Knee Pain Treatment — Symptoms, Causes, and Treatment in Singapore

Knee pain is a common complaint that affects many people worldwide. Managing knee pain effectively depends on the cause of the injury and finding the right knee pain treatment. Injury to the knee can result from an incident like falling from a ladder or riding a bike at high speed. The cause can also be a chronic condition like arthritis. 

Any part of the knee can get hurt, including the bones, muscles, tendons, ligaments, and cartilage. This article discusses the common causes, diagnosis, and treatment for knee pain in Singapore.

Common Causes of Knee Pain 

Knee Ligament Injuries

The knee has four ligaments that join the bones of the knee together: the Cruciate Ligaments (ACL and PCL) and the Collateral Ligaments (MCL and LCL). The cruciate ligaments cross each other inside the knee and stabilise the forward and backward movement of the knee.

The collateral ligaments are on the sides of the knee; they stabilise the sideway movements of the knees. The MLC is on the inside of the knee and the LCL is on the outside.

Cruciate Ligament Injuries

The ACL often sustains damage during sports activities that require a sudden stop or change of direction, such as tennis or soccer. An ACL tear can happen just as an athlete, with feet planted in one direction, twists their body in another direction. 

Injury to the PCL usually comes from a hard blow to the front while it’s bent, such as during a car accident. 

Collateral Ligament Injuries

MCL injuries are more common than LCL injuries because the inside of the knee is often more vulnerable to blows to the outer side of the knee that cause it to buckle inward.

Kneecap (patella) Injuries

The patella is the central bone in front of the knee joint. This bone can get fractured by a direct hit, such as during a hockey game. Knee pain can also result from patellar dislocation, tendonitis, bursitis, and kneecap osteoarthritis. 

Knee Cartilage Injuries

In the knee, the meniscus and articular cartilage cushion the bones inside the knee joint. Injuries to the meniscus are more common than articular cartilage injuries. A meniscus tear happens when the knee is twisted during sports activities like tennis or basketball when players suddenly stop or change direction. Injuries to the meniscus don’t only affect sports participants. Anyone who steps wrong while hiking can suffer cartilage injury. 

In older people when the meniscus has become worn down it can also tear, leading to pain and discomfort.

Articular cartilage is more prone to age-related wear and tear, but it can also get damaged through overuse or high-impact trauma.

Tendon Injuries

Tendons are soft tissues that connect muscles and bones. In the knee, the quadriceps and patellar tendons can get injured, with most injuries causing damage to the patellar tendons.

Tendon injuries can happen to anyone who experiences a direct, forceful blow to the front of the knee, or falls and lands awkwardly. Tendon tears are also common in sports that require a lot of jumping. 

Other Causes of Knee Pain

As well as injuries to different parts of the knee, knee pain can also have other causes. 

Long-Term Stress on Joints Caused By Obesity 

Too much weight on load-bearing joints can cause cartilage damage. Overweight and obesity can cause long-term stress on joints, contributing to gradual wear and tear of the joint and damage to soft tissue. Eventually, it can result in loss of cartilage in the joints, resulting in osteoarthritis.

Metabolic causes of knee pain

The body’s metabolic processes can affect joint health. For instance, gout, which is a build-up of uric acid in the blood, can cause urate crystals to form in the joints, including the knee. These crystals can cause sudden, severe pain and inflammation.

Other metabolic causes of knee pain include diabetes and very low levels of certain vitamins or minerals.

Infection

A fall or contact with something that caused an open wound on or near the knee can cause infection and severe knee pain. In addition to the pain, the joint will appear red and swollen and feel hot.

When to Seek Medical Help

Often, one can treat a knee injury and the accompanying pain at home. However, it’s essential to know when the injury requires medical attention. Depending on the nature of the injury, you could easily worsen the situation by not getting timely and proper treatment. 

Seek medical advice if you experience these symptoms:

• You can’t put weight on your knee 
• You experience severe knee pain
• Your knee looks wrong or misshaped
• Your knee gives away under you
• Your knee is very swollen
• Your knee is red, swollen, and painful, and you have a fever
• Instability in your knee or feeling like your knee is about to give way
• It feels as if your knee is locked, preventing you from extending or bending it

Diagnosis of Knee Pain

To determine the extent of your knee injury or other cause of your knee pain, the doctor will inquire after your medical history, conduct a thorough physical exam and order additional diagnostic tests to assess the cause of the knee pain accurately. The extra diagnostic tests may involve one or more of the following imaging tests, as well as lab tests.

