Knee Pain Location Chart: Understanding Discomfort SourcesBy Nigel Chua
Understanding the location of knee pain is crucial because it can influence symptoms, functional status, and knee-related quality of life in older adults with chronic knee pain. Different areas of the knee may indicate specific injuries or conditions, and accurate diagnosis requires a knowledge of knee anatomy and common pain patterns in knee injuries.
In this article, we will explore the concept of a knee pain location chart, understand the possible causes of knee pain based on specific locations, and discuss when seeking professional medical advice is warranted.
What's a Knee Pain Location Chart?
A knee pain location chart is a visual representation that categorises the different areas around the knee where pain can manifest. This chart serves as a valuable tool for both medical professionals and individuals experiencing knee discomfort.
The knee pain location chart typically divides the knee into specific regions, such as the top, bottom, inner, outer, middle, and back of the knee. Each section of the chart corresponds to distinct anatomical structures and potential sources of pain, allowing for a more accurate assessment of the problem.
Understanding the knee pain location chart empowers individuals to communicate their symptoms more effectively to healthcare providers, leading to more precise diagnoses and tailored interventions. Whether the pain is concentrated in a single area or radiates throughout the knee joint, the chart provides a framework for organising and interpreting the complex nature of knee pain.
Understanding the Normal Anatomy of the Knee
The knee joint is the largest in the body and is crucial for movement. It's a complex hinge joint that connects the thigh bone (femur) to the shin bone (tibia). The knee joint also includes the patella (kneecap), which articulates with the femur to form the patellofemoral joint.
The knee joint is supported by ligaments, including the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), as well as the medial and lateral collateral ligaments. Cartilage, such as the meniscus, provides cushioning and stability within the joint.
Muscles, including the quadriceps and hamstrings, surround and support the knee, allowing for movement and stability.
Possible Causes of Knee Pain Per Location
As mentioned, the knee pain diagnosis chart enables medical professionals to provide an initial idea of the possible causes of their patient's knee joint pain. Here are some of the conditions they consider per location:
Pain on the Knee Itself
Pain in the whole knee may be attributed to the following conditions:
Anterior Cruciate Ligament Injury
An ACL tear is an injury to the anterior cruciate ligament (ACL) in the knee, which connects the thigh bone to the shin bone and prevents excessive bending or twisting of the knee. Symptoms of an ACL injury include a loud pop or a "popping" sensation in the knee, severe pain, inability to continue activity, pain with swelling, and loss of full range of motion.
The pain may present throughout the knee due to the interconnected nature of the knee joint, where damage or instability in one area can affect the entire joint. Click here to explore more aspects of this condition that causes knee pain.
Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome (PFPS) is a common condition characterized by dull pain in the front of the knee, particularly during activities that involve repeated bending of the knee. This pain usually begins gradually and is frequently activity-related. The syndrome is related to the complex structure of the knee joint and the soft tissues around the kneecap.
Factors such as misalignment of the kneecap, overuse, abnormal tracking of the kneecap in the trochlear groove due to alignment issues or muscular imbalances, as well as overuse and improper sports training techniques or equipment contribute to PFPS.
Due to the interconnected nature of the knee joint, the pain from PFPS may present throughout the knee, which can cause discomfort and affect the overall quality of life of individuals with this condition
A dislocated patella occurs when the kneecap pops out of its vertical groove at the knee joint, often due to force or patellar instability caused by loose tendons and ligaments. Symptoms include an audible pop, intense pain, swelling, and bruising.
The pain from a dislocated patella presents throughout the whole knee due to the severe nature of the injury, impacting the surrounding ligaments, tendons, and structures. The pain can radiate throughout the knee joint, affecting the entire area due to the traumatic event causing the dislocation.
Pain at the Top of the Knee
Pain at the top of the knee, also known as anterior knee pain, can stem from various sources, including the following:
Quadriceps tendonitis is an inflammation of the quadriceps tendon, which connects the quadriceps muscles in the front of the thigh to the top of the kneecap. The main symptom of quadriceps tendonitis is pain at the top of the knee, arising during or after physical activity and when flexing the knee.
The condition is caused by overuse of the knee joints or leg muscles and is common in athletes involved in activities such as volleyball, basketball, track and field, gymnastics, and tennis. It can also occur in individuals who have recently increased their physical activity.
Other symptoms of quadriceps tendonitis include stiffness, swelling, tenderness, weakness, and poor mobility.
Bursitis is an inflammation of the bursae, small sacs filled with fluid that reduce friction in the body. Knee bursitis is common and often caused by overuse, trauma, or infection. Symptoms include pain, tenderness, swelling, and warmth. The pain of knee bursitis is located at the top of the knee due to the inflammation of the bursae situated near the knee joint.
