Table of Contents
Definition
Knee pain refers to any pain in the knee and its nearby regions. It is a common medical condition affecting hundreds of millions of individuals worldwide. Its prevalence in adults is 25%.
Anatomy of the Knee
The knee is one of the most complex joints anatomically. All of these structures play a role in knee pathology and, thus, knee pain.
Bones
Three main bones form the knee joint.
- The femur, or thighbone, is the longest bone in the body and supports weight bearing.
- The tibia or shinbone is the main weight-bearing bone.
- The patella or kneecap sits in front of the knee and protects it.
Muscles
Two main muscle groups enable movement at the knee. They are connected to the bones through various tendons.
- The quadriceps are present at the front and extend or strengthen the knee.
- The hamstrings are present at the back and flex or bend the knee.
Ligaments
The knee has four main ligaments that stabilise it during various movements.
- The anterior cruciate ligament prevents anterior dislocation of the tibia.
- The posterior cruciate ligament prevents posterior dislocation of the tibia.
- The medial collateral ligament controls inward, side-to-side movements.
- The lateral collateral ligament controls outward, side-to-side movement.
Cartilage
Two main cartilage types are present in the knee, which smoothen movements at the joint.
- Articulating cartilage is made of hyaline cartilage and covers the ends of the bones. It is the location at which joint movements occur.
- Menisci are multiple bands of fibrocartilage which strengthen and establish the knees.
Synovial Fluid
The lubricating fluid acts as a shock absorber for the knee joint and carries nutrients. It is enclosed between synovial membranes and is also present in bursae.
Types of Knee Pain
Knee pain is categorised into different categories depending on location and time of onset.
Acute Knee Pain
Acute knee pain is often the result of sudden mechanical trauma or injury to the knee joint. It often involves the ligaments, menisci and bones. It can occur as a result of sudden movements during falls, accidents, or sports. Acute pain often resolves with immediate intervention, but if managed incorrectly, it is a common cause of chronic knee pain.
Chronic Knee Pain
Knee pain is considered chronic after not being resolved for two or three months. It usually fluctuates in intensity and is associated with decreased functional ability. The causes include underlying medical conditions such as patellofemoral syndrome, arthritis, and causes of acute knee pain.
Superficial Knee Pain
Superficial knee pain occurs at or near the outer surface of the knee joint or over the kneecap. Pain, discomfort and other symptoms are usually localised.
Deep Knee Pain
Deep knee pain stems from deep structures of the knee. Even though the symptoms might be localised, they are felt diffused all over the knee. Deep knee pain is often described as a throbbing, dull ache.
Radiating Knee Pain
Knee pain does not always remain limited to the knee joint and its neighbouring areas— it can start spreading to the other parts of the body, such as the thigh, calf or foot, often as a result of a nerve or musculoskeletal injury.
Referred Knee Pain
Referred knee pain is pain that originates from another body part but manifests itself in the knee. It is often associated with hip and pelvis abnormalities.
Knee Pain Causes and Risk Factors
Various risk factors can predispose a patient to knee problems, which result in knee pain. These factors also affect the outcomes of knee problems for which they are seeking treatment.
Age
Body tissues undergo considerable wear and tear over the years. With increasing age, the cartilage in the knee joint thins and erodes. Ligaments stabilising the knee joint also become less lax and weak, leading to joint instability.
Weight
Knees are primary joints for weight bearing. Being overweight puts excess pressure on them, which advances the breakdown of knee structures. It can also cause bone fractures and ligament tears in or near the knees.
Sex
Men and women have different anatomy. Women have a wider pelvis and hips, which leads to a change in how their lower limbs align. Their thighbones often bow slightly inward. Such an alignment makes them more prone to stress on their knees, resulting in knee pain and other problems.
Previous History
The knee is a highly complex joint. It is difficult for knee injuries to completely heal because it is a stress-absorbing joint that dictates mobility. Often, patients have areas of weakness and instability in their knees after treatment. Sometimes, scar tissue forms, too. Any recurrent trauma can cause or aggravate knee pain. In addition, certain medical conditions like autoimmune disorders can also cause knee pain.