X-ray. X-rays help with knee pain diagnosis through images that reveal fractures, signs of arthritis, bone spurs, or other underlying issues. 

Computerized tomography (CT) scan. CT scans provide more detailed images than X-rays. CT scans detect complex fractures, bone abnormalities, and joint alignment issues. Doctors use CT scans to assess severe trauma and plan complex surgeries.

Ultrasound. This technology uses sound waves to produce real-time images of soft tissue structures like ligaments, tendons, muscles, and bursae. These images can thus reveal ligament tears, tendonitis, and bursitis as the cause of knee pain. These soft tissue problems don’t show up on X-rays.

Magnetic resonance imaging (MRI). An MRI can provide invaluable information about joints, bones, and soft tissue, facilitating the diagnosis of small tendons, ligaments, muscle tears, and injuries as well as subtle fractures that go unnoticed by x-rays.

Lab tests

Lab tests are called for when the analysis of blood or joint fluid can help confirm the diagnosis.

Knee Pain Treatments

Knee pain that is not severe and not caused by a sudden trauma usually responds well to conservative treatments. There are many remedial steps you can take at home to relieve pain and start rehabilitating your knee. 

Home Care: Implement RICE

Rest, ice, compression, and elevation (RICE) is an effective and simple treatment for mild to moderate knee pain that anyone can do at home.

Rest: Resting the knee gives it time to start healing and protects it against further injury in the short term.

Ice: Applying ice can help reduce swelling and inflammation, provided the ice doesn’t come in direct contact with the skin. Be sure to wrap the ice in a cloth and apply it for 15 – 20 minutes several times during the day until the swelling has subsided. 

Compression: A compression bandage around the knee can reduce swelling and discomfort. Wrap the bandage securely around the knee, but not too tightly.

Elevation: Keeping the leg raised with the knee higher than your heart will help reduce swelling. 

Medication

For mild to moderate knee pain, your doctor or specialist will suggest medication for pain relief. These may include over-the-counter NSAIDs like ibuprofen, aspirin, and naproxen sodium or strong prescription medications for extreme pain.

Be cautious when taking NSAIDs. These medicines have a range of side effects that can become serious when the recommended daily dose is exceeded.

Topical Knee Pain Treatment

Topical treatments are gels, creams, sprays and patches that you can apply directly to your skin. They contain different ingredients that affect pain differently.

Nonsteroidal anti-inflammatory creams and gels work well for joints close to the skin, such as knee joints. They also avoid the side effects of oral NSAIDs by bypassing the digestive system. Topical NSAID creams and gels are effective for knee pain caused by arthritis. 

Some topical products contain salicylates, the same ingredient responsible for pain relief in aspirin. Others contain capsaicin, a compound in chillies that causes a burning sensation. Capsaicin interferes with the nerve cells that send pain messages to the brain.

Another kind contains menthol or camphor, which causes a numbing and cooling sensation that distracts from the pain. Topical anaesthetics, on the other hand, create numbness that reduces pain.  

These over-the-counter medications are safe to use, provided you follow the product directions.

Physical Therapy

Exercise is an integral part of knee injury recovery as advised by a specialist. Under the guidance of a qualified physical therapist, the correct strengthening exercises can improve flexibility and relieve knee pain. An injured knee needs strengthening and stretching exercises to help it move correctly again. 

Knee pain caused by factors other than injury can also benefit from exercise. For instance, knee pain caused by chronic degenerative meniscal tears or osteoarthritis can also be relieved with exercises that build up the muscles around the knee. Strong muscles can take on some of the pressure that previously burdened the joint, and made it painful. 

Injections 

Knee specialists often make use of injections to treat knee pain and other symptoms associated with knee conditions. These injections include;

Corticosteroids: Cortisone injections deliver powerful medication directly into the knee joint. It relieves pain immediately and reduces inflammation. Corticosteroids are synthetic medicine that works like hormones. 

The effects of these injections last for a limited time and only address the symptoms, not the root cause of the knee pain. Although some people find long-term relief from these injections, doctors don’t recommend having regular corticosteroid injections. 

Hyaluronic Acid: Hyaluronic acid injections are used to lubricate the knee joint. It is a thick fluid that acts like cartilage, absorbing shock and helping bones to move smoothly in the joint. Hyaluronic injections must be repeated every six months, but some people experience relief for 3 years. 

Platelet-rich plasma (PRP): PRP injections with high concentrations of the patient’s own platelets have been used successfully to treat pain stemming from a meniscus tear or osteoarthritis. An orthopaedic specialist will consider this knee pain treatment for patients who don’t respond to conservative treatments or can’t undergo surgery.

Cartilage Regeneration

Several cartilage-regeneration techniques can help with knee pain. Autologous chondrocyte implantation (ACI) is one of them. This procedure involves harvesting cartilage cells, allowing them to multiply in a lab, and then surgically reintroducing them into the knee. This is a new procedure and not suitable for all knee pain cases. 

Radiofrequency Ablation (RFA) 

This is another option if all other treatments fail to subdue your knee pain. This non-surgical procedure uses radiofrequency waves to disrupt pain signals to the brain. The procedure destroys nerves, but its effect is not permanent, since the nerves will eventually grow back and the pain may start again. 

Surgery For Knee Injuries

Several surgical options are open to orthopaedic surgeons when:

• The extent of the knee injury or damage is so severe that it can only be addressed by surgery.
• All non-surgical treatments had no or too little effect on the function of the knee or the knee pain.

Surgical options for knee pain treatment include the following procedures. 

Arthroscopic Surgery

Arthroscopic surgery is a minimally invasive procedure. The surgeon makes tiny incisions on the knee where a small tube (arthroscope) with a tiny camera is inserted. The surgeon uses tiny surgical instruments, also inserted through tiny incisions, to perform the procedure. Arthroscopic knee surgery is leveraged for knee pain stemming from minor fractures, damaged cartilage, a torn meniscus, patella problems, and ligament tears, to mention a few instances.

Partial Knee Replacement

Partial knee replacement surgery replaces a damaged part with artificial joints (prosthesis) made of metal and plastic components. Surgeons opt for this operation when only one part of the knee is damaged, and the other parts can be left intact. This is not such a major procedure as total knee replacement and patients can return to normal activities much sooner.

Total Knee Replacement

Total knee replacement or Knee Arthroplasty replaces the entire knee with a new knee joint. Surgeons perform this operation when the knee joint is extensively damaged by arthritis, fractures, and torn ligaments or cartilage. 

During this procedure, the specialist removes and replaces the damaged cartilage and bone surfaces to restore function and reduce pain. The replacement joints are constructed from metal alloys, high-grade plastics, and polymers. Total recovery from this major operation can take up to a year.

ACL Reconstruction

The anterior cruciate ligament (ACL) is one four ligaments that stabilizes the knee joint. When torn, the damaged ligament is replaced by a graft of the patient’s tissue, such as a hamstring or patellar tendon. ACL tears are common among athletes and hikers and can cause considerable pain.  

Meniscus Repair

The meniscus cartilage cushions and supports the knee joint. It can get injured and tear, leading to pain, swelling, and stiffness. Meniscus repair is a surgical operation that repairs the torn meniscus with sutures or other techniques. There is also a procedure that removes the damaged parts of the meniscus. 

Another surgical option is debridement, which involves removing damaged or loose pieces of cartilage to enable smooth knee joint function. 

Alternative Treatments For Knee Pain

• Therapeutic Massage

Therapeutic massage has gained wide acceptance as an effective aid for pain relief. Massage therapy is particularly helpful after joint replacement surgery or injury, improving circulation and flexibility, and decreasing muscle stiffness, resulting in less pain.

The modality has the added benefit of lowering stress levels and helping patients to relax.

• Acupuncture

If you are not afraid of needles, acupuncture is worth a try. It has been practiced for centuries and recent research confirms the efficacy of acupuncture for pain relief. However, it seems that acupuncture only works for knee pain caused by osteoarthritis. Research has also shown that the modality is effective for the treatment of post-operative pain.

• Chiropractic care

Chiropractic is an alternative therapeutic modality focused on treating conditions affecting the nervous system and the spine. A chiropractic adjustment involves spinal or joint manipulation aimed at improving joint mobility and spinal alignment. 

These specialised techniques can indirectly relieve pain caused by patellar tendonitis, meniscal tears, osteoarthritis, rheumatoid arthritis, sprains, and overuse. 

Lifestyle Habits to Support Joint Health

Many healthy lifestyle habits support healthy joints and help people avoid knee pain and knee pain treatment.

Maintain a Healthy Weight

Extra weight has a negative impact on bone and joint health. Carrying extra weight puts unnecessary pressure on joints and accelerates wear and tear of the knee joint. Research has shown that 10% weight loss leads to better function and decreased inflammation, resulting in less pain.

Change Your Activities

If you have knee pain, choose your activities carefully. While it’s essential to stay active, choose low-impact activities like swimming and cycling to avoid straining the knee. A personal trainer or physiotherapist can advise you on low-impact exercises that strengthen the quadriceps and hamstring muscles without putting excess force onto the knee joint.

Maintain a Healthy Diet

One of the best things you can do for your joint pain is to follow an anti-inflammatory diet, which includes:

• Fatty fish
• Nuts and seeds
• Leafy greens
• Legumes
• Fruits and berries
• Whole grains
• Dairy
• Certain herbs and spices

As far as possible, try to avoid processed food, which is highly inflammatory.

Take Supplements

Joint supplements such as glucosamine and chondroitin contain active ingredients that can protect the knee joints and provide pain relief. 

Glucosamine and chondroitin are compounds in cartilage that keep cartilage soft and malleable so bones can move smoothly together. Many patients find these supplements helpful for pain relief, but it’s not a universal experience. It’s worth trying to see if it works for you.

Other supplements that may be helpful include omega-3 and turmeric supplements. Take them regularly and at the same time every day.

Wear Proper Shoes That Support the Knee Joint

The shoes you wear can have repercussions on the long-term health and proper function of your knees. Shoes that put unnecessary strain on knee joints, which may lead to knee problems in the long run, include high heels, shoes with poor arch support, and poorly fitting, or worn shoes. 

Quit Smoking

Smoking is detrimental to the body’s innate healing process. It leads to the narrowing of the blood vessels, which reduces blood flow, hampering natural healing. Smoking causes inflammation in many parts of the body, including joints, and inflammation is painful. 

Knee Pain Treatment in Singapore

Singapore offers a variety of effective knee pain treatments, ranging from non-invasive therapies like physiotherapy and medication to advanced surgical options. 

Ray of Health

Ray of Health is a healthcare platform in Singapore focused on musculoskeletal health, offering insights and treatments for various conditions. Led by Dr. James Tan, an experienced orthopaedic surgeon in Singapore, the platform provides information on:

• Orthopaedic Treatments: Addressing orthopaedic issues related to the upper limbs, spine, and lower limbs.
• Sports Injuries: Guidance on prevention and treatment of common sports-related injuries.
• Specific Conditions: Information on effective knee pain treatment by an orthopaedic doctor in Singapore, shoulder dislocation, meniscus tears, ACL tears, and more.

Ray of Health emphasises personalised care, aiming to help individuals lead comfortable and active lives through customised treatments.

RadLink

RadLink is a leading provider of comprehensive diagnostic imaging services in Singapore. Their services include:

• Diagnostic Imaging: RadLink offers premium diagnostic services such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasound, Mammography, and Bone Mineral Densitometry (BMD).
• Nuclear Medicine: Advanced imaging techniques for diagnosing and treating various conditions.
• Needle Biopsy: Procedures like breast biopsies and MRI-US-guided prostate fusion biopsies.
• Teleradiology: Remote radiology services facilitating timely consultations and diagnoses.
• Radiopharmaceuticals: Production and supply of radiopharmaceuticals for medical imaging.

RadLink operates multiple centres across Singapore, including specialised facilities like RadLink Women Imaging and RadLink PET and Cardiac Imaging Centre. Their team comprises experienced radiologists dedicated to delivering accurate and efficient diagnostic services.

Conclusion

Knee pain is a common occurrence, and it strikes all of us at some time in our lives. Fortunately, many knee pain treatments are available to help ease the pain. You can also adopt a healthy lifestyle to protect your knees and prevent unnecessary knee pain.