Lateral Knee Pain


Lateral Knee Pain
Lateral collateral ligament injury is caused by a blow to the inside of your knee, which stretches the outside (lateral side) of your knee and injures the ligament. A ligament is a band of tissue that connects one bone to another. The lateral collateral ligament runs down the outer side of your knee.

What causes lateral side of knee pain?

Iliotibial band syndrome is a common knee injury that usually presents as lateral knee pain caused by inflammation of the distal portion of the iliotibial band; occasionally, however, the iliotibial band becomes inflamed at its proximal origin and causes referred hip pain. The iliotibial band is a thick band of fascia that is formed proximally by the confluence of fascia from hip flexors, extensors, and abductors. The band originates at the lateral iliac crest and extends distally to the patella, tibia, and biceps femoris tendon ( Figure 1 ),1 Iliotibial band syndrome occurs frequently in runners or cyclists, and is caused by a combination of overuse and biomechanical factors. The syndrome can cause significant morbidity; however, most patients respond to a conservative treatment approach that involves stretching and altering training regimens. Iliotibial band syndrome is caused by excessive friction of the distal iliotibial band as it slides over the lateral femoral epicondyle during repetitive flexion and extension of the knee resulting in friction and potential irritation. In patients with iliotibial band syndrome, magnetic resonance imaging (MRI) studies have shown that the distal iliotibial band becomes thickened and that the potential space deep to the iliotibial band over the femoral epicondyle becomes inflamed and filled with fluid.2 Despite a clear pathophysiology, it is unclear why this syndrome does not affect all athletes. Few studies 3 – 7 have shown any direct relationship between biomechanical factors and the development of iliotibial band syndrome. Excessive pronation causing tibial internal rotation and increased stress in the iliotibial band was believed to be a factor in the development of iliotibial band syndrome; however, the literature does not support this theory. Some observational studies 4, 6 have identified potential risk factors for the development of iliotibial band syndrome, including the following: preexisting iliotibial band tightness; high weekly mileage; time spent walking or running on a track; interval training; and muscular weakness of knee extensors, knee flexors, and hip abductors. Hip abductor weakness seems to contribute to the development of iliotibial band syndrome. Strengthening of the hip abductors has led to symptom improvement.6 The primary initial complaint in patients with iliotibial band syndrome is diffuse pain over the lateral aspect of the knee. These patients frequently are unable to indicate one specific area of tenderness, but tend to use the palm of the hand to indicate pain over the entire lateral aspect of the knee. With time and continued activity, the initial lateral achiness progresses into a more painful, sharp, and localized discomfort over the lateral femoral epicondyle and/or the lateral tibial tubercle. Typically, the pain begins after the completion of a run or several minutes into a run; however, as the iliotibial band becomes increasingly irritated, the symptoms typically begin earlier in an exercise session and can even occur when the person is at rest. Patients often note that the pain is aggravated while running down hills, lengthening their stride, or sitting for long periods of time with the knee in the flexed position.7 The differential diagnosis for lateral knee pain is listed in Table 1, Patients with iliotibial band syndrome often demonstrate tenderness on palpation of the lateral knee approximately 2 cm above the joint line. Tenderness frequently is worse when the patient is in a standing position and the knee is flexed to 30 degrees. At this angle, the iliotibial band slides over the femoral condyle and is at maximal stress, thus reproducing the patient’s symptoms.1, 6 Swelling may be noted at the distal iliotibial band and thorough palpation of the affected limb may reveal multiple trigger points in the vastus lateralis, gluteus medius, and biceps femoris. Palpation of these trigger points may cause referred pain to the lateral aspect of the affected knee. Strength of the lower extremity should be assessed with particular emphasis on examining the knee extensors, knee flexors, and hip abductors. Weakness in these muscle groups has been associated with the development of iliotibial band syndrome.4, 6, 7 The Ober’s test can be used to assess tightness of the iliotibial band ( Figure 2 ), With the patient lying on the side with the unaffected side down and the unaffected hip and knee at a 90-degree angle, the examiner stabilizes the pelvis, then abducts and extends the affected leg until it is aligned with the rest of the patient’s body. The affected leg is lowered into adduction. If the iliotibial band is normal in length and unaffected, the leg will adduct and the patient will not experience pain. If the iliotibial band is tight, the leg will remain in the abducted position and the patient may have lateral knee pain.1, 6, 8 A tight iliotibial band contributes to the excess friction placed on the iliotibial band as it slides over the femoral condyle during flexion and extension of the knee. A clinical diagnosis is based on the history and physical examination. If the diagnosis is in doubt or other joint pathology is suspected, MRI can aid in the diagnosis and provide additional information about patients considered for surgery. In patients with iliotibial band syndrome, MRI shows a thickened iliotibial band over the lateral femoral epicondyle and often detects a fluid collection deep to the iliotibial band in the same region.2 Treatment requires activity modification, massage, and stretching and strengthening of the affected limb. The goal is to minimize the friction of the iliotibial band as it slides over the femoral condyle. The patient may be referred to a physical therapist who is trained in treating iliotibial band syndrome. Most runners with low mileage respond to a regimen of anti-inflammatory medicines and stretching; however, competitive or high-mileage runners may need a more comprehensive treatment program. The initial goal of treatment should be to alleviate inflammation by using ice and anti-inflammatory medications. Patient education and activity modification are crucial to successful treatment. Any activity that requires repeated knee flexion and extension is prohibited. During treatment, the patient may swim to maintain cardiovascular fitness. If visible swelling or pain with ambulation persists for more than three days after initiating treatment, a local corticosteroid injection should be considered 6 ( Figure 3 ), As the acute inflammation diminishes, the patient should begin a stretching regimen that focuses on the iliotibial band as well as the hip flexors and plantar flexors. The common iliotibial band stretches ( Figure 4 ) have been evaluated for their effectiveness in stretching the band. The stretch shown in Figure 4C was consistently the most effective in increasing the length of the iliotibial band in a study 9 of elite distance runners. Although this study 9 demonstrates the effectiveness of stretching the iliotibial band, participants in the study did not have iliotibial band syndrome and studies have not demonstrated that stretching hastens recovery from the syndrome. Once the patient can perform stretching without pain, a strengthening program should be initiated. Strength training should be an integral part of any runner’s regimen; however, for patients with iliotibial band syndrome particular emphasis needs to be placed on the gluteus medius muscle.6 A strengthening exercise geared toward the gluteus medius is shown in Figure 5, Running should be resumed only after the patient is able to perform all of the strength exercises without pain. The return to running should be gradual, starting at an easy pace on a level surface. If the patient is able to tolerate this type of running without pain, mileage can be increased slowly.

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For the first week, patients should run only every other day, starting with easy sprints on a level surface. Most patients improve within three to six weeks if they are compliant with their stretching and activity limitations.1 For patients who do not respond to conservative treatment, surgery should be considered.

The most common approach is to release the posterior 2 cm of the iliotibial band where it passes over the lateral epicondyle of the femur. In a retrospective study 10 of 45 patients who underwent surgical release of their iliotibial band, 84 percent of the patients reported that their surgery results were good to excellent.

How do you treat lateral side knee pain?

Lifestyle and home remedies – Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may help ease knee pain. Some people find relief by rubbing the affected knee with creams containing a numbing agent, such as lidocaine, or capsaicin, the substance that makes chili peppers hot. Self-care measures for an injured knee include:

Rest. Take a break from your normal activities to reduce repetitive strain on your knee, give the injury time to heal and help prevent further damage. A day or two of rest may be all you need for a minor injury. More severe damage is likely to need a longer recovery time. Ice. Ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You also can use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don’t use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin. Heat. You may experience temporary pain relief by applying a heat pack or hot-water bottle to the painful area on your knee. Compression. This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that’s lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation. Elevation. To help reduce swelling, try propping your injured leg on pillows or sitting in a recliner.

How long does lateral knee pain take to heal?

LCL Tears. Your LCL (lateral collateral ligament) is a vital band of tissue on the outside of your knee. Athletes are more likely to tear it, causing a lot of pain and other symptoms. LCL tears usually heal after three to 12 weeks, depending on severity.

Is walking good for outer knee pain?

1. You sit for long periods of time – If your knee hurts, you might want to stay off of it. But resting too much makes your muscles weaken and often makes knee pain worse. Find a way to get moving without hurting your knee. Some good exercises for people with knee pain include walking, swimming, and water aerobics.

Is it bad if the side of my knee hurts?

Pain – knee Knee pain is a common symptom in people of all ages. It may start suddenly, often after an injury or exercise. Knee pain also may begin as a mild discomfort, then slowly get worse. Leg pain in older children or young adolescents can occur for many reasons. An Osgood-Schlatter lesion results from continued trauma to the anterior tibial bone and causes a visible lump below the knee. The muscular components of the lower leg include the gastrocnemius, soleus, peroneus longus, tibialis anterior, extensor digitorum longus, and the Achilles tendon. The location of knee pain can help identify the problem. Pain on the front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as in chondromalacia patella. Pain on the sides of the knee is commonly related to injuries to the collateral ligaments, arthritis, or tears to the meniscuses.

  1. Pain in the back of the knee can be caused by arthritis or cysts, known as Baker’s cysts.
  2. Baker’s cysts are an accumulation of joint fluid (synovial fluid) that forms behind the knee.
  3. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the joint, or infection.

Instability, or giving way, is also another common knee problem. Instability is usually associated with damage or problems with the meniscuses, collateral ligaments, or patella tracking. A Baker cyst is seen as a swelling behind the knee. It forms when joint fluid collects behind the knee. The swelling may be due from inflammation or from other causes, like arthritis. The condition can be seen in both adults and children. Tendinitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. Tendinitis pain in the knee is located in the front of the knee. The pain gets worse when going up and down stairs or inclines. Tendinitis knee pain can happen in runners, skiers, and cyclists.

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Can LCL heal on its own?

Surgical Treatment – LCL tears rarely need surgery, because the ligament usually heals itself. Surgery is typically only needed when other ligaments or structures of the knee are also injured.

Can I tear my LCL without knowing?

What is a lateral collateral ligament (LCL) injury? – The lateral collateral ligament (LCL) is the ligament located in the knee joint, Ligaments are thick, strong bands of tissue that connect bone to bone. The LCL runs along the outside of the knee joint, from the outside of the bottom of the thighbone ( femur ) to the top of the lower-leg bone ( fibula ).

  • The LCL helps keep the knee joint stable, especially the outer aspect of the joint.
  • An injury to the LCL could include straining, spraining, and partially or completely tearing any part of that ligament.
  • According to Orthogate, the LCL is one of the more commonly injured ligaments in the knee.
  • Because of the location of the LCL, it’s common to injure the LCL along with other ligaments in the knee.

The main cause of LCL injuries is direct-force trauma to the inside of the knee. This puts pressure on the outside of the knee and causes the LCL to stretch or tear. Symptoms of an LCL injury can be mild or severe, depending on the severity of the sprain or if it’s torn.

swelling of the knee (especially the outer aspect) stiffness of the knee joint that can cause locking of the knee pain or soreness on the outside of the kneeinstability of the knee joint (feeling like it’s going to give out)

To diagnose an LCL injury, your doctor will examine your knee and look for swelling. They’ll also move your knee in various directions to determine where your pain is and how severe your symptoms are. If your doctor believes you may have a torn ligament, you may undergo imaging tests like X-rays or MRI scans,

splinting applying ice elevating the knee above the hearttaking a pain relieverlimiting physical activity until the pain and swelling are goneusing a brace (knee immobilizer) or crutches to protect the kneephysical therapy or rehabilitation to strengthen and regain range of motion

For more severe injuries, treatment may also include physical therapy, rehabilitation, or surgery. Physical therapy strengthens and helps you regain range of motion. Surgery may include ligament repair or reconstruction. Surgery doesn’t usually treat injuries to only the LCL.

using proper technique and alignment when doing physical activities, including walkingstretching regularly to maintain good range of motion in the bodystrengthening the muscles of the upper and lower legs to help stabilize the jointusing caution when playing sports where knee injuries are common, such as soccer and football

For minor injuries, the ligament may heal without any issue. However, it’s important to note that if the ligament got severely stretched, it may never regain its prior stability. This means that it’s more likely that the knee will be somewhat unstable and you could easily injure it again.