Occupation
Occupations with heavy physical workload and movement at the knee for long periods often lead to knee pain, such as:
- Construction work
- Mining
- Landscaping
- Cleaning services
- Driving
Sports
Athletes often put excess joints on their knee joints. They are also more likely to suffer from sudden-impact injuries. As a result, they often have “bad knees” — the prevalence of knee pain in young athletes is 40%.
Sedentary Lifestyle
A lack of physical activity weakens the leg muscles and knee ligaments, leading to knee problems and, as a result, knee pain.
Associated Signs and Symptoms of Knee Pain
A number of signs and symptoms are associated with the clinical presentation of knee pain, and these often help establish the cause of knee pain.
Swelling
Knee pain and swelling often present together. There is fluid accumulation or effusion in the knee joint. Swollen joints and knee pain are often seen together in knee arthritis, which is inflammation of the knee joint, such as:
- Septic arthritis
- Osteoarthritis
- Rheumatoid arthritis
- Gout
- Psoriatic arthritis
Stiffness
Knee stiffness means the knee has lost its range of motion. Its flexibility has reduced, and in severe cases, it cannot move at all.
- Different types of arthritis, especially osteoarthritis
- Tendon overuse
- Ligamentous tears and sprains
- Muscle weakness
Bruising
Bruising refers to blood oozing out onto body tissues after damage to blood vessels. It is usually a sign of traumatic knee problems and is often associated with knee pain.
- Patellar fracture
- Tibial fracture
- Meniscal tear
- Anterior cruciate lugament tear
Instability
Instability refers to excessive movements within the knee joints. It causes mobility problems and is often associated with problems related to knee ligaments and menisci, the structures that stabilise the knee.
Red Flags for Knee Pain
Red flags for knee pain require immediate medical intervention. They often point towards complex underlying causes that need to be treated promptly. Without urgent care, they can lead to poor prognosis. Medical professionals and patients alike should be concerned about the following:
- Severe, shooting pain in the knee
- Sudden and severe knee pain with no obvious cause
- Inability to put weight on the affected lower limb
- Visible deformation of the knee and your lower limb
- Severe swelling in the knee
- Knee constantly popping, locking and giving way
- Persistent pain that continues despite initial management
- Signs of systemic infection such as high body temperature, shivering and alternation of consciousness
Differential Diagnoses for Knee Pain
The differential diagnoses for knee pain can be divided into which parts of the knee are involved. A few differentials of localised knee pain are given below:
| Anterior Knee Pain | Medial Knee Pain | Lateral Knee Pain | Posterior Knee Pain | Pain On Kneecap | Pain Below Kneecap |
| Prepatellar bursitis | Medial meniscus tear | Iliotibial band syndrome | Baker’r cyst | Bursitis | Osteochondritis dessicans |
| Quadriceps tendinosis, tear or tendon rupture | Medial collateral ligament injury | Lateral meniscus tear | Arthritis | Tendinopathy | Patellofemoral instability |
| Infrapatellar bursitis | Pes anserine bursitis | Lateral collateral ligament injury | Neurological or vascular conditions | Chondromalacia | Patellar instability |
| Tibial tuberosity avulsion fracture | Arthritis | Patellofemoral syndrome | Sinding-Larsen and Johansson syndrome | ||
| Fat pad impingement | Plica syndrome | Patellar maltracking | Osgood-Schlatter disease |
Diagnosis and Treatment of Knee Pain with ANF Therapy®️:
ANF Therapy®️ is an innovative approach to managing knee pain and associated symptoms. This frequency therapy uses ANF Devices that are charged with certain frequencies. These frequencies strengthen weakened neurological frequencies in the body. This way, ANF Therapy®️ addresses pain and inflammation and activates the natural healing process. It doesn’t only treat symptoms but targets the root cause of the disease.
How Does It Work?
ANF Therapy®️ works on the principle of Neuro-frequency modulation. This frequency therapy for pain management aims to identify imbalances in the neurological system of the body. ANF Devices are applied to different parts of the body to stimulate neuroreceptors and activate optimal communication between the nervous system and other body systems.
How Do ANF Certified Neuro Orthopedic Practitioners Approach Knee Pain?
Treatment of knee pain with ANF Therapy®️ consists of the following steps:
1-History:
ANF Practitioners ask certain questions to find the root cause of the problem. They can also provide a questionnaire to assess the patient thoroughly. History of knee pain includes the following questions:- Nature and characteristics of knee pain (severity, onset, and location)
- What are mechanical symptoms (popping, locking or giving away)
- Mechanism of injury?
- What are aggravating and relieving symptoms?
- Medical History
- Previous surgical history
Characteristics of Pain:
To make an accurate diagnosis, ANF Practitioners ask about onset (sudden or gradual), nature of pain (dull, radiating, sharp), location (anterior, posterior, medial, or lateral knee), duration (how long the patient has pain), aggravating and relieving factors of knee pain. These questions help differentiate between acute and chronic knee pain.Associated Symptoms:
ANF Practitioners ask patients about mechanical symptoms like popping, clicking, locking, catching, and giving away. If the patient has locking episodes, it indicates meniscal tears. A Popping sensation in the knee joint suggests ligament injury or tear. Knee instability and episodes of giving away can be due to patellar subluxation or ligament tears. Clicking or crackling can be due to osteoarthritis.History of Causative Injury:
Patients can encounter knee injuries due to direct blows to the knee, decelerating or stopping suddenly, jumping, twisting, or hyperextending knee joint. These specific details help ANF Therapists pinpoint the place of injury that is causing knee pain. Direct lateral forces on the knee joint can damage the medial collateral ligament, which causes knee pain. Direct blow to the flexed knee can damage the posterior cruciate ligament. Deceleration or quick-stopping injuries damage the anterior cruciate ligament. A blow on the medial side of the knee joint damages the lateral collateral ligament. Similarly, sudden twisting movements can damage multiple ligaments, leading to severe knee pain.Previous Medical History:
Knee pain can occur due to medical conditions like gout, osteoarthritis, rheumatoid arthritis, pseudogout, and many other degenerative joint diseases. ANF Practitioners make a personalised treatment protocol for each patient according to the causative factor.2-Physical and Neurological Examination:
The Neuro Orthopaedic Practitioner conducts a comprehensive palpation examination to identify the root cause of injuries, inflammation, or pain. This detailed assessment aims to detect tissue weaknesses, which might be uncomfortable due to inflammation. The practitioner may examine areas such as the popliteal nerves, knee joint, adductor muscles, hamstrings, calf muscles, gastrointestinal tract, nervous and lymphatic systems (for hidden inflammation), kidneys, ovaries, neurological stress points, lumbar spine, and gluteal muscles. The examination encompasses the nervous, cardiovascular, lymphatic, and musculoskeletal systems and may include various health tests to evaluate their functionality. Based on the findings, a personalised ANF Protocol will be created to address the root cause of knee pain, utilising devices from different categories such as P&I, antioxidants, MC, and energy devices.3-Application of Devices:
After a detailed history and thorough examination, ANF Practitioners will apply ANF Devices to certain body areas. These devices are activated by body heat. ANF Devices for knee pain include positive and negative anti-inflammatory devices, antioxidant devices, blood flow, MC, and energy devices.4-Expected Outcome:
ANF Therapy®️ aims to restore weakened frequencies in impaired tissues and systems, reduce inflammation and oxidative stress, and promote self-healing. Most patients respond to ANF Therapy®️ within 10 to 60 minutes after applying the ANF Devices. The potential aim of ANF Therapy®️ is a 50% reduction in pain within 20 minutes, improved range and fluidity of movement, better tissue quality with less oedema, increased muscle and ligament resistance, reduced inflammation in musculoskeletal tissues, enhanced quality of life, and improved strength. A small percentage of patients may experience detox symptoms initially. However, as treatment progresses, patients generally experience less discomfort, reduced pain, and an overall sense of well-being.5-Follow up:
The duration of treatment can range from a few days to several months, and the number of ANF Devices applied may vary accordingly. ANF Devices are changed after 72 hours. ANF Practitioners guide patients on these changes, the number of required sessions, and follow-ups.Benefits of ANF Therapy®️ Over Other Treatment Options for Knee Pain
- Root Cause Targeting: ANF Therapy®️ addresses the underlying causes of knee pain rather than just treating the symptoms, leading to more effective and lasting relief.
- Non-Invasive Approach:
- Reduces Inflammation From Root Cause:
- Minimal Side Effects:
- Sustainable Results:
- Holistic Health Improvement: This therapy not only alleviates knee pain but also aims to improve overall health by optimising neurological and biochemical functions.
- No Dependency on Medications:
Join ANF Therapy®️ To Upskill Your Clinical Practice
ANF Academy offers clinical training for medical professionals to provide them with detailed knowledge about frequency medicine. It mainly focuses on neurological oscillations, neurobiochemical processes and their functions in the body, advanced palpation skills, and techniques to assess the neurological system. The ANF Clinical Training Program provides expertise on the ANF methodology for managing injuries and inflammation effectively, aiming for optimal patient outcomes.
Training Highlights Include:
- Mastering advanced clinical skills and techniques for neurological examinations.
- Techniques for identifying the differences between healthy and inflamed nerves.
- Methods to investigate the physical effects (signs and symptoms) of disrupted neurological oscillations.
- Strategies to pinpoint and treat the underlying causes of pain, injury, or pathology, focusing on addressing root causes rather than merely symptoms.
The ANF Clinical Training Program:
- It starts with developing the ability to locate, palpate, and evaluate nerves and the level of inflammation.
- Enhances advanced clinical skills to discover the interconnections among different body systems and the underlying causes of symptoms.
- Provides education on the various stages of treatment using ANF neuro tech Devices tailored to match the healing phases of injured tissues.
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About Authors
Writer:
Dr. Shahzaib Nasir
Dr. Shazaib Nasir, MBBS, RMP, is a medical writer at ANF Academy. He graduated from Multan Medical and Dental College, Pakistan. He works as a medical officer in the Oethpaedics department at Ibn-e-sina Hospital and Research Institute, Multan. He deals with patients suffering from chronic orthopaedic problems and pain. He is passionate about healthy eating and exercising. Moreover, he believes that frequency medicine can be the future of Orthopaedics.
Editor:
Dr. Shama Nosheen
Dr. Shama Nosheen, MBBS, RMP, is a skilled medical editor and writer at ANF Academy, specializing in medical communications. For 5 years, she has been working with renowned international healthcare companies as a medical writer, aiming to bridge the gap between patients and doctors. She is a graduate of Nishtar Medical University Multan. She grabbed American Board certification (ABAMS) in Aesthetic Medicine after graduation. Working with ANF Academy, she has developed a thorough understanding of ANF Therapy®️ that works on the principles of frequency medicine.
Reviewer:
PT. Irina Heinisuo Berná
Her background includes a Degree in Physiotherapy and a Master’s in Innovation and Research in Health Sciences, enriching her expertise in holistic health care. At ANF Academy, she seamlessly integrates clinical practice, academic teaching, and research into her daily activities to shape the future of ANF Therapy®️. Irina’s work symbolizes integrating education and compassionate care to improve global health outcomes.
Final Reviewer:
Dr. Mikel H-G Hoff
Dr. Mikel H-G Hoff, Founder of ANF Therapy®️, holds a bachelor’s degree in medicine and a Ph.D. in biochemistry, specializing in the bio function of the human body, specifically the neurological system. He is a manual therapist and sports psychologist. He is committed to revolutionizing healthcare by educating medical professionals and directly treating patients to enhance their quality of life. His extensive background in sports injury therapy, manual therapy, and various medical specializations, including biochemistry and nerve system signalization, empowers him to deliver pain-free solutions and lasting patient outcomes.
