tired legs. The cause of gonarthrosis is the intraarticular progressive deformity of the cartilage and bone tissue associated with age-related changes, including hormonal changes. Accompanying pain symptoms are: 

• Periodic crunch in the knee when walking, squats.
• Slightly limited mobility of the knee (s).
• The knee starts to hurt not only when walking for long distances, but also when rising from bed, a chair.
• The area below the knee hurts a lot when weights are raised from a squatting position.
• The pain under the knee when walking is accompanied by pain when climbing the elevated terrain, stairs, as well as during the descent.
• The pain begins to acquire the character of a constant, aching and subsides only in the prone position, at rest.
• In the acute stage of gonarthrosis, pain can manifest itself at night as acute, severe.

Differentiation of pain below the knee when walking is simple enough: 

• Vascular changes do not provoke increased pain over time, with age.
• The pain associated with fatigue, is at rest and does not recur.

[8]

Severe pain under the knee

Severe pain under the knee can be caused by multiple causes, but most often they relate to injuries, breaks, fractures.

If the knee joint is seriously injured as a result of a bruise, blow or fall, it is the severe pain under the knee, in the joint itself, in the surrounding tissues that serves as the first signal that requires immediate medical attention. Cross strong pain symptom develops swelling, there may be hematomas.

Also a factor that provokes strong painful sensations below the knee, can be such diseases: 

• Purulent infectious process in the joint, which, in addition to pain, causes hyperthermia of the body, fever, general intoxication of the body.
• Bursitis in the acute stage, which is accompanied by severe pain in squats, moving up or down the stairs, often during long walking.
• Osteoarthritis, which manifests as severe pain under the knee in the morning or before bedtime. During the day, the pain symptom, as a rule, subsides, but the knee is swollen, can hurt with palpation, is limited in mobility.
• Rheumatoid arthritis, which is considered an autoimmune disease, affects not only the knee, but also other joints of the human body. In addition to strong, unbearable pain, rheumatoid arthritis provokes skin flushing around the knee, knee deformity.
• Dislocation of the patella - complete or incomplete, associated with a professional factor (sports, dancing, ballet). Severe pain under the knee, above the joint, almost complete immobilization, deformity of the joint, and swelling are characteristic signs of traumatic injury to the patella.
• Sprain or complete rupture of the ligaments when falling, hitting the zone below the knee. In addition, rupture of the ligament may be due to a sharp turn of the leg with a strong blow to the knee (most often - collisions in sports).
• Damage, rupture of the meniscus, which is accompanied not only by a strong pain symptom, but also by hemorrhage (hemarthrosis), swelling of the joint. Ballotting (loss of stability) of the patella is related to the fact that exudate and blood accumulate in the cavity of the articular sac.

[9], [10], [11], [12]

Knee pain

The knee cup is a patella, as rheumatologists, osteopaths, surgeons call it. The patella is a structural part of the knee system, which is supported by Musculus quadriceps femoris, the tendons of the quadriceps muscle of the thigh. Patellar calyx is responsible for the normal slip of the tendon-ligament apparatus.

If the cartilaginous layer of the patella is damaged, chondropathy develops, smooth and painless gliding, the movement of the joint is disturbed, and pain increases under the calyx of the knee. Signs of chondropathy can be the following clinical manifestations: 

• Pain under the cup, in the joint itself, with intense physical exertion.
• The characteristic sound of "friction" under the cup.
• Painful sensation on palpation in the area under the patella.
• Swelling of the joint, accumulation of exudate.
• Decreased muscle tone, atrophy.

In addition, pain under the calyx of the knee can be triggered by instability of the patella with complete or incomplete subluxation. Causes that cause pathological tilt or pod knee subluxation can be as follows: 

• Overstretching whether the detachment of the external ligament, which supports the patella.
• Atrophy of the external ligament.
• Atrophy of Musculus vastus medialis - the internal (medial) broad muscle of the thigh.
• Anatomically abnormal structure, shape of the legs.
• Valgus shape of the legs (X-shape).
• Hip dysplasia, femoral condyles.
• Offset (lux) or too high location of the patella (patella) - patella alta.
• Anatomical pathology of the tibia, flat feet - rotation of the tibia (“raking” feet inside when walking).