Chondromalacia patellae, also known as "runner's knee," is a common condition causing pain in the kneecap. It is often seen in young, athletic individuals due to overuse, injury, or excessive stress on the knee. The symptoms include knee tenderness, pain, and a grinding sensation, especially after prolonged sitting or vigorous activities. The pain from chondromalacia presents at the top of the knee due to the softening of the kneecap cartilage, causing abnormal knee movement and grinding sensations
Knee osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage in the knee joint. This can cause pain, stiffness, and swelling, leading to difficulty in moving the knee. The pain associated with knee osteoarthritis typically presents at the top of the knee due to the inflammation and irritation of the joint lining and surrounding tissues. This can result in discomfort and tenderness at the top of the knee, especially during weight-bearing activities or movement.
Plica syndrome, also known as medial plica syndrome, is an irritation of the fold in the knee joint membrane, causing pain, swelling, and instability. It's common among athletes and can result from injuries or trauma.
Symptoms include knee pain, swelling, clicking, popping, reduced range of motion, and difficulty with certain movements. The pain associated with plica syndrome presents at the top of the knee due to the irritation of the fold in the tissue lining the knee joint.
Pain at the Bottom of the Knee
Pain at the bottom of the knee, particularly beneath the kneecap, may indicate conditions such as the following:
Osteochondritis dissecans (OCD) of the knee is a rare condition causing knee pain and dysfunction, with the highest incidence in patients aged 10-20 and a higher occurrence in males. The most common location for OCD lesions is the distal femur. The pain associated with OCD is felt at the bottom of the knee due to the impact on the distal femur, which is the most common location for OCD lesions.
Patellar tendonitis, also referred to as jumper's knee, is the inflammation of the tendon linking the kneecap to the shin bone, often resulting from excessive strain during demanding physical activities like sports.
The pain associated with patellar tendonitis presents at the bottom of the knee, usually between the kneecap and where the tendon attaches to the shinbone (tibia).
Symptoms include pain, swelling, tenderness around the patellar tendon, and discomfort when bending or straightening the leg. The condition is caused by repetitive stress and strain on the knee tendon tissues from activities like jumping, running, and other high-impact sports, which can lead to weakened and sore tendon tissues over time
Patellofemoral instability occurs when the kneecap (patella) dislocates or moves out of place, leading to pain and instability in the knee. This condition can feel like the kneecap is slipping, shifting, or giving way, and may be accompanied by swelling and difficulty straightening the knee.
The pain is often felt at the bottom of the knee due to the displacement of the patella, which can cause stress on the patellar tendon and the attachment point of the tendon to the shinbone, resulting in pain in this area.
Pain on the Inner Knee
Pain in the inner knee can be attributed to the following conditions:
Medial Collateral Ligament Injury
Medial collateral ligament (MCL) injury is damage to the tissue that stabilizes the knee and prevents it from extending too far inward. It causes pain, stiffness, swelling, tenderness along the inside of the knee, and a feeling of instability.
The injury occurs when the inner knee is hit hard, leading to the ligament stretching or tearing. The pain presents on the inner knee due to the location of the MCL, which is situated on the inner side of the knee joint, connecting the femur to the tibia.
Medial Meniscus Tear
A medial meniscus tear is a common knee injury that affects the inner part of the knee joint. It can cause pain, swelling, and stiffness, particularly at the side or in the centre of the knee, depending on the tear's location.
Individuals with this condition may experience a locking or catching sensation in the knee, especially during activities like twisting or squatting. The pain from a medial meniscus tear presents on the inner knee due to the tear's location and its impact on the surrounding structures within the joint.
Pes Anserine Bursitis
Pes anserine bursitis is the inflammation of the fluid-filled sac in the knee joint, causing swelling, pain, and tenderness. The pain is felt on the inner part of the knee, especially when straightening or bending the knee, and when using stairs.
This condition is prevalent in women over 50 with obesity and is common in older adults, athletes, diabetics, and obese individuals. The pain presents on the inner knee due to irritation and increased fluid secretion by synovial cells in the bursa lining, which leads to inflammation and pain in the area.
Pain on the Outer Knee
Pain on the outer knee often indicates the following conditions:
Lateral Collateral Ligament Injury
The lateral collateral ligament (LCL) injury is characterized by symptoms such as pain, swelling, tenderness, and an unstable feeling in the knee, often caused by direct blows or repeated stress, especially in sports.
The pain associated with LCL injury is typically located on the outer side of the knee, and other symptoms may include numbness, stiffness, and locking of the knee. This is due to the specific location and function of the LCL, a thin band of tissue that stabilizes the knee.
Lateral Meniscus Tear
A lateral meniscus tear is an injury to the meniscus, a structure in the knee joint located on the outer side. It acts as a shock absorber and helps regulate movement and absorb shock. The pain is felt on the outer portion of the knee, accompanied by swelling, sudden pain at the time of injury, clicking or snapping sound at the joint when moved, and locking of the knee.
This injury can result from trauma or twisting and can lead to symptoms like pain, swelling, clicking or snapping sounds, locking of the knee, and instability. The location of the tear within the meniscus is crucial for treatment decisions, with tears in the red zone potentially healing on their own or with surgery, while tears in the white zone typically require surgical treatment.
Meniscus tears can be either traumatic or degenerative, and the key symptom is pain in the knee joint.
Iliotibial Band Syndrome
Iliotibial Band Syndrome (ITBS), also known as IT band syndrome, is a common overuse injury causing pain on the outside of the knee, commonly seen in runners and cyclists.
The condition results from friction or compressive forces on the IT band, leading to inflammation. That is, the iliotibial band, a tendon on the outside of the leg, becomes irritated or swollen from rubbing against the hip or knee bones, causing discomfort when bending the knee.
The most common symptom of IT band syndrome is pain located on the outside of the knee that increases with activity such as running or cycling.
Pain in the Middle of the Knee
Pain in the middle of the knee can be linked to the following syndrome:
Anterior Cruciate Ligament Tear
An Anterior Cruciate Ligament (ACL) tear is a common knee injury, often occurring during sports involving sudden stops, jumps, and changes in direction. The symptoms include a popping sensation, severe pain, swelling, and knee instability.
The pain is typically felt in the middle of the knee due to the location of the ligament, which connects the thigh bone to the shin bone, preventing excessive bending or twisting. This injury is often associated with a loud pop or popping sensation in the knee, and pain, especially when attempting to bear weight on the knee.
Tricompartmental osteoarthritis affects all three compartments of the knee joint, causing severe symptoms such as swelling, stiffness, pain, and impaired movement. The pain associated with tricompartmental osteoarthritis is typically felt in the middle of the knee, and it may be accompanied by difficulty bending and straightening the knee.
Pain in the Back of the Knee
Pain in the back of the knee can be associated with conditions such as the following:
Baker's cyst, also known as popliteal cyst, is a fluid-filled swelling at the back of the knee caused by tissue inflammation, leading to pain, fluid buildup, and occasional joint issues. The pain from a Baker's cyst is felt in the middle of the knee and may cause sharp pain, swelling, and a feeling like water is running down the leg.
This condition can be caused by knee injuries, osteoarthritis, inflammatory arthritis, or gout, often affecting individuals aged 30 to 70. The pain presents in the middle of the knee due to the location of the cyst, which is situated at the back of the knee joint.
Popliteal Artery Entrapment Syndrome
Popliteal Artery Entrapment Syndrome (PAES) is a rare condition affecting the main artery behind the knee and is common among athletes.
The symptoms include a heavy feeling in the leg, lower leg cramping at night, swelling in the calf area, changes in skin colour around the calf muscle, pain or cramping in the calf during exercise, cold feet, tingling, numbness, knee pain, lower leg pain, and swelling behind the knee.
It's caused by an irregular calf muscle pressing on the artery, resulting in reduced blood flow to the lower leg. The pain associated with PAES presents in the middle of the knee due to the entrapment of the popliteal artery by the calf muscle
When to See a Doctor
While minor knee discomfort may resolve with rest, ice, and over-the-counter pain relievers, certain symptoms warrant prompt medical attention. If you experience severe or persistent pain, swelling, instability, redness, warmth, or limited range of motion in your knee, you must immediately consult a healthcare professional for a thorough evaluation.
Additionally, if the pain significantly interferes with your daily activities, affects your ability to bear weight, or is accompanied by signs of infection, seeking medical advice becomes crucial. Furthermore, individuals with a history of knee injuries, underlying joint conditions, or systemic illnesses should be vigilant about any new or worsening knee pain and seek appropriate medical care to prevent potential complications.
Can Physiotherapy Help Relieve Your Knee Pain?
Physiotherapy can effectively help with various knee conditions by addressing their underlying causes and providing targeted treatment.
At Phoenix Rehab Singapore, for instance, we ensure that our patients gain access to high-quality care from a qualified and multidisciplinary team of healthcare professionals that can provide treatment plans specific to our patient's needs, including physiotherapy for knee pain.
For example, the treatment plan for a meniscus tear typically involves non-operative methods, meniscectomy, or meniscal repair, depending on the type of tear and the symptoms experienced. You may also explore your options in addressing knee locking and other conditions that cause knee pain by clicking here.
Understanding the nuances of the knee pain location chart provides valuable insights into the potential causes and implications of knee discomfort. Whether the pain originates from the top, bottom, inner, outer, middle, or back of the knee, each location offers valuable clues that can guide medical assessments and interventions.
With a deeper understanding of the knee pain location chart and its implications, you are better equipped to navigate your healthcare journey and make informed decisions that contribute to your overall well-being.