  1. The joint could become swollen and sore simply from physical activity or minor injury.
  2. For those with a major injury who don’t have surgery, the joint will most likely remain unstable and easily injured.
  3. You may not be able to do physical activities that require repetitive use of the knee, including running, climbing, or biking.

Pain could result from minor activities like walking or standing for extended periods. You may have to wear a brace to protect the joint during physical activity. For those who have surgery, the outlook will depend on the severity of the original injury and the surgical procedure.

Is an LCL tear worse than ACL?

As a physical therapist, I am often asked by patients, what is the worst ligament to tear? The quick answer is that the ACL (Anterior Cruciate Ligament) is most likely to be considered the worst ligament in the knee to tear.

How do I know if I strained my LCL?

MCL and LCL sprain signs and symptoms – If you sprain your MCL or LCL, you may have symptoms such as:

Knee pain and swelling. Tenderness over the injured ligament. Weakness or instability at your knee joint.

Is cycling good for LCL injury?

Treatment – Standard treatment includes:

Crutches may be necessary if muscle weakness and guarding are great. A knee brace may be helpful temporarily. Ice application frequently repeated for periods of 20-30 minutes, repeated 3-4 times per day (see caution below). Physical therapy may be helpful to diminish swelling and encourage return of full motion. Safe, strengthening activities, such as biking, should be performed daily as soon as pain permits. Anti-inflammatory medication for 1-2 weeks (e.g. Diclofenac/Voltaren or Ibuprofen/Motrin). Weight training may be required for full recovery of strength. Functional testing and a running program should precede return to sport. Alternative treatments include hydrotherapy, limb massage and nutritional therapy.

What happens if LCL injury is left untreated?

At Your Knee Specialist Appointment – A knee specialist will examine your knee to determine the nature of your injury, including whether there are additional ligament or tendon injuries that might complicate your recovery. The doctor may perform an LCL injury test such as the varus, or adduction stress test, which compares the adduction (bending inward) ability of both knees.

What does a Grade 1 LCL tear feel like?

How is a tear of the lateral collateral ligament diagnosed? – Your doctor will generally ask you how the injury occurred, how your knee has been feeling since the injury and whether you have had other knee injuries. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. Your injury will be classified as follows:

Grade 1 — Some tenderness and minor pain at the point of the injury. This means there have been small tears in the ligament. Grade 2 — Noticeable looseness in the knee (the knee opens up about 5 millimeters) when moved by hand. There is major pain, tenderness and swelling on the inner side of the knee. This means there have been larger tears in the ligament, but it is not completely torn. Grade 3 — Considerable pain and tenderness at the inner side of the knee; some swelling and marked joint instability. The knee opens up slightly less than half an inch when moved. A grade 3 LCL tear means the ligament is completely torn. There may also be a tear of the anterior cruciate ligament.

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If there is too much pain and swelling to accurately judge how serious the injury is, your doctor may recommend that you wear a light splint, apply ice and raise your knee. Once the swelling and pain have gone down somewhat, he or she can then make the diagnosis.

Can you walk with an injured LCL?

Symptoms of lateral collateral ligament (LCL) injury – If you have a mild LCL injury, you may not experience any symptoms. If you have a more severe LCL injury, you may experience pain, instability, swelling and stiffness. Other symptoms of an LCL injury include:

Inability to walk Decreased range of motion in the knee Popping sound at the time of the injury Swelling in the knee

What happens if LCL injury is left untreated?

At Your Knee Specialist Appointment – A knee specialist will examine your knee to determine the nature of your injury, including whether there are additional ligament or tendon injuries that might complicate your recovery. The doctor may perform an LCL injury test such as the varus, or adduction stress test, which compares the adduction (bending inward) ability of both knees.

Does it hurt to walk with an LCL tear?

