Table of ContentsView AllTable of ContentsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Causes
Diagnosis
Treatment
Coping
If you have been an athlete in the past, the chances of your developing one of the three are even higher.
This article will take you through the causes of standing knee pain, how it is diagnosed and treated, and suggestions for coping.
Panuwat Dangsungnoen / EyeEm / Getty Images
What Causes Knee Pain While Standing?
Conditions that cause standing knee pain often start as nuisances. However, they can become more serious if they are not promptly treated. Factors such as overuse, injury, and muscle imbalance may lead to one of these conditions.
Patellofemoral Syndrome (PFS)
Patellofemoral syndrome (PFS), also known as patellofemoral pain syndrome or “runner’s knee,” is a painful knee condition that occurs when nerves at the front of the knee sense pain. It is also the most common cause of knee pain in adults (18–40 years old) in the United States.
The causes of PFS are multifactorial and complex but most studies point to four major contributing factors:
Of the four contributing factors, overuse appears to be the most important.
Overactivity with a knee that has structural issues is especially troubling. Muscle imbalances—with one side of the knee being stronger or more flexible than the other—can lead to inflammation and pain.
The result of muscular imbalances is that the forces placed on the knee don’t travel through its normal channels, via the quadriceps and other muscles surrounding the kneecap and through the trochlear groove. This can irritate the nerves in the tendons, synovial tissues, and muscles surrounding the knee cap.
Who Is at Risk for PFS?PFS often impacts athletes and those who engage in running, basketball, and other sports. Women are especially vulnerable to PFS, particularly at a younger age. This is thought to be partially due to the greater likelihood of patellar malalignment in females, in addition to muscular imbalances.
Who Is at Risk for PFS?
PFS often impacts athletes and those who engage in running, basketball, and other sports. Women are especially vulnerable to PFS, particularly at a younger age. This is thought to be partially due to the greater likelihood of patellar malalignment in females, in addition to muscular imbalances.
PFS is most symptomatic during positions when the knee is flexed, such asafter sitting for a prolonged period, exercises that require deep squatting, or, most commonly, climbing stairs.
Strengthening the muscles around your hips and quadriceps and stretching your iliotibial band, hamstrings, and quadriceps can help relieve strain on your knee.
Chronic Degeneration of the Meniscus
The meniscus is a rubbery c-shaped piece of cartilage that cushions the knee. When the meniscus is torn abruptly, it can cause your leg to lock up and impact your ability to walk, but more often than not the cartilage in your knee is damaged over time due to wear and tear.This is when standing knee pain can become a problem.
Chronic degeneration of the meniscus can occur from excessive standing or running. Acute meniscus tears are usually from sudden pivoting or twisting as seen in basketball or football. A torn meniscus normally produces localized pain that is worse during twisting and squatting motions.
Levels of PainPain from a torn meniscus varies widely but some people are able to:WalkStandSitSleepOthers experience swelling and joint pain.
Levels of Pain
Pain from a torn meniscus varies widely but some people are able to:WalkStandSitSleepOthers experience swelling and joint pain.
Pain from a torn meniscus varies widely but some people are able to:
Others experience swelling and joint pain.
Osteoarthritis
Althoughosteoarthritisis usually associated with old age, many younger adults suffer from early osteoarthritis. This could happen if you have suffered a serious knee injury in the past.
How is Standing Knee Pain Diagnosed?
A standing knee pain diagnosis is usually based on a detailed medical history and a physical examination. The questions that you will be asked will range from the medications you are using to questions about trauma to the knee, including previous surgeries, and activities of overuse.
PFS is considered a diagnosis of exclusion, which means your physical therapist, primary care doctor, orthopedist or another healthcare professional must rule out other conditions that it may mimic.
If you describe that your knee is giving out or that you feel a catching sensation in the knee, you may be asked to get an MRI. Those symptoms might be signs of damage to the ligaments or cartilage of the knee.
Chronic Degenerative Meniscal Tear
If a healthcare professional suspects a meniscus tear, they may listen for clicking or popping of the knee upon movement. A McMurray test may be performed, which involves bending and rotating your knee and listening for a pop or click. The test is positive if a pop or click is heard.
If your medical history and clinical examination put you at high risk of a meniscus tear, you will be asked to get an MRI to look for loose cartilage in the knee. If the MRI is inconclusive, an arthroscopy can be performed to help detect the tear. Still, an MRI is the go-to imaging technique used to help diagnose meniscus tears.
