Dr. Mandelbaum for U.S. News & World Report: 'Referred' Knee Pain: What to Know
Posted on Sep 19, 2019 11:52am PDT
MEDICALLY SPEAKING, "referred pain" means that the pain you're
experiencing on one part of your body isn't the actual source of the
problem. An extreme but straightforward example of the referred pain concept
is in the case of heart attacks. You may recall that one sign of a heart
attack is a sensation of pain in the jaw. That doesn't mean there's
a problem with your jaw. It's a problem with your heart that is "referring"
pain to the jawline. With knee pain, there are some considerations to
make in deciding whether the pain is caused by a knee problem or an issue
in another part of the body that is
referring pain to the knee.
Though it may seem strange on the surface, it's relatively common that
the first and only sign of a problem with the hip joint is the onset of
knee pain. In people who have
arthritis, referred knee pain can often delay the diagnosis of a hip problem. It
can be especially problematic if a provider who doesn't specialize
in orthopedics is treating the pain. Referred pain is different than radiating
pain. Whereas radiating pain tends to travel along an identifiable path,
"from point A to point B," referred pain seems to come from
the place it's being felt – in this case, the knee, even though
the problem is in the hip. One classic signal of
osteoarthritis in the hip is referred pain to the groin, lower thigh and knee.
In addition to hip problems being one possible root cause of referred knee
pain, so too are the feet. The way we walk has a significant effect on
our knee joints, especially over time. For example, if the feet roll too
deeply inward or outward while walking, the lower part of the leg is forced
to move in a way that puts additional strain and pressure on the knee
with every step. People who have a limited range of motion in their ankles
also tend to have referred pain in the knees. A significant leg-length
discrepancy can also create a referred pain situation in the knees. One
completely modifiable risk factor for referred knee pain from foot problems
is ill-fitting footwear. Those "well-loved" sandals, no matter
how comfortable they are, could be putting your knees at unnecessary risk.
Remember, your knees are shock absorbers. So give them the best cushion
you can by choosing supportive shoes that are in good condition.
Your
iliotibial band, or IT band for short, is a thick band of tissue that extends along the
outer thigh, from the hip to the knee. It's responsible for the efficiency
with which we can walk and run. Especially in athletes who repeatedly
flex and extend the knee, the IT band can become irritated over time,
leading to referred outer knee pain. Physiologists,
physical therapists and
orthopedic specialists are usually able to spot a problem with the IT band quickly. IT band issue
can be tough to treat. They require quite strong commitment from the patient
to do proper stretching exercises and to modify training regimens to alleviate
irritation of the area so that inflammation can decrease. However, IT
band problems do respond well to a diligent commitment to conservative
treatment. Conservative treatment can often be all that's necessary
to make the referred knee pain go away.
Of course, not all sources of knee pain are due to a problem with another
part of the body. Some are, in fact, the result of a problem with the
knee itself. Either way, getting to the bottom of the pain is crucial.
Journaling or otherwise keeping track of the characteristics of your knee
pain can help before you see a doctor about it. Where on the knee do you
feel the pain? Which activities worsen or lessen the pain? What times
of day does the pain appear? Your ability to precisely describe these
things is a valuable way to assist your doctor in accurately diagnosing
and treating the problem that is causing the
knee pain.