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If you want to know more precisely, here are the most common causes per location, more precise than the usual list.
The patellofemoral pain syndrome is the most common form. Here, overload irritates the structures around the kneecap, often in young, active people and somewhat more often in women, encouraged by knock knees. Typical is pain on stairs, in a deep squat and after long sitting, for example at the cinema. If the pain sits at a point below the kneecap and appears in jump-intensive sport, that points more to a patellar tendinopathy. Frequent occupational kneeling can also irritate a bursa.
The inner side is the most common pain region. A stabbing pain after a twisting movement that worsens when getting up from a squat fits the inner meniscus, sometimes with a feeling of locking. Pain after a sideways impact points to the inner ligament. A pressure pain a little below the inner joint space can come from the tendon attachment of several muscles, the pes anserinus syndrome. With bow legs the inner joint space is also prone to osteoarthritis.
On the outer side, runner's knee, the iliotibial band syndrome, is the most common cause. A tight band of tendon rubs over a bony prominence on the outer knee. Typical is stabbing pain that appears in runners after a certain, consistent running distance and worsens when running downhill. Less often the outer meniscus, the outer ligament or osteoarthritis in the outer joint space are behind it, the latter often with knock knees.
Pain or a feeling of tightness in the hollow of the knee often comes from a Baker's cyst, a pouch filled with joint fluid. It is usually a consequence of another knee problem such as osteoarthritis or meniscus damage. If the calf suddenly swells and hurts, a burst cyst can be behind it, which needs to be distinguished from a thrombosis and should therefore be medically checked.
Besides the location, the timing helps to narrow down the cause. Pay attention to when exactly your knee hurts.
Location and character together often give a clear picture. Only the medical examination brings certainty, if needed with ultrasound, X-ray or MRI.
Seek medical help or the emergency room immediately if
you cannot bear weight on the leg after a fall or accident or the knee is visibly misaligned (suspected fracture or torn ligament), the knee is locked and can no longer be straightened, it is hot, red and heavily swollen and comes with fever (suspected joint infection), or if a calf suddenly swells, hurts and is warm (suspected thrombosis). New numbness or weakness in the leg should also be assessed immediately.
These warning signs are rare but important. In the vast majority of cases knee pain is harmless and treatable. With persistent or recurring symptoms, an orthopaedic assessment is still worthwhile so that causes such as osteoarthritis or meniscus damage are detected early.
As different as the causes are, a few basic principles apply almost always. The most important is not to rest the knee permanently but to load it wisely. Longer immobilisation weakens the muscles and often prolongs the symptoms. Instead, the following building blocks help:
If the symptoms persist, physiotherapy is the next sensible step. There you learn targeted exercises that fit exactly your cause, and work on mobility, strength and technique.
If the pain appeared acutely after an injury, the well-known PRICE rule helps in the first hours: protect and pause from sport, rest, ice or cooling (never directly on the skin), compression with an elastic bandage and elevation of the leg. This limits the swelling. Afterwards it is important not to immobilise the knee for too long, but to move it gently again as soon as the symptoms allow.
The most common chronic cause of knee pain is knee osteoarthritis, technically gonarthrosis. The protective joint cartilage gradually breaks down, the joint becomes more sensitive and stiffer. Typical are the start-up pain mentioned above, a short morning stiffness, pain on stairs and sometimes a rubbing or grinding in the joint. The good news: precisely with osteoarthritis, movement, muscle building and a healthy weight are the most effective measures, because they stabilise and relieve the joint. Painkillers, physiotherapy and joint-friendly sports complement this. Read more in our article on osteoarthritis.
If inflammation is behind it, however, for example a gout attack with a suddenly very painful, red and warm knee, the treatment is different. Then it is about the inflammation and the uric acid level. Read more in our article on gout. If you want to know how knee pain fits into the bigger picture of joint pain, the corresponding article helps.
Painkillers can bridge a painful phase so that you get moving again. For muscular and inflammatory knee pain an anti-inflammatory such as ibuprofen or diclofenac often works well, also applied as an ointment or gel directly on the knee, which puts less strain on the body. Important: with a hot, swollen knee do not simply keep training under painkillers, but clarify the cause. Painkillers should be used at a low dose and for a short time. Anyone who regularly takes other medications, is pregnant or has pre-existing conditions should discuss the choice with a doctor or pharmacy. Read more on effect and precautions on our page about ibuprofen.
So that short-term help does not become a permanent solution: brite helps you manage your remedies, get reminded of the maximum duration and check interactions.
In physically active children and adolescents, knee pain at the front below the kneecap is common. Often Osgood-Schlatter disease is behind it, an irritation at the attachment of the patellar tendon to the shin bone that develops during the growth phase through repeated load. Typical are pain and sometimes a small swelling below the kneecap, especially during sport. Usually this is harmless and improves on its own with adjusted load and patience. With strong or persistent symptoms, a visit to a paediatric or orthopaedic practice is worthwhile.
A lot can be prevented by keeping the knee strong and mobile. Regularly include strength exercises for thigh, hip and gluteal muscles, as strong muscles guide and relieve the joint. Increase training volume slowly rather than in jumps, warm up before sport and provide variety between demanding and gentle activities. Pay attention to good, well-fitting footwear and to suitable insoles for misalignments. A healthy body weight relieves the knees with every step. And anyone who sits a lot should move the knee regularly rather than keeping it at the same angle for hours.
The bottom line: knee pain is usually treatable, and the location and character of the pain often already point the way to the cause. The most important step is to load the knee wisely rather than rest it, to strengthen the muscles and not to hesitate with warning signs. With some patience and the right measures, most people get rid of their knee pain well.
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This article is for general information and does not replace medical advice, diagnosis or treatment. Exercises and information on painkillers are kept general. With strong, persistent or post-accident knee pain, please contact a doctor or pharmacy.