If you are experiencing standing knee pain, a healthcare professional will examine your knee for range of motion and signs of inflammation like warmth, redness, or swollen areas of the knee. They may also ask you about the medications you are taking, and how the condition has affected your daily life. A joint aspiration may be performed to rule out conditions that mimic osteoarthritis like gout and rheumatoid arthritis.
Over time, bony spurs can develop due to the frequent rubbing of bone on bone. A standing X-ray can detect bone sclerosis, subchondral cysts, and joint space narrowing.
An MRI is unnecessary to diagnose osteoarthritis unless a meniscal tear is suspected. An MRI may also be used to evaluate the cartilage if cartilage loss is suspected but can not be verified on X-rays.
How is Standing Knee Pain Treated?
Conservative treatment methods are usually used to treat the conditions that cause knee pain while standing.
The R.I.C.E. Method
TheRICE Methodof rest, ice, compression, and elevation involves:
The RICE protocol may be used immediately after injury and before you see a healthcare professional.
Medication
PFS, meniscus tears, and early osteoarthritis may all cause inflammation of the knee. Taking over-the-counter (OTC) anti-inflammatory medications such as acetaminophen and ibuprofen can help to reduce the pain and swelling.
If analgesics are used to decrease PFS pain, a short course ofNSAIDsis preferred.They are also considered first-line treatment for osteoarthritis.
If OTC medications fail, thenprescription-strength NSAIDswill typically be prescribed. If symptoms are still unresponsive to oral medication, injections may be tried. A trial of cortisone injections will usually be initiated first and generally provide some degree of relief for most patients, although the duration of relief varies.
Other types of injections that lubricate the joint may be tried as a last resort for osteoarthritis.
Physical Therapy
Physical therapy has been proven to help speed up the time of recovery from osteoarthritis, meniscus tears, and PFS.Physical therapy may include strengthening exercises, a stretching regimen, and massages.
A simple muscle strengthening regimen that focuses on weaknesses of muscle groups around the knee—like the hip abductors or quadriceps—may help alleviate symptoms. Quad strengthening exercises, particularly isometric quad strengthening, are the most beneficial for maintaining knee health and mitigating pain.
Surgery
Surgery is rarely used for PFS or osteoarthritis, but it may be used to repair a torn meniscus, although the chronic degenerative tears that cause standing knee pain rarely need surgery.
Early diagnosis and conservative treatment methods such as anti-inflammatory medication, a knee brace, or a cortisone shot have been shown to improve outcomes and help avoid surgery, like a knee replacement from osteoarthritis.
A knee support brace or a cortisone shot may also be used to prolong the time to surgery even for those with a long withstanding injury.
Standing knee pain can be very debilitating and limit your activities. You may find that you are stopping activities that you previously enjoyed due to your pain. Chronic degenerative conditions, like osteoarthritis and meniscus tears, can lead to much more serious complications.
The combination of early diagnosis and treatment and lifestyle changes such as reducing alcohol intake, quitting smoking, and maintaining a healthy weight may be all that you need to alleviate your pain and get back to doing the activities you love pain-free.
Summary
Knee pain while standing can often begin as a nuisance. However, serious degeneration of the joint is likely without prompt treatment and lifestyle modifications, including weight management.
Pain is experienced as dull, achy, or sharp while standing and likely results from one of three conditions: patellofemoral syndrome, chronic degenerative meniscus tears, or early osteoarthritis. Past athletes have an increased risk of developing knee pain while standing.
Diagnosis strategies vary but generally center around a physical examination and supplemental imaging (when necessary). Treatment includes the R.I.C.E. protocol, medication, physical therapy, and surgery.