Besides the fact that tilting, subluxation causes pain under the calf of the knee, a person may feel a spilling painful symptom under the patella or in the entire joint, hear a crunch or a click. But the most characteristic sign of subluxation is a feeling of instability, mobility of the patella.

[13], [14], [15]

Pulling pain under the knee from behind

The pulling nature of pain in the area under the knee joint may be associated with osteochondrosis of the lumbosacral spine. Infringement of the nerve roots provokes an irradiation symptom, which is felt as a aching, pulling pain under the knee from behind while the nerve endings are located.

Also, the pain associated with the back zone under the knee can be caused by varicose veins, vascular pathology. These diseases require differential diagnosis using angiography, ultrasound of blood vessels and x-rays of the knee joint, lumbosacral area.

The pulling pain under the knee from behind is a characteristic sign of a developing Becker cyst, which in the initial stage is asymptomatic, only occasionally manifested by pulling, intermittent pain. As the formation increases, there is pressure on nearby nerve endings, this is accompanied by painful sensations behind the knee joint, numbness and tingling in the feet. Movement of the knee becomes limited, it is especially difficult to bend the leg. A large-sized cysts is visible to the naked eye, it is painful on palpation and often causes swelling of the entire joint.

Aching pain under the knee

The aching nature of pain may be associated with inflammation in the periosteum of the knee joint. The aching pain under the knee, constant, lasting for hours, poured into the thigh area gives a lot of unpleasant feelings to the patient, and can also be accompanied by limiting the mobility of the leg in the extension process. Inflammation of the periosteum requires accurate diagnosis and timely treatment, as it can lead to complications up to complete immobility of the legs.

In addition, the aching pain under the knee can be caused by such factors as diseases: 

1. Rheumatoid arthritis, which provokes debilitating, aching pain in the affected joints, including the knee, under it. Today, medicine has studied more than 100 kinds of arthritis, but it is rheumatism that is one of the most difficult in terms of therapy, since it affects all joints, even small ones, and is considered a systemic disease. Rheumatoid arthritis rarely affects one knee, most often it develops in several large joints at once. 
2. Osteoarthritis is a type of osteoporosis that also has the definition of degenerative arthritis. This is the most common type of arthritis that causes nagging pain under the knee. Worn cartilage tissue develops gradually over many years and manifests itself in the form of aching, periodic sensations. In the stage when the cartilaginous tissue of the knee is deformed and almost disappears, severe paroxysmal pain appears, which again is replaced by aching pain under the knee. Osteoarthritis "reacts" to many factors - changes in weather conditions, heat, cold, overstrain, static voltage, and so on. 
3. The initial stage of chondrama is another type of arthritic deformity of the cartilage, which is manifested by pain under the knee and is often localized between the thigh and the patella. Chondromalacia is also provoked by injuries that have not been treated, “neglected”. The consequence of such traumatic cartilage damage is the softening of the cartilage, the aching pain of the popliteal during active movements - running, jumping. In a neglected form, this pathology can lead to disability and complete immobilization of a person.

Pain under left knee

Most often, the knee joints hurt at the same time - right and left.

However, the pain under the left knee is a fairly common phenomenon in such diseases: 

• Irradiating symptom characteristic of radicular syndrome in lumbodynia, radiculopathy, osteochondrosis of the lumbosacral spine. The lumbago can signal itself to one who shoots pain in the area of the knee, without manifesting itself at the main site of an intervertebral disc injury. 
• Vascular symptom that indicates venous congestion, arterial occlusion. The pain under the left knee may increase during physical exertion - walking for long distances. Painful sensations are aggravated by bending the leg when lifting up - up the stairs, while raising the leg when stepping over an obstacle. A characteristic feature of a painful symptom is subsiding at rest or when the movement is stopped, because of this, the clinical syndrome of this disease has been called the “window disease”: you walk hurts, you stop to look at the window - there is no pain. For varicose veins and vascular pathologies of the lower extremities, one-sided pains, such as pain under the left knee, are characteristic.

[16]

Pain under the right knee

Unilateral pain under the knee is most likely associated with vascular pathologies or with the formation of a popliteal cyst.

The cyst of Becker (Baker) is a neoplasm that has an inflammatory, less often traumatic, infectious etiology. A cyst forms in the posterior part of the knee joint, if it forms in the right leg, pain under the right knee is an inevitable symptom that is not initially manifested, but as the cyst grows, increases. A noticeable compaction develops in the popliteal fossa, the skin is not hyperemic, it is easily displaced above the formation, not soldered to it. The cyst is noticeable with a straight leg, a bent knee, if the knee joint is bent, the cyst seems to fall inward and is not visible. Becker's cyst can cause injury, mild meniscus damage, synovitis, osteoarthritis, rheumatoid arthritis. The pain under the right knee, associated with a small cyst, as a rule, does not cause severe discomfort, only a feeling of pressure. There are some difficulties with movements, but they do not limit the mobility of the knee. A large cyst provokes a sensation of tingling, numbness, cold, which indicates a clear impairment of blood circulation in the leg tissues. Thrombosis, thrombophlebitis can be called as a possible complication of a developing cyst.

The pain under the right knee is also provoked by arthrosis in the initial stage, which can “start” with one leg, but then spreads to both joints. Complicated with arthritis overweight, varicose veins, which can be an independent cause of pain in the knee joint of one leg. Varicose veins are characterized by aching, pulling pains that may increase with exertion. Usually, varicose dilatation develops more intensively in the supporting leg, which accounts for the main load when walking, performing exercises. At rest, in a horizontal position with the legs raised (legs), the pain subsides, and it also passes if the person “paces”, that is, consciously activates the blood circulation.

[17]

Sharp pain under the knee

Sharp pain under the knee is a symptom that requires not only medical consultation, examination, diagnosis, but also immediate help.

Among the causes provoking sharp, severe pain in the knee, under the knee, the most dangerous are such injuries, injuries and diseases: 

• Traumatic damage to the cartilage - meniscus. It is possible to damage, tear the meniscus not only by doing professional sports, but also in everyday life with a sharp, unsuccessful turn, jump (landing) and even bending down or crouching. Violation of the structure of the meniscus is manifested by sharp pain, immobilizing the entire knee, especially its extensor function. The knee joint quickly swells, it hurts even when touched. Trauma to the meniscus should be treated as quickly as possible, because in a neglected form, it leads to complete immobilization of the leg. As a first aid, cold is shown on the joint, taking an analgesic drug (nonsteroidal anti-inflammatory agent) and immediate medical attention. As a rule, an x-ray of the knee is assigned, which indicates the state of the bone tissue, and not the cartilage. The condition of the meniscus is checked using ultrasound. Therapeutic measures depend on the severity of the injury. If a sharp pain under the knee is accompanied by extensive swelling and hyperemia of the skin, dislocation is possible, it is reset. A meniscus rupture may imply a surgical intervention, in which parts of the cartilage are reconstructed, stitched together. After the first stage of treatment, therapeutic exercises, physiotherapy, and observance of the mode of gentle exercise on the knee are shown. 
• Sharp pain under the knee is characteristic of ligament breaks, which can be triggered by falling on the knee joint, striking the joint, and turning in some sports (hockey, soccer). Sharp pain of the joint can serve as a sharp, acute swelling of the joint, soreness. When bending or straightening, clicking or crunching when moving. If the ligament is broken completely, a hematoma gradually develops at the site of injury. As a first aid, you can apply ice, cold, take anesthetic drug and immobilize the knee at a right angle. Cold compress is designed to relieve edema, prevent intraarticular hemorrhage, tight bandage helps reduce pain symptom. It is obligatory to visit a doctor, diagnose damage and treatment. It is believed that the most dangerous rupture is a violation of the integrity of the cruciate anterior ligament, which recovers and heals extremely slowly and difficultly.

Acute pain under the knee

Any acute pain is a signal that the disease is acute, the inflammation is curling rapidly, or the trauma needs emergency medical care. No exception and acute pain under the knee, which is triggered by such factors: 

Fracture of the knee joint. The patella is most often injured as a result of a fall from a height or onto a bent knee. In traumatology, horizontal fractures of the patella are most often diagnosed, which manifest as acute pain under the knee, in the area of the knee itself. A horizontal fracture is accompanied by the displacement of fragments and is treated only with the help of fixation (gypsum). Complicated fractures may require surgery, complications can lead to endoprosthetics. Also, a fracture may be accompanied by a separation of the patella, when the line of injury passes below and provokes severe pain just below the knee. A multi-foliate fracture of the patella is less frequently diagnosed, it is triggered by a very large force, requiring high speed and application energy. Vertical fracture is located from the top down, it does not lead to displacement. The most rare variant of a patella fracture is an osteochondral type of injury caused by an already developing process of deformation and degeneration of bone tissue in arthritis, osteoarthritis. Fracture symptoms are typical:

• Sharp, sharp pain under the knee.
• Edema that develops rapidly.
• Internal bleeding in the articular bag, in the cavity - hemarthrosis.
• Leg immobilization
• Deformation of the joint (retraction inside the fragments).
• Hematoma, blood penetration into the subcutaneous tissue. The bruise extends down the leg, up to the foot.
• Possible loss of sensitivity of the knee and legs in general.

First aid for fracture - call a doctor, cold at the place of injury, immobilization of the knee and leg. The prognosis of patella fractures is generally favorable, provided that timely medical care is provided.

Synovitis of the knee - inflammation of the inner part of the joint and accumulation of exudate in the cavity. Sharp, acute pain under the knee, fever, leg immobility requires immediate treatment, in the advanced stage synovitis can provoke deformation of bone and cartilage tissue, development of arthrosis.

Occupational injuries of those who are familiar with sports, ballet, dance - dislocation, subluxation, incomplete dislocation of the patella (patella). Symptoms that show dislocation - a sharp pain under the knee, in the joint, difficulty in moving, pain in the leg when advancing. The knee swells severely, deformed. As a first aid, cold lotions are shown, knee fixation with the help of a tire according to the location from the buttock to the ankle, intake of anesthetic drug. Independent reduction of dislocation is unacceptable, as this may provoke a rupture of ligaments and further surgical intervention. Only a traumatologist, an orthopedic surgeon, a surgeon after examining and diagnosing damage can repair a damaged patella. Therapeutic measures for dislocation, subluxation suggest relief of a sharp pain symptom, fixation of the joint for a month or more. Even appointed massage, physiotherapy. 

Acute pain under the knee may be caused by other pathologies of the bone tissue, tendon-ligamentous apparatus in the acute stage - arthritis, bursitis, osteoarthritis, tendonitis.

[18], [19]

Knee pain

Pain in the knee, pain under the knee when squatting due to excessive load on the joint, which may already be inflamed or injured.

The cause of the pain is microdamages of cartilage tissue, tendonitis, bursitis in the initial stage. If the pain is felt periodically and does not bother, it indicates that the disease is only developing, is being formed and it is possible to stop it at an early stage. A painful symptom when squatting is a fairly common, typical complaint of people involved in sports and fitness. Causes of pain when squatting: 

• Illiterate performance of strength exercises, non-compliance with technology. For example, there are training options, during which the knees should be parallel to the foot, looking forward. An acute angle when squatting, diluting the knees can cause additional stress on the joint and cause pain.
• Acute, severe pain in the presence of evidence of traumatic injury - rupture or, at least, sprains. If after straightening the pain does not go away, you need to put a cold compress on your knee and seek medical help, undergo a diagnosis.
• Constant pain under the knee when squatting indicates a possible disease - Schlätter’s disease. Especially if the painful symptom accompanies the descent from the stairwell, from the threshold. Schlätter's disease has been little studied and is most often diagnosed in young people.
• The pain under the knee when squatting, accompanied by a crunch, most likely speaks of developing arthritis. The initial stage of arthritis is characterized by transient pain, especially after loads on the joint.
• The pain in sitting can be connected with fashion, this applies to the fair sex, who are experimenting with walking on heels of inconceivable height. Shoes with heels above 6 centimeters are considered traumatic from an orthopedic point of view and can cause persistent pain in the knee joint, below the knee.
• Metabolic disorders, which lead to weakness of the muscular, tendon-ligament apparatus, are also one of the causes of pain when squatting.

If the pain under the knee when squatting is caused by a simple overload or incorrect exercise, the symptom is quite simply and quickly eliminated. Persistent pain, not associated with pathological etiology, can be removed with the help of cold compresses, compresses from the leaves of fresh cabbage, warm, relaxing baths. Also effective exercises in the prone position - "scissors" (cross swing) and "bicycle". In uncomplicated cases, when the disease causing pain is in the initial stage, there is enough physiotherapy procedures, the use of ointments, gels. Launched forms of the disease - arthritis, bursitis, trauma, require long-term comprehensive treatment.

Knee pain during extension

Painful sensation in the knee joint, below it is most often associated with meniscus damage, gonarthrosis and other disorders of the knee structure. In addition, the extension becomes painful and difficult, the knee swells, and the meniscus clearly shows accumulation of exudate. Also typical is extension pain for damage to the ligamentous apparatus, especially when stretching the cruciate ligament. PKS - anterior cruciate ligament injury is typical for those who are engaged in sports exercises, they train a lot. An abrupt stop during fast, energetic movement, excessive rotation provokes pain when straightening. The back ligament (ZKS) can also be damaged, but it is much stronger and more elastic, therefore less likely to be ruptured or stretched. Her injuries can be caused by a fall, an accident, a strong high-energy strike. The main signs of damage to the PKS (anterior cruciate ligament) - a characteristic click, swelling, pain when the leg is straightened, instability of the knee joint. If the gap occurs instantly, painful shock, vomiting, even loss of consciousness is possible.

Arthritis in the acute stage, bursitis can also be factors that cause a painful symptom during extensor movements. Differential diagnosis in such cases is sufficiently accurate, additional methods of research of the knee joint only help to clarify the nature, stage of the disease and give direction for effective therapy.

[20]

Aching pain under the knee from behind

The aching pain under the knee from behind, clearly localized in the popliteal fossa is a symptom of Becker's cyst. This is a benign tumor, a neoplasm that shackles the movement of the leg, provokes light pain, and in the initial stage it proceeds without clinical manifestations. The cyst is almost invisible in the first months, it can be detected randomly when palpating in the upright position of the leg. If the leg is bent, the tumor seems to “fall” into the popliteal fossa and is not noticeable. The skin over the cyst is not hyperemic, there is no swelling in the joint, in principle, the leg looks healthy, only transient aching pain under the knee behind can be the first signal of the disease. The reason for the formation of cysts is considered trauma of the meniscus or arthritis in the first stage, less often - synovitis. The pain becomes more noticeable if the cyst expands and grows in size, squeezing the nerve endings and disrupting the normal blood supply of the joint and the leg as a whole. If Becker's cyst does not begin to heal in a timely manner, it can lead to serious, serious complications - varicose veins, thrombosis, or rupture of the walls of the cyst. The rupture of the capsule formation is accompanied by severe pain and hyperthermia.

In addition to cysts, aching pain behind the knee joint is often provoked by bruises, hematomas, traumatic origin.

[21]

Sharp pain under the knee from behind

Sharp pain under the knee from behind is diagnosed for serious injuries, injuries - fractures, ruptures, displacements.

In traumatological practice there is a concept - a triad of damage to the knee joint. This is a complete rupture of the anterior cruciate ligament, a complete detachment of the collateral medial ligament and trauma of the meniscus. Such a pathological complex is characteristic of professional athletes involved in active, traumatic sports - football, hockey, baseball, combat sports. In the triad syndrome, there is a sharp pain under the knee from behind, a painful symptom in the whole joint, as well as a typical sign “front drawer”, displacement of the axis of rotation, leg deformity, especially during the extension test. For the triad, the manifestation of an effusion is uncharacteristic; it is compensated by a complete rupture of the medial capsule, as a result of which blood flows from the articular cavity. Such complex injuries require immediate hospitalization, often surgery.

In addition, a sharp pain under the knee at the back may be associated with a rupture of the capsule of a Becker cyst, a condition that is not often encountered in practice. As a rule, the neoplasm is started to be treated at the stage of increasing in size, but in a neglected state, the accumulated exudate can break through the wall of the cyst and cause severe pain in the back of the knee joint.

Knee pain

Lateral pain in the knee joint is most often diagnosed in athletes who have ligaments and tendons exposed to intense stress. The pain under the knee on the side is accompanied by difficulties in unbending the legs, pulling sensations during long walking and rarely transforms into an acute pain symptom. In addition to athletes, similar pain affects office workers who are forced on duty to be in a static posture, which also applies to the knee joints. Also, taxi drivers, drivers of public transport, in a word, those who are sitting behind the wheel in the same posture, also complain of a nagging side pain in the knee area. This is a typical factor provoking the characteristic pain of lateral localization, it is called - static overvoltage. As a result, statics, muscles, blood vessels of the body do not receive adequate blood supply, with chronic static poses, especially in a sitting position, thrombophlebitis often develops, and a painful symptom under the knee from behind is a secondary manifestation of the underlying disease.

The reason why a person feels pain under the knee from the side can be osteochondrosis, a bruise or temporary overstrain of the muscles. Very rarely, these symptoms provoke varicose veins due to their anatomical location in other areas.

Severe pain under the knee from behind

If the knee hurts in the lower part of the back, it is a signal of serious damage to the ligament, tendon, less often a rupture of a Becker cyst or a septic bursitis.

Acute pain symptom, which can be localized at the site of injury, but then spread sideways and behind the knee, is characteristic of sprain and rupture of the ACL, the anterior cruciate ligament. The trauma of the PCD, even partial, is immediately accompanied by severe edema, the entire knee swells up, and severe pain appears under the knee in front and behind. However, more typical is the posterior localization of pain for tearing or stretching the posterior sacral ligament, injuries of this kind manifest themselves in the form of severe edema in the popliteal fossa, instability of the patella and a strong pain symptom.

A large-sized Becker cyst with purulent exudate is also one of the reasons for recognizing acute, intense pain under the knee from behind. A cyst may fester due to developed arthritis, concomitant skin lesions or as a result of constant mechanical pressure during physical exertion - sports, professional activities. Severe pain of any localization requires medical assistance and timely treatment.

Pain and swelling under the knee

Puffiness at the bottom of the knee may be associated with a vascular, venous factor, with an inflammatory infectious process in the acute stage, with an insufficient rehabilitation period after treatment, surgery, and excessive stress on the knee. Also typical is swelling, pain and swelling under the knee, around the joint when meniscus is damaged. Patella fracture, dislocation, sprain or rupture of the ligaments, especially PKS - anterior cruciate ligament, Becker's cyst - this is an incomplete list of possible factors causing pain. The popliteal fossa is considered to be quite vulnerable and vulnerable, the skin in this area is not protected, so any violation of the structure of the knee joint, accompanied by edema, can lead to swelling behind the joint. The pain and sensation of pressure, swelling in the popliteal cavity manifests itself quickly and requires inspection, differential diagnosis. Immobilization of the leg and knee bandaging with an elastic material can help as a first aid. Rubbing, cold lotions are not effective and sometimes even harmful, especially if the swelling is associated with venous congestion. To relieve a painful symptom, you can use a non-steroidal anti-inflammatory agent, and then you should contact a traumatologist, osteopath, rheumatologist, phlebologist. If the pain is associated with an injury, a splint or plaster will be applied to the knee, and physiotherapy procedures will be prescribed. A phlebologist, having determined varicose veins or thrombophlebitis, will advise methods and methods of unloading or activating blood circulation, and will prescribe venotonic intake. Rheumatoid arthritis is treated for a long time and in a complex, since it is a systemic disease. In any case, swelling under the knee is a signal of a violation of tissue trophism, vascular conductivity, it is necessary not only to stop it, but also to treat the root cause of the symptom.

Pain in the vein under the knee

The legs are equipped with two types of venous system - there are deep and superficial veins. Pain in the vein under the knee is associated with the expansion or blockage of the vena saphena parva - a vein that is located from the outer zone of the ankle to the knee joint.

The pain of the vascular etiology is not typical for the knee joint, but pain in the vein under the knee is a fairly frequent complaint, especially from women. Disruption of blood flow in the leg, in the area of the knee is most often associated with varicose veins, thrombophlebitis, which have their own etiology. As a rule, vascular pathologies "start" in the puberty period, when the adolescent body begins to grow rapidly, and the vessels do not have time to develop as quickly as the bone system. Pain in the vein under the knee is rarely one-sided, more often both popliteal veins hurt. But sometimes, with a constant load on the supporting leg, it suffers more, for example, the right. Differentiating pain in vena saphena parva — the vein beneath the knee and other types of pain are fairly easy: 

• Pain in the vein is never acute, intense as with rheumatism, arthritis, bursitis or knee injuries.
• Pain in the vein under the knee rarely disrupts the physical activity of a person and does not provoke a decrease in the mobility of the joint itself.
• provokes a decrease in the mobility of the joint itself.
• Venous pains are accompanied by a characteristic feeling of tired legs, often with cramps, numbness.