What Is an LCL Knee Ligament Injury? Medically Reviewed by on August 12, 2022 An LCL injury (a torn LCL or a LCL tear) is a strain or tear to the lateral collateral ligament (LCL). The LCL is a band of tissue that runs along the outer side of your, It helps to hold the bones together so that your joint remains stable when you move.

A direct blow to the inside of the knee. The force of the blow can impact the ligament along the outside edge of the knee enough to stretch it or make it tear. It’s common among athletes who play sports like football or hockey in which players collide with each other. Changing directions quickly or pivoting on one foot. This can happen during fast-paced sports like soccer or basketball, where players make sharp, sudden turns or stops. Wrestlers can have LCL damage if their legs twist outward in a sudden movement when they’re on the mat. Landing badly or awkwardly from a jump. This can happen during a basketball or volleyball game.

These injuries tend to happen more often in men and boys than women and girls. If you hurt your LCL, it’s common to have and swelling. These symptoms are also common:

Your knee may feel stiff, sore, or tender along the outer edge. Your knee may feel like it could give out when you’re or standing. Your knee may lock in place or catch when you walk, instead of moving smoothly. You may not have your normal range of motion. Your may feel numb or weak, along with your, if it’s a severe tear. You may have bruising on or around the knee.

When you visit your doctor, tell them how the injury happened, to check, they’ll do the following:

Examine your knee. Put pressure on the side of your knee when your leg is both bent and straight Order the following imaging tests:

An X-ray to make sure that you don’t have a broken An to confirm that your LCL is stretched or torn

LCL grades If you have an LCL injury, your doctor will give it a grade:

Mild or Grade I – Your LCL is lightly overstretched. Your knee typically is stable. Moderate or Grade II – Your ligament is seriously stretched or partially torn. You may have some knee instability. Severe or Grade III – Your LCL is completely torn. It’s difficult to put weight on your knee.

Your treatment will depend on the grade of your injury.

Mild or Grade I Moderate or Grade II

Wear a knee brace to prevent side-to-side movements Physical therapy

Severe or Grade III

Surgery Platelet rich plasma (PRP) treatment

Home care for an LCL injury You’ll probably need to keep your off that knee for a while. What else you’ll need depends on your injury. For minor strains and partial tears, you can:

Put ice on your injured knee. Wrap it in an elastic bandage. Elevate it, and stay off of that leg (you may need crutches until your injury heals). Take (nonsteroidal anti-inflammatory ) such as, ibuprofen, and,

Physical therapy You may need this if you have a more serious LCL tear. Your physical therapist, or PT, will show you how to do exercises to strengthen the muscles around your knee. You’ll probably also do, like walking, and wear a knee brace at first.

Surgery If your LCL tore all the way through, you may need to have surgery to repair it. Athletes who want to play sports again may opt for surgery, for instance. The surgeon may stitch up your torn LCL or attach it to the bone where it tore. It depends on how you damaged your ligament. LCL surgery is an “open-knee procedure,” which means the surgeon can’t work through smaller arthroscopic cuts, as with some other types of knee surgery.

Platelet-rich plasma (PRP) Your doctor injects platelet-rich plasma into the affected area. It’s thought to speed healing but there’ s little clinical evidence that it really helps. Depending on how bad your injury was, your knee may heal within weeks or months.

  1. Once you feel stronger and have no pain, your doctor can check to see if your knee has healed and is stable.
  2. After that, you should be able to get back to your regular activities, like playing sports.
  3. If you have had a previous LCL injury, you’re at a greater risk of getting another one in the future.

It’s therefore very important that you take precautions to prevent another tear from occurring. Here are some things that you can do:

Wear a knee brace during athletic activity like football or skiing. This supports the ligaments in the knee area and reduces side-to-side movement. Use correct techniques when doing sports and other physical activities. Positioning and aligning your knee the right way during these activities helps prevent LCL injuries, especially when jumping, lifting, and pivoting. Do stretches and conditioning exercises before practicing or participating in a game. These will help to strengthen the legs and areas around the knee, as well as to improve flexibility and reduce the risk of an LCL injury.

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