Causes and Treatments for Bilateral Knee Pain
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Smith BE, Selfe J, Thacker D, et al.Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis.PLoS One. 2018;13(1):e0190892. doi:10.1371/journal.pone.0190892Pereira PM, Baptista JS, Conceição F, Duarte J, Ferraz J, Costa JT.Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.Int J Environ Res Public Health. 2022;19(15):9241. doi:10.3390/ijerph19159241Peters JSJ, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.Matar HE, Duckett SP, Raut V.Degenerative meniscal tears of the knee: evaluation and management.Br J Hosp Med. 2019;80(1):46-50. doi:10.12968/hmed.2019.80.1.46.Johns Hopkins Medicine.Knee Arthritis.Gupta Y, Mahara D, Lamichhane A.McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10Gaitonde DY, Ericksen A, Robbins RC.Patellofemoral Pain Syndrome.Am Fam Physician. 2019;99(2):88-94.Magni A, Agostoni P, Bonezzi C, et al.Management of Osteoarthritis: Expert Opinion on NSAIDs.Pain Ther. 2021;10(2):783-808. doi:10.1007/s40122-021-00260-1Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH.Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.J Phys Ther Sci. 2018;30(2):307-312. doi:10.1589/jpts.30.307
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Smith BE, Selfe J, Thacker D, et al.Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis.PLoS One. 2018;13(1):e0190892. doi:10.1371/journal.pone.0190892Pereira PM, Baptista JS, Conceição F, Duarte J, Ferraz J, Costa JT.Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.Int J Environ Res Public Health. 2022;19(15):9241. doi:10.3390/ijerph19159241Peters JSJ, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.Matar HE, Duckett SP, Raut V.Degenerative meniscal tears of the knee: evaluation and management.Br J Hosp Med. 2019;80(1):46-50. doi:10.12968/hmed.2019.80.1.46.Johns Hopkins Medicine.Knee Arthritis.Gupta Y, Mahara D, Lamichhane A.McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10Gaitonde DY, Ericksen A, Robbins RC.Patellofemoral Pain Syndrome.Am Fam Physician. 2019;99(2):88-94.Magni A, Agostoni P, Bonezzi C, et al.Management of Osteoarthritis: Expert Opinion on NSAIDs.Pain Ther. 2021;10(2):783-808. doi:10.1007/s40122-021-00260-1Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH.Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.J Phys Ther Sci. 2018;30(2):307-312. doi:10.1589/jpts.30.307
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Smith BE, Selfe J, Thacker D, et al.Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis.PLoS One. 2018;13(1):e0190892. doi:10.1371/journal.pone.0190892Pereira PM, Baptista JS, Conceição F, Duarte J, Ferraz J, Costa JT.Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.Int J Environ Res Public Health. 2022;19(15):9241. doi:10.3390/ijerph19159241Peters JSJ, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.Matar HE, Duckett SP, Raut V.Degenerative meniscal tears of the knee: evaluation and management.Br J Hosp Med. 2019;80(1):46-50. doi:10.12968/hmed.2019.80.1.46.Johns Hopkins Medicine.Knee Arthritis.Gupta Y, Mahara D, Lamichhane A.McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10Gaitonde DY, Ericksen A, Robbins RC.Patellofemoral Pain Syndrome.Am Fam Physician. 2019;99(2):88-94.Magni A, Agostoni P, Bonezzi C, et al.Management of Osteoarthritis: Expert Opinion on NSAIDs.Pain Ther. 2021;10(2):783-808. doi:10.1007/s40122-021-00260-1Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH.Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.J Phys Ther Sci. 2018;30(2):307-312. doi:10.1589/jpts.30.307
Smith BE, Selfe J, Thacker D, et al.Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis.PLoS One. 2018;13(1):e0190892. doi:10.1371/journal.pone.0190892
Pereira PM, Baptista JS, Conceição F, Duarte J, Ferraz J, Costa JT.Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.Int J Environ Res Public Health. 2022;19(15):9241. doi:10.3390/ijerph19159241
Peters JSJ, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.
Matar HE, Duckett SP, Raut V.Degenerative meniscal tears of the knee: evaluation and management.Br J Hosp Med. 2019;80(1):46-50. doi:10.12968/hmed.2019.80.1.46.
Johns Hopkins Medicine.Knee Arthritis.
Gupta Y, Mahara D, Lamichhane A.McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10
Gaitonde DY, Ericksen A, Robbins RC.Patellofemoral Pain Syndrome.Am Fam Physician. 2019;99(2):88-94.
Magni A, Agostoni P, Bonezzi C, et al.Management of Osteoarthritis: Expert Opinion on NSAIDs.Pain Ther. 2021;10(2):783-808. doi:10.1007/s40122-021-00260-1
Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH.Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.J Phys Ther Sci. 2018;30(2):307-312. doi:10.1589/jpts.30.307
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