Lateral Knee Pain - Causes, Treatment & Exercises | Pain Care

Lateral Knee Pain – Causes, Treatment & Exercises for Pain on Outside of Knee

Lateral knee pain is refereed to the pain that happens on the outside of the knee.

It is not a very common place to have pain. However, lateral knee pain is more prevalent among the athletes in running or cycling activities.

The pain might start gradually over time due to chronic diseases such as arthritis or suddenly after a trauma or knee/ligament injury.

The symptoms vary widely between a dull aching or sharp pain to a very restricted knee movement.

Lateral knee pain can occur from the lateral collateral ligament injury, which is a very common cause or it might indicate direct trauma to the fibula of the leg or peroneal nerve irritation.

Moreover, most athletes suffer from iliotibial band injury. Many other causes such as swelling, effusion, and contusions of the quadriceps muscles.

Causes & Treatment

There are many causes of the lateral knee pain.

In this article, We will provide a brief summary of the most common causes of outside knee pain, identify the symptoms and the treatment of each cause.

Here is the list of the most common causes of lateral knee pain.

1

Lateral Collateral Ligament Injury

The lateral collateral ligament (LCL) connects the femur bone from above to the fibula of the leg below.

lateral collateral ligament injury

This ligament is composed of collagen fibers to provide stability to the lateral side of the knee joints. 


The tear of LCL usually happens suddenly due to the direct blow of the inside of the knee and sudden fall when the knee is bent inwards.


LCL injury is aggravated by walking, sports, flexing the knee, and moving up and down stairs. LCL is less prevalent than medial collateral ligament injury.


Moreover, LCL is not connected to the lateral menisci of the knee joint. That's why LCL injury independent of the lateral meniscus injury, unlike the medial collateral ligament injury.


Symptoms of the lateral collateral ligament sprain are:

  • Lateral pain and swelling of the knee joint.
  • Bruising of the knee.
  • Knee stiffness and instability.
  • Limited knee movement

LCL injury is classified into three grades according to the extent and the severity of the injury.


Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, exercises, knee bracing, and surgery in a complete rupture of the lateral collateral ligament.

2

Iliotibial Band Syndrome

The iliotibial band is a thick fibrous strip of the fascia on the outside of the knee that helps in the coordination and stability of the lateral side of the knee joint.

Iliotibial Band Syndrome

Iliotibial Band (ITB) syndrome results from an inflammation of the ITB on the lateral side of the knee.


ITB usually cross bone and muscles on the outside of the knee, leaving a space underneath called "Bursa" that facilitate the friction at that point.


People who overuse the knee joint, they gradually get ITB syndrome that makes the friction worse and very painful. This usually occurs for runners, weight lifters, athletes who do running, hiking, cycling, and squatting.


Symptoms of the iliotibial band syndrome are:

  • Outer knee pain.
  • Inflamed knee joint.
  • Gait problem and imbalance, especially during exercise.
  • Limited knee motion

Those symptoms are aggravated in people with flat feet, during activities such as running or walking.


Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, especially during the first 72 hours after the injury, Stopping the activities for a period of time till recovery, stretching exercises, knee strap, steroid injection, and surgery in cases of a very thick iliotibial band.

3

Lateral Meniscus Tear

As we know, each knee joint has two crescent-shaped cartilages inside the knee joint. One on the medial side, which is called "medial meniscus" and one on the outside of the knee, which is called "lateral meniscus".

Meniscus Tear

Those menisci act as shock absorbers of any trauma that is applied to the knee joint.


The lateral meniscus is less vulnerable to injury than the medial meniscus because it is not attached to the lateral collateral ligament.


The lateral meniscus is usually injured either suddenly during trauma and sudden twisting or the knee or gradually due to the wear and tear.

Symptoms of the lateral meniscus tear are:

  • Outer knee pain and swelling.
  • Instability during the knee movement.
  • Difficulty to extend the knee.
  • Limited knee motion.
  • Locking feeling.

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, knee brace, exercise, and surgery in the cases of a complete lateral meniscus tear.

4

Knee Arthritis

Arthritis is the process of wear and tear inside the knee joint. The lateral side of the knee is usually less commonly affected than the inner side of the knee.

Knee Pain Caused By Arthritis

Knee arthritis is a very serious condition and affects millions of people worldwide and it is one of the most common leading causes of disabilities in the USA.


Knee arthritis is classified into two main categories:

Osteoarthritis

This is the degenerative type and usually affects the people over the age of 50 years old.

Rheumatoid arthritis

This is the inflammatory type of the knee arthritis. This is an autoimmune disease which affects mainly the young females in their reproductive ages.

Symptoms of the knee arthritis are:

  • Dull aching knee pain.
  • Knee stiffness, especially at morning.
  • Clicking sound in the knee.
  • Difficulty to flex and extend the knee.
  • Limited knee motion.
  • Locking feeling.
  • Red, hot, and swollen knee joint.

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, exercises, intra-articular steroid injection, Non-steroid anti-inflammatory drugs (NSAIDs) to treat the pain, and knee replacement surgeries in cases of knee damage.

5

Knee Synovitis

Synovial membrane lines and lubricates the knee joint. Synovitis happens when the synovial membrane is inflamed.

synovial fluid in the knee

The cause of this inflammation varies widely. It might happen on its own or due to an underlying disease such as gout and rheumatoid arthritis.


Symptoms of the knee synovitis are:

  • Pain and swelling of the knee joint.
  • Tender knee joint.
  • Hotness and redness over the knee joint.
  • Knee stiffness.

Treatment: The treatment of the knee synovitis varies according to the cause. However, PRICE " Protect, Rest, Ice, Compression, Elevation" of the knee is usually very effective.

Moreover Non-steroid anti-inflammatory drugs (NSAIDs) are very helpful to alleviate the pain in cases of arthritis or gout. Arthroscopic surgery in complicated cases to remove the diseased synovial tissue. 

6

Nerve Problem

The peroneal nerve is one of the main branches of the sciatic nerve that runs down the outside of the leg along the lower part of the leg up to the foot.

Nerves in the Knee Joint

This pain might be referred or due to the direct impact to the peroneal nerve on the lateral side of the leg.


Referred pain occurs in the lumbar disc protrusion which does some pressure on the sciatic nerve and radiates to the leg.


Symptoms of the neurological problems of the leg include pain, weakness, tingling sensation, numbness, pins sensation in the leg, and limping gait.


Treatment includes rest, avoiding leg cross or applying any pressure on the knee, and surgery in case of nerve entrapment.

7

Patellofemoral syndrome

Patellofemoral Pain Syndrome (PFPS) also called as runners' knee, chondromalacia patellae, or anterior knee pain.

Chondromalacia Patella

Patellofemoral syndrome is usually leads to the anterior knee pain, however, it causes pain on the lateral side of the knee as the patella do some frictions on the bone underneath.


Patellofemoral syndrome is more common among the athletes, especially adult females. This might happen due to overuse, vigorous exercise, knee bending, and sudden jumping.


Symptoms of the lateral meniscus tear are:

  • Dull aching pain in the knee joint.
  • Tenderness in the kneecap.
  • Swollen knee, especially after exercise.
  • Cracking or clicking sound when flexing the knee.

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the knee to alleviate the pain and pressure, strengthening exercises, knee bracing, and sports massage.

8

Hamstring Tendonitis

This is an inflammation of the hamstring muscles at the back of the thigh, especially the biceps femoris muscle at the site of its attachment on the lateral side of the knee.


Symptoms of the hamstring muscles' tendonitis are:

  • Painful and tender knee joint, especially during the flexion.
  • Knee stiffness.
  • Some acceleration and deceleration work
  • Swollen knee.

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the knee to reduce the pain, exercises, and knee bracing.

9

Proximal/Superior Tibiofibular Joint Sprain

This is one of the most uncommon causes of the outside knee pain.


The tibiofibular joint is located between the top of the tibia and the fibula below the knee joint on the lateral side.

For this dislocation to happen, a huge force must be applied such as in car accidents and sustained impact of the knee in a fully bent position.


Symptoms of the proximal tibiofibular joint dislocation are:

  • Lateral knee pain.
  • Instability, especially during exercises and squatting.
  • Deformity on the lateral side of the knee.
  • Tingling and numbness on the outer side of the knee due to the peroneal nerve damage associated with the dislocation.

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the knee to reduce the pain, exercises, knee bracing, and surgeries to repair the ligament.

10

Miscellaneous

Miscellaneous causes include:

  • Excessive lateral pressure syndrome
  • Slipped capital femoral epiphysis
  • Perthes' syndrome

How to Prevent the Lateral Knee Pain?

Unfortunately, it is very difficult to avoid lateral knee injury because they are unpredictable most of the time and due to unforeseen circumstances or a sudden accident.

However, many preventive measures can help to decrease the risk of a lateral knee injury such as:

  • Using a cautious and proper technique when doing physical activities.
  • Doing regular stretching exercises to keep a good motion of your body.
  • Doing strengthening exercises of the upper and lower muscles of the leg to stabilize the knee joint.
  • Be cautious when you play sports where knee injuries are most common, such as football, climbing, running, and soccer.
  • Rest enough! Lateral knee pain usually heals spontaneously, however, the main key to preventing re-injury during the healing period.
  • Try to warm up for a few minutes before doing some sort of vigorous activity.
  • Lose weight, especially if you are overweight. Shedding some pounds off will help to reduce the pressure on your knee joint and improve the health of the knee joint
  • Perform some stretching exercises for the quadriceps and hamstring muscles to improve the motion of the knee joint and strengthen your knee.

Exercises That Help in Lateral Knee Pain

You must know that stretching exercises help to facilitate the knee mobility and strengthen the knee joint.​

However, you should give your joints time to heal before beginning the exercises to avoid any further inflammation or complications.

Below, we will discuss some effective exercises that will help if you are having lateral knee injuries.

Static Quads Contractions

You can begin that exercise as soon as you start feeling pain or even before to prevent the pain. This exercise can be done daily. 

You can do that exercise by contracting the quadriceps muscles and holding for 10 seconds then release for 3-5 seconds.

Try to repeat that exercise up to 20 times. This exercise will help to strengthen your knee joint and facilitate the range of motion in your knee.

Hamstring Isometric Contractions

Hamstring isometric contractions help to strengthen the hamstring muscles. Hamstring muscles are located on the back of your thighs.

You can do that exercise by doing repetitive contractions against resistance, holding, and relaxing before repeating again.

You can do that many times up to 20 repetitions.

Half Squats

You can do that test by standing up with your feet just wider than shoulder width while keeping your back straight.

Try to squat up to 45 degrees and return back to standing. Try to do at least 3 sets of 10-20 repetitions during the period of physical rehabilitation.

You can strengthen your muscles more by adding more weight or increasing the squat depth up to 9 degrees.

Calf Raises

You can do that test by standing with your feet wider than your shoulder width.

Try to lift your heels up as high as possible away from the floor. Aim or 3 sets of 20 repetitions each.

This exercise helps to strengthen the calf muscle and increase the motion of the knee joint.

Bottom Line: If you are having a joint pain on the outside of your knee, you should rest from doing any activities. If you did not treat any of those injuries properly, it might cause some instability in your knee.

Prevention is always better than treatment!.

As you can see, most of the injuries have similar signs and symptoms which make it hard to distinguish them. If you had any injury, please consult your therapist to avoid any complications.

Dr. Sachin
 

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