Treatment of the initial stage of varicose dilatation is carried out on an outpatient basis, often with the help of compression garments, bandaging with elastic materials and taking venotonics. If the pain in the vein under the knee is caused by a prolonged process, the veins are expanded by 4 or more millimeters, sclerotherapy or miniphlebectomy is indicated.

[22], [23], [24]

Pain in ligaments under the knee

The ligament is a specific fibrous tissue that is designed to connect the bone structures, muscle tissue with each other.

In the knee are the main four ligaments, providing the union and functionality of the hip and tibia: 

• PKS - the anterior cruciate ligament, which controls the forward movement, rotation.
• ZKS - posterior cruciate ligament, providing posterior rotation and stable position of the joint.
• MKS - medial (middle) collateral internal ligament.
• BCS - lateral collateral ligament (external ligament).

The pain in the ligaments under the knee is most often caused by diseases, injuries of those ligaments that are behind the knee joint. Most often provokes such pain stretching ZKS - posterior ligament, although such injuries are very rare, because it is strong enough. To injure the PCL, you need a very large blow, for example, a sharp blow to the front of the lower leg in accidents or contact sports. The so-called bumper injury is the most common cause, resulting in severe pain in the ligaments under the knee from behind. If ZKS is injured, pain is formed in front of the knee.

In addition, a painful symptom in the ligaments is caused by stretching, which may be accompanied by joint stiffness, swelling. The most dangerous in terms of consequences and prognoses is the stretching of the cruciate ligaments of all kinds, especially the damage to PKS. Injuries of the anterior cruciate ligaments are poorly treated and rehabilitated for a long time, moreover, the stretching of the ACL is often accompanied by rupture and pain shock.

Standard actions in such cases are cold to the place of stretching, analgesic taking, bandaging with elastic materials and referring to a trauma specialist for differential diagnosis.

[25], [26]

Pain in the child's knee

About 20% of all complaints of knee pain occur in children's traumatology. As a rule, pain under the knee in a child is associated with vascular disorders. Particularly characteristic in this sense are complaints made by adolescents. In the pubertal period, the bone system develops first, the vascular system does not keep up with its intensive growth, which provokes recurrent pain in the zone of large joints. The child’s knee suffers from insufficient blood supply, fortunately this condition is considered transient with age. However, there are pathologies, such as varicose veins, thrombophlebitis, which can “start” in childhood, adolescence, and accompany a person throughout life, occasionally causing pain in the knee joint.

Vascular pains under the knee are not accompanied by deformation of the joint itself, rarely leading to swelling or restriction of leg movements. The pain depends on weather conditions, the presence of associated diseases, such as acute respiratory infections, acute respiratory viral infections, temperature (heat or cold), physical activity, exercise. The knees no longer hurt (twist) at rest, at rest, after a massage or rubbing. Also, the pain under the knee in a child caused by venous insufficiency is well removed by drugs that dilate the blood vessels. More specific treatment is usually not required.

A more serious cause that provokes pain under the knee of a child is rheumatism or spondylitis. These are systemic diseases, symptomatically manifested in the form of joint pain, edema, and occasionally - fever

Body. Pathological changes in the bone tissue are visible on X-rays, the analysis of blood serum shows a high level of C-reaction and ESR. Treatment is prescribed by a rheumatologist, orthopedic surgeon, less often - by a therapist. Also, such a child requires regular follow-up control, a special diet and regular intake of certain anti-inflammatory drugs.

[27],

Diagnosis of pain under the knee

Diagnostic measures of painful symptoms in the joints, including the knee, are fairly standard. Traumatology, orthopedics, phlebology, osteopathy - these are areas in medicine that have a good clinical base, including historical. Diagnosis of pain under the knee is differential in nature and consists of the following actions: 

• Primary visual inspection.
• Collecting anamnesis, including hereditary, professional.
• The nature of the pain, its localization and interaction with other clinical manifestations is clarified.
• Testing is conducted - flexion, extension.
• Mandatory is x-ray.
• Appointed ultrasound of the joint (duplex).
• An important diagnostic step is angiography (leg veins).
• MRI may be prescribed, CT scan - computer methods for bone tissue examination.
• Appointed UAC (complete blood count), biochemical blood test.
• Puncture of the articular cavity may be required.

Diagnosis of pain under the knee is directly related to the nature of the injury, damage to the joint and is carried out comprehensively, often in stationary conditions, where it is easier and faster.

Pain treatment under the knee

Treatment of a pain symptom in the knee joint depends on the severity of the damage to the knee. If the pain is intense, strong, the first therapeutic event is the relief of pain, immobilization of the knee, and delivery of the patient to the hospital.

In all other cases that are not defined as acute conditions, the treatment of pain under the knee involves the following steps: 

1. Relieves inflammation and swelling of the joint. Cold compresses, gentle bandaging or reliable fixation of the joint depending on the type of damage are shown, nonsteroidal anti-inflammatory drugs are prescribed - Ibuprom, Ibuprofen, Diclofenac. Antibiotics may be prescribed if the cause is identified as an infection. 
2. Physiotherapeutic procedures are required to strengthen the muscles and restore stability of the knee joint. 
3. The performance of physiotherapy exercises supporting a certain muscle group in a toned condition for the prevention of atrophy is shown.
4. A rehabilitation complex is being developed, which includes the performance of special exercises.

If the injury is serious, the treatment of pain under the knee can be performed by surgical methods. The method of surgical intervention depends on such factors: 

• Type and severity of injury.
• The number of traumatic injuries (combined trauma, comminuted fractures, and so on).
• Risk assessment of recurrent knee disease (meniscus injury, bursitis).
• Occupational risks associated with the possible retirement of the sport profession.
• The willingness of the patient in the sense of comorbidities, chronic diseases and so on.
• Operations may be as follows: 
• Arthroscopy is a sparing operation with small, low-impact incisions. This type of operation is effective when the meniscus is broken, and the ligament breaks are restored.
• Endoprosthetics - applied after unsuccessful conservative treatment. Replaced part of the knee, at least - the joint completely (with osteonecrosis).

In addition, modern treatment of pain under the knee, in the joint itself, offers non-traumatic, effective methods: 

• Introduction of glucosamine, chondroitin sulfate to restore cartilage.
• Bioprostheses - it is a sheet lining, instep supports, which help reduce the load on the knee joint and reduce pain with flat-footedness, gout.
• Adrenosteroids, which are inserted directly into the joint, are designed to prevent arthritic pain.
• Almost all diseases of the knee in the initial stage have a favorable prognosis, which provides timely, comprehensive treatment.

[28], [29], [30]

Pain prevention under the knee

Prevention of diseases of the knee joint requires compliance with certain rules and recommendations. By following the tips, you can avoid complications and pain symptoms.

Preventing pain under the knee involves a reasonable distribution of the load on the joint, even during professional sports. It is known that statistics on the number of injuries of the knee joint are directly related to many types of sports competitions. More than 45% of pain symptoms in the knee are caused precisely by damage as a result of training or competition. In addition, those who play sports are shown a special diet that contains products that strengthen the ligaments and cartilage tissue. It is also important to monitor the body mass index, the extra weight load on the knee joints leads to their deformation, destruction and pain. If the knee treatment has already passed, the prevention of pain under the knee should include rehabilitation measures - joint development, knee maintenance with the help of elastic bandaging, taking special medicines that strengthen vessels, ligaments, tendons and bone tissue.

Recommendations that include prevention of pain under the knee: 

• If a person is engaged in a traumatic sport, the knee should be protected with a special knee pad, a cross-shaped bandage, and a wedge heel.
• If human activity is associated with monotonous leg movements that can destroy the structural elements of the knee, you should introduce a regime of regular workouts, breaks in work.
• If the knee is injured as a result of a bruise, the joint and the whole leg should be immobilized, and the general physical activity should be limited. Sometimes 2-3 days are enough for the knee to recover and not hurt.
• To prevent pain under the knee, hypothermia of the joints should be avoided in the knee itself.
• If human activity is associated with a sitting position for more than 4-6 hours, the correct posture and position of the legs is important. Constantly bent knees, crossing legs, legs on legs - these are the most harmful positions for the knee joint. It is necessary to find time to periodically straighten and straighten the leg (s).

For the prevention of pain in the knee joint, it is necessary to strengthen the muscles of the thigh (quadriceps) - lunges, squats, exercise "bicycle" will help keep the muscular system in shape and remove the excessive load from the knees.

[31]