Knee Pain When Walking
Knee Pain When Walking: An Overview
Knee pain when walking is a common complaint, with over 25% of adults experiencing regular knee pain1. You may experience knee pain as you go up the stairs, when you try to bend down or squat, or sometimes even from simply weight bearing. The knee joint is comprised of a number of moving parts, which include the femur (thigh bone), the tibia (shin bone), the patella (knee cap), and a many ligaments, tendons, and cartilage and fluid-filled sacs (bursae), which work to reduce friction and allow for smooth movement. Painful conditions of the knee arise when one or more of these parts become damaged, restricting the range of motion (ROM). Damage can occur with an acute injury or repetitive strain and overuse. The treatment for your knee pain when walking will depend entirely upon what the diagnosis is.
What is normal knee range of motion (ROM) and how does it relate to knee pain when walking?
A limited ROM due to injury can cause knee pain when walking by putting abnormal strain on particular structures in the knee. Range of motion (ROM) refers to the range (in degrees) of the knee joint from full extension to full flexion. A straight knee (at full extension) is at 0 degrees, and a completely bent leg (full flexion) is about 140 degrees2. There are slight variations in the average variation of ROM between men and women, but also obviously individual variations from person to person. Normal walking, including up and down regular stairs, requires the knee to move between about 2-70 degrees of flexion2. Losing more than a few degrees of flexion in the knee causes a limp, poor gait, and puts a lot of pressure on the kneecap which over time can lead to damage in the cartilage. Losing degrees of extension is a bigger issue. As the knee extends, in the last few degrees of this motion, a mechanism known as the ‘knee-lock’ occurs, which allows the knee to support the person’s bodyweight despite the thigh muscles being relaxed. If the last few degrees of extension are missing, this mechanism cannot work, leaving the upper leg muscles and knee ligaments to bear the weight and force. This almost always results in biomechanical problems, knee pain when walking and bending, and risk of further injury.
What causes knee pain when walking?
Broadly, there are traumatic and medical causes which lead to the development of particular conditions that cause knee pain when walking. Traumatic events include falling from a height, receiving a directly blow to the knee, or sudden or repetitive movements during sport. Medical factors that lead to knee pain when walking include obesity, degenerative conditions (such as osteoarthritis), autoimmune diseases (such as rheumatoid arthritis), gout, tumors, and infections.
What types of conditions cause knee pain when walking?
Spanning from the traumatic and medical causes mentioned above – there are a very large number of conditions that can cause knee pain when walking. Just a few of the most common issues can be categorised into:
Meniscal (Cartilage) Problems:
- Swelling may be sporadic
- Pain is usually sharp and feels deep inside the knee
- There may be an audible clicking sound as the person moves
- Usually caused by a traumatic event that caused the pain to begin with
- Can sometimes be degenerative in nature
- Some examples include medial and lateral meniscal tears.
Medial Ligament Problems:
- Knee feels unstable
- Possible swelling and pressure inside the knee
- Pain feels deep but localized
- Usually caused by a traumatic injury such as a fall or sprain
- Medial collateral ligament tears and sprains are examples.
Anterior (Front) Knee Pain:
- Usually a niggling ache at the front of the kneecap
- Pain is worse as the person walks on an incline or up stairs
- Usually no bruising or swelling
- Conditions usually come about over time
- Some examples of such conditions include patellofemoral pain syndrome, chondromalacia patellae, prepatellar bursitis, Osgood-Schlatters disease, tendinopathies and illiotibial band syndrome.
Other medical conditions that can cause knee pain when walking may include:
- Arthritis, including osteoarthritis, rheumatoid arthritis and gout
- Baker’s cyst
- and more.
Diagnosing the Cause of Knee Pain When Walking
Your sports podiatrist will carry out a thorough examination in order to diagnose what is causing your knee pain when walking. The examination will begin with the podiatrist collecting a thorough medical and physical activity history. You may be asked about your regular occupation, any sports you regularly partake in, any relevant medical conditions that you have, and whether you’ve sustained any injuries to your legs recently or in the past. Your sports podiatrist will then proceed with a physical examination, which will include palpation (physically feeling) the knee joint and a testing a number of parameters such as muscle flexibility and ROM of the knee joint. Your sports podiatrist may also conduct a biomechanics assessment in order to aid them in their diagnosis of your knee pain when walking. In some cases, diagnostic imaging such as xray, MRI or ultrasound many be required in order to confirm or to rule out particular conditions.
The role of Biomechanical Assessment in Diagnosing Knee Pain When Walking
Biomechanical assessment is a valuable tool in assisting your sports podiatrist with diagnosing the cause of your knee pain when walking. A recent review of the scientific literature confirmed that biomechanical data can be used effectively to classify knee joint movement and therefore assist in the correct diagnosis of knee joint conditions3 The assessment involves placing markers on the subject’s legs and asking them to walk on the treadmill. A camera records the footage and specialised software assists the sports podiatrist to replay the footage in slow motion and analyse the patient’s gait in great detail. The results of the analysis help to identify gait abnormalities and structural imbalances and malalignments, which may indicate a particular condition and hence the possible cause of knee pain when walking.
Treatment for Knee Pain When Walking
As you will have discovered, there are many different conditions that can cause knee pain when walking. For this reason, there are numerous treatments that may be recommended by your sports podiatrist, dependent on what is causing your pain. Some of the treatment methods that may be recommended to you might include:
- shockwave therapy
- dry needling
- particular exercises to stretch or strengthen
- knee supports or braces
- strapping techniques
- changes in footwear or custom made orthotics
- surgical intervention, in some cases.
Please be aware that the information provided in the article above regarding knee pain when walking, is intended for educational purposes only and should not be taken as general medical advice. If you have knee pain when walking, you should make an appointment promptly with a suitably qualified sports podiatrist who will be able to make a diagnosis and provide you with an individualised treatment plan. Appointments can be made online at www.sydneypodiatrist.net.au or by calling 93883322.
Karl Lockett– sports podiatrist.
References and Further Reading:
1 Bunt, C. W., Jonas, C. E., and Chang, J. G., (2018). Knee Pain in Adults and Adolescents: The Initial Evaluation. American Family Physician, 98(9).
2Rowe, P.J., Myles, C. M., Walker, C., Nutton, R., (2000). Knee joint kinematics in gait and other functional activities measures using flexible electrogoniometry: how much knee motion is sufficient for daily life? Gait & Posture, 12(2).
3Abid, M., Mezghani, N., Mitiche, A., (2019). Knee joint biomechanical gait data classification for knee pathology assessment: a literature review, Applied Bionics and Biomechanics.