Medial Knee Pain - All About Pain On Inside of The Knee | Pain Care

Medial Knee Pain – Causes, Treatment & Exercises for Pain On Inside of Knee

The knee joint is one of the most complex joints in your body. It bears all of your body weight. That's why it is composed of an integrated network of bones, ligaments, tendons, two menisci, and cartilage.

Knee pain is the most common complaint worldwide. When that pain affects the inside of the knee, it is called "Medial Knee Pain".

Medial Knee Pain is affecting the medial side of the knee which is more close to the midline of the body. It is not uncommon to have a pain on the medial side of the knee.

This area is surrounded by many ligaments and muscles which control how your knee moves. That pain can happen from a variety of reasons; it might come gradually like arthritis or acutely like the sudden trauma or sports injury.

Medial Knee Pain - Causes & Treatment

There are many causes of the medial knee pain. Most of them are mainly related to the injuries and strenuous physical activities.

In this article, we are going to review the most common causes of medial knee pain, how to identify the symptoms of each cause, and the lines of treatments as well.

Here are the most common causes of inside knee pain.

1

Medi​​​​al Collateral Ligament Injury (MCL)

The medial collateral ligament (MCL) is located on the inner side of the knee which is responsible for the sideway stabilization of the knee during movement.


MCL injury happens when a force applied to the outside of the knee, causing outstretch of the ligament.


This usually happens acutely in sudden movements such as falling from a height or some kinds of sports such as football and skiing.


Symptoms of the MCL injury are:

  • Pain and redness of the affected knee medially.
  • Swelling, stiffness, and unstable knee, especially during walking or standing.
  • Locking knee.
  • Limping gait.
  • Popping sound at the time of trauma.

Those symptoms are aggravated by walking, flexing or extending the knee, and sports.

The severity of MCL injury varies according to the extent of the tear in the ligament.


Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, Physical therapy, Non-Steroidal anti-inflammatory drugs"NSAIDs" to relieve the pain, Knee bracing for additional support, and exercises.


All of that might help you to alleviate the medial knee pain. However, if the ligament is severely affected, you might need a surgical intervention.


MCL injury is a very serious injury. It might take few weeks only to heal slight injuries.

However, tears requiring surgeries might take many months for a complete recovery.

As per the updated medical studies, Published in Iowa Orthopedic Journal and up-to-date, Medial collateral ligament injury is the most common cause of medial knee pain, especially among the young athletes. Usually, complete recovery can be achieved by conservative treatment except in severe cases.

2

Medial Meniscus Injury

​Each knee joints has two menisci between the thigh and shins. Those menisci serve as a cushion between the bones in the knee joint.


They work mainly as shock absorbers to absorb the trauma and sudden movements. Moreover, the menisci help to distribute the body weight evenly.


If the body weight was not distributed evenly, this might lead to the damage to the knee joint. That's why the function of the menisci is very crucial for the knee joint.


The meniscus can be injured if the knee was under pressure during sports and excessive physical activity. It can be also damaged during the malrotation of the knee.


Medial meniscus injury includes four types of injury which are bucket handle, flap, radial, and degenerative.


Symptoms of the medial meniscus injury are:

  • Pain and stiffness in the knee.
  • Locking pain.
  • Imbalancing gait.

Those symptoms might vary depending on the extent of the medial meniscus/cartilage tear.


Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, Physical therapy, Knee bracing for additional support, and exercises.

Physical therapy is very helpful, especially after the pain goes away. It also helps to restore the full knee motion. However, in the cases of extensive damage, Surgery will be must and it might take months for full recovery. 

3

Arthritis

​Knee Arthritis is an inflammation of knee joint as a result of wear and tear of the knee cartilage in the inside part of the knee.


There are two types of arthritis—Osteoarthritis and rheumatoid arthritis.


Osteoarthritis- This is the degenerative kind of arthritis that happens gradually and is commonly affecting the elderly over the age of 50. 

The patients usually suffer from pain, stiffness, and swelling of the joints. The pain tends to be more severe throughout the day.


Rheumatoid Arthritis- This is the autoimmune type of arthritis. Usually, it affects the young females like any other autoimmune disease.

The patients usually suffer from morning stiffness that lasts for more than 30-minutes. The pain tends to be milder throughout the day and with exercises.


Symptoms of arthritis are:

  • Pain and swelling of the knee joint.
  • Morning stiffness.
  • Limited knee movement
  • Clicking sensation, especially in osteoarthritis.

Arthritis is classified into mild-moderate- severe depending on the severity of the pain and the extent of the damage to the affected joint.


Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, exercises, intra-articular steroid injection, knee braces, and physical therapy.

4

Medial Plica Irritation

​First of all, we need to know what is the plica. Plica is the small layer of synovial folds that is found in the anterior and the medial part of the knee.

Surprisingly, Plica is only found in 50% of general population and it is believed that plica is embryonic connective tissue remnants.


Plica is usually asymptomatic, however, the overuse of the knee in flexing, extending, or squatting can result in irritation of the medial plicae which leads to thickening of the plicae.

The thickened plicae will be trapped between the bones. When the plicae are stuck in the anterior part of the knee, it is often misdiagnosed with patellofemoral syndrome.


The physician usually assumes the patellofemoral syndrome first. If there is no improvement, the surgeon usually uses arthroscopy to look inside the knee if there are any plica to remove or not.


Symptoms of Medial Plica Syndrome include:


  • Sharp or dull pain, especially during squatting.
  • The patient might feel thickening on the inner side of the knee.
  • Cracking sound of the knee during movement
  • Locking knee.
  • Limited knee motion.

Treatment: Usually, the treatment is conservative and depends mainly on physical therapy.

The main core of the physical therapy and rehabilitation is to strengthen the quadriceps muscle.

Moreover, orthoscopic surgeries are very rare because the plicae are part of the synovial folds that protect the knee.

However, the surgeries are necessary only if there is a localized or limited tear or pathology

5

Pes Anserine Bursitis

A bursa is a fluid-filled sac that alleviates the pressure and friction between joints. Bursas are everywhere in your body.


Bursas are also found in the knee between the medial collateral ligament and the tendons of the three following muscles: the sartorius, gracilis, and semitendinosus. This overall area called " the pes anserinus."


If this bursa is overused or damaged, it will lead to the secretion of extra fluid in a response to the irritation. This extra fluid will accumulate and causes swelling on the medial side of the knee. Inflammation of the pes anserinus is known as pes anserine bursitis.


Pes anserine bursitis can result from variety of reasons that cause the overuse of the bursa such as obesity, damage of the medial menisci, osteoarthritis, sudden rotation of the knee while walking or standing, and tight hamstring muscles due to poor activity habits or strenuous physical training.


Pes anserine bursitis happens very gradually and most often in overweight women of middle age and athletes such as runners.


Symptoms of Pes anserine bursitis include:

  • Pain and stiffness few inches below the medial side of the knee joints.
  • Swelling and weakness of the knee, especially during exercise, flexion, or extension.
  • Limited knee movement.

Patients might be misdiagnosed with medial collateral ligament injury because they usually suffer from same symptoms.


Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, Physical therapy, assistive strengthening exercise for hamstring muscles, intra-articular corticosteroid injection, and surgery only in the severe cases.

6

Knee Contusion/Bruise

Knee contusion is a direct trauma to the knee that leads to bruises and swelling in the knee joint.


This contusion might happen on the inner side of the knee or anywhere depending on the site of the trauma.


Symptoms of knee contusion include:


  • Pain and swelling of the medial side of the knee.
  • Skin discoloration on the inside of the knee.
  • Limited knee movement
  • Knee stiffness

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg. The price formula will help to reduce the pain, bleeding, redness, and inflammation of knee joint.

How to Prevent Pain on Inside of Knee?

As we all know that knee pain is very excoriating and not all the reasons for  knee pain is preventable.

Orthopedic surgeons and physical therapists recommend that regular exercises are the key to strengthen your leg muscles and in turn, to prevent knee pain effectively.

The two main muscles that play an important rule in the prevention of knee pain are quadriceps muscles (anterior thigh muscles) and hamstrings (posterior thigh muscles)

Exercises that help to strengthen quadriceps and hamstring muscles include:

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    Quadriceps isometric hold
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    Hamstring isometric hold
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    Chair Pose
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    Leg presses
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    Swimming
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    Mini squats
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    Resistance band knee flexion
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    straight leg lifts
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    Biking
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    Leg liftings and extensions

Moreover, you should always be careful to begin and finish your exercise with hamstring and quadriceps stretching because they are the main included muscles to prevent the medial knee pain.

Below, we are going to discuss some beneficial exercises that will be helpful to strengthen your knee muscles :

Quadriceps Isometric Hold

This is an isometric exercise that helps to strengthen the motion of your knee joint. Usually, you contract the quads and hold it for a certain duration. This might hurt your knee at the beginning.

Your quadriceps are considered the largest muscles on the anterior part of your thighs till the knee. To contract it isometrically, all you need is to sit on the floor with a fully extended and straight legand your hands straight at your sides.

Try to contract your quadriceps actively and hold for few seconds then slowly release that squeeze and repeat it many cycles.

Hamstring Isometric Hold

Hamstring isometric hold is completely the opposite of quadriceps isometric hold because the hamstrings are located on the posterior side of your thighs.

Hamstring muscles function is to produce knee flexion when you bend your knee to the back and move your heel upwards to your butt.

To do a hamstring isometric hold, sit in a chair and try to fully extend your leg with your heel straight on the floor.

Then, try to flex your knee and apply a force with the heel. Once you feel a bulge in your hamstrings, that means that they are now contracted.

When you feel that contraction, hold for few seconds then release. You can do these cycles repetitively and you can also switch the sides of legs.

Chair Pose

Chair pose is mainly a yoga exercise that aims to strengthen your knee muscles.

To do it, you have to stand with your legs and hips are away from each other and your arms are fully extended with the palms of your hands are facing each other.

You should try to maintain your back straight and abdomen tight. Then try to flex your knee. You should maintain that posture until your thighs are parallel to the floor or you started to feel more pain in your knee.

You can remain in that posture for 35-45 seconds before you release then start again.

Leg presses

This is a weight training exercise in which the athlete pushes the weight away using their legs.

That exercise is very useful to strengthen your knee and it is also used to evaluate your lower body muscle strengthen. However, Take care it might cause serious knee injury if you bent your knee in the wrong direction.

In nutshell, the medial knee pain or what is called "inside knee pain" can be mild or severe. If you have severe excoriating pain, this might be due to the medial collateral ligament injury. 


However, if your pain is mild, you can better treat it by doing some strengthening exercises that will support your knee. Furthermore, If your pain is persistent, it is always best to consult your medical physician to know the exact cause of your knee pain and to treat it effectively.

Dr. Sachin
 

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