Dr. Tariq Jagnarine
Family Medicine/ Endocrinology/Diabetes

Chronic knee pain is long-term pain, swelling, or sensitivity in one or both knees. The cause of the knee pain can determine the symptoms you experience. Many conditions can cause or contribute to chronic knee pain, and many treatments exist. Each person’s experience with chronic knee pain would be different.

People who are overweight or obese are at a greater risk for knee problems. For every pound that someone is overweight, the knee must absorb an extra 4 pounds of pressure when they walk, run, or climb stairs. Other factors that increase the risk for chronic knee pain include:
* Age
* Previous injuries or trauma
* Athletic activity or physical exercise

Temporary knee pain is different from chronic knee pain. Many people experience temporary knee pain because of an injury or accident.
Chronic knee pain rarely goes away without treatment, and it isn’t always attributable to one incident. It’s most often the result of several causes or conditions.
Physical conditions or diseases can cause knee pain. These include:
* Osteoarthritis: pain, inflammation, and joint destruction caused by degeneration and deterioration of the joint
* Tendinitis: pain in the front of the knee that is made worse when climbing, taking stairs, or walking up an incline
* Bursitis: inflammation caused by repeated overuse or injury of the knee
* Chondromalacia patella: damaged cartilage under the kneecap
* Gout: arthritis caused by the buildup of uric acid
* Baker’s cyst: a buildup of synovial fluid (the fluid that lubricates the joint) behind the knee.
* Rheumatoid arthritis (RA): a chronic autoimmune inflammatory disorder that causes painful swelling, and can eventually cause joint deformity and bone erosion.
* Dislocation: dislocation of the kneecap, most often the result of trauma
* Meniscus tear: a rupture in one or more of the cartilages in the knee
* Torn ligament: tear in one of the four ligaments in the knee. The most injured ligament is the anterior cruciate ligament (ACL)
* Bone tumours: osteosarcoma (second most prevalent bone cancer) most commonly occurs in the knee.

Factors that may make chronic knee pain worse:
Injuries to the structure of the knee can cause bleeding and swelling, and can create a chronic problem over time, if not treated properly.
* Sprains and strains
* Overuse
* Infection
* Bad posture and form when doing physical activity.
* Not warming up or cooling down before or after physical activity
* Improperly stretching the muscles
* Poor footwear

The symptoms of chronic knee pain are different for each person, and the cause of the knee pain often affects how the pain feels. Chronic knee pain may present as:
* Constant ache
* Sharp, shooting pain when in use.
* Dull burning discomfort
* Chronic swelling and pain when the knee is touched.

Each possible cause of chronic knee pain requires a different diagnostic test. These include blood work, physical examination, X-rays, CT scan or MRI, and other imaging tests. The doctor would determine the types of tests to undergo to see what’s causing the chronic knee pain.

Each underlying cause of chronic knee pain has a specific type of treatment. These treatments may include:
* Physical therapy
* Medication
* Surgery
* Injections
Bursitis, a common cause of knee pain, is treated in the following ways:

Ice the knee for 15 minutes once an hour for three or four hours. Do not apply the ice directly to the knee; instead, cover the knee with a cotton towel. Place ice in a plastic zip-close bag, and then place the bag on the towel.
* Wear cushioned flat shoes that support the feet and don’t exacerbate the pain.
* Avoid sleeping on the side. Use pillows positioned on either side of the body to prevent it from rolling onto the side. When lying on the side, keep a pillow between the knees.
* Stay seated when possible. If it is a must-stand, avoid hard surfaces, and keep the weight equally divided on both legs.
* Lose weight, if overweight or obese.

Some knee pain, especially pain caused by osteoarthritis, would likely be permanent. That’s because the structure of the knee is damaged. Without surgery or another type of extensive treatment, people would continue to feel pain, inflammation, and swelling in the knee.
The long-term outlook for chronic knee pain involves managing pain, preventing flare-ups, and working to reduce irritation to the knee.

Persons can prevent some, but not all, of the possible causes of knee pain.
If chronic knee pain gets worse because of overuse, or tends to be the most painful after physical activity, make lifestyle changes to help treat the pain. These approaches include:
* Warm up before exercise. Stretch the quadriceps and hamstrings before and after exercise.
* Try low-impact exercises. Instead of tennis or running, give swimming or bicycling a shot. Or mix low-impact exercises with high-impact exercises to give the knees a break.
* Lose weight.
* Walk down hills. Running puts extra force on the knee. Instead of running down an incline, walk.
* Stick to paved surfaces. Rough roads or pocked walkways may be hazardous to the knee’s health. Stick to smooth paved surfaces, like a track or walking arena.
* Get support. Shoe inserts can help treat foot or gait problems that may be contributing to knee pain.
* Replace the running shoes frequently to ensure they still have proper support and cushioning.