Pressure & (sometimes) pain behind the kneecap
November 8, 2018 5:56 AM   Subscribe

My right knee has been feeling weird for the last week or so and I don't know what my first port of call for doing something about it should be.

I've had more pain than usual in my right knee for the last week or so, and for the last few days I've had a near-constant feeling of pressure buildup behind the kneecap. It's not painful all of the time, only some of the time, but the pressure feeling is more consistent while I'm awake - it doesn't hurt a lot when it does hurt, but I feel really unusually aware of the fact that my knee is there all the time due to the pressure.

Background on the knee: I had some pain/crunching in it for a while a few years ago, and had an MRI at that point that showed a slight meniscal tear. There wasn't any followup or suggested treatment at that point. The crunching & pain has been a lot better for the last year or so since I've been doing more stretching and overall exercise, but some of that exercise has a lot of knee involvement (rowing on a machine & cycling over the summer) and I've been getting more use-related pain recently.

I'm hypermobile all over and I know I habitually twist my knees a lot, particularly the right one, particularly while I'm driving or just sitting around. I often don't notice I'm doing this until it hurts, although I've been a lot more aware of the knee twisting for the last few days since the feeling of pressure has increased.

My question is, who do I need to see about this? I think my three main options are:

a) Go to the GP, where they'll inevitably not take it super seriously and either suggest I self-refer for NHS PT or refer me to a specialist knee person in six months' time. The treatment experience won't be great but I will have seen someone who is technically a doctor.

b) Pay for private PT; I would rather not spend the money right now but I could if it's my best option. I also strongly prefer this as an option over NHS PT as I can arrange it at a more convenient time & location and private PT people tend to be much more hands-on than the NHS people are allowed to be, so I'd get massage/manipulation if appropriate as well as suggestions for exercises to do. The treatment experience will be good, but it will cost me and I'm cheap and Christmas is coming.

c) Do nothing and either hope it gets better or hope it stays okay enough until my private health insurance outpatient limit resets in March next year (I've run out of outpatient budget for this year) and get PT or a referral to a doctor via insurance then. The treatment experience will likely be good and it won't cost me, but I'll have to wait.

The thing I'm beanplating on is whether I need to see an actual doctor about this or not - I don't know enough about the meniscus or inside-of-kneecap knee issues to know whether this is something I can fix via PT or something I'm going to want someone to do more investigation on. I feel like I'm going to get more useful advice from someone on the PT side on what kind of activity I can still do and anything I should be doing now to not exacerbate it, but I suspect stretching alone can't fix a meniscus if the tear there is getting worse.

The outcome I'm looking for is for my knee not to hurt or feel like there's pressure there, but also not to accidentally do stuff to it that will wreck it further in the future even if it feels okay in the meantime.

Would be great to hear from other people who've had knee weirdness like this - what was the issue and how did you resolve it? Is there anything I can do about the pressure in the meantime? It feels like there's air in there that needs to pop, but more congested than usual and nothing is popping.
posted by terretu to Health & Fitness (10 answers total) 4 users marked this as a favorite
In case any of this is relevant: I'm 29, currently presenting as female, and moderately active.
posted by terretu at 6:02 AM on November 8, 2018

Personally, I would go to a GP first and, if he recommends a specialist, ask him if I could afford to wait until March. I would not see a PT until I had a better idea what is wrong, as a misguided or inexperienced PT can sometimes make things worse. With your history, I certainly wouldn't want to wait 5 months before taking action. Yes, it might cost a few quid, but I'd rather be out a few quid than have my legs stop working.
posted by ubiquity at 6:03 AM on November 8, 2018

This sounds like my knees! I am 32, active fat, hurt them both playing football at different times.

I have meniscus tears and, in one knee, a partial MCL tear. For the most recent knee injury (1.5 yr ago) my treatment thus far has been: go to doctor and get referral to sports medicine/orthopedic doc, who was able to give me an explanation of what sorts of exercises would help strengthen my knee,and write an order for an MRI. I can’t afford the MRI but I kept it on file anyway in case things got worse and I felt like I needed more information. For the older knee (about 3 years ago) I never went to the doctor or did anything to take particular care of it besides RICE and bracing it when I worked out.

For knee #2, I did the brace/RICE thing but also used the advice of the orthopedist, and a PT I know, to do exercises to strengthen my quad muscle, which helped relieve a lot of the pain. I do a lot of stretching now, even so long post-injury, and do a lot of yoga and other body-weight exercises. That pressure feeling is likely swelling—keep your knee elevated in a non-straining position as much as possible. I lie in bed on my back with my knees over a big pillow and it helps relieve this. I ice above my kneecap or right below, depending on where I feel the pressure, and I am very careful especially of side-to-side movement. If your knee is unstable from the meniscus tear, fast lateral movement can be a ticket to a worse tear! I didn’t work with a PT long-term, just once to get information and then did the exercises on my own. There are lots of YouTube and other resources for knee-strengthening exercises and I used many of those once I understood the basics.

IANAD but I am very certain that my second knee injury was made more likely, and more severe, by the fact that I was favoring my previously-injured knee, and over-taxed my “good knee.” Now I have two bad knees and almost-daily knee pain, and have lost the ability to play some sports/do some outdoor activities. Don’t be me!
posted by assenav at 6:42 AM on November 8, 2018 [1 favorite]

Yeah was gonna say it sounds MCL related. Twisting of knees, especially under load, is hard on the ligaments.
posted by some loser at 7:00 AM on November 8, 2018

I've also had some bad knee issues this year at age 31.

Early this year, I injured my left knee and definitely felt that same sort of pressure. Basically, it's just swelling under the knee cap. Ibuprofen helped relieve the inflammation and my GP referred me to PT and we had like 3 sessions and I felt much more stable.

A few months later, I injured my other knee while exercising. I was being cheap and didn't want to spend the money on going back to the doctor and PT, so I just treated it the same. After a week, I twisted it really badly and felt a pop. My knee swelled up and wouldn't carry my weight. It turns out I tore my ACL and my torn meniscus flipped over inside my knee to a point where it could not fully straighten. Surgery was the only solution and it has been a long recovery.

Your GP or a good PT can evaluate the type and severity of meniscus tears. Often strengthening the surrounding muscles is enough to allow you to return to normal activities. But there are some tears and plenty of other knee issues that are only repairable via surgery.

Also - cycling is actually a really good exercise for those with knee problems and a huge part of my recovery protocol, but I was told that rowing is not a good idea.
posted by galvanized unicorn at 7:01 AM on November 8, 2018

Back in the nineteen-hundreds, when I was closer to your age, I had some intermittent knee pain that was getting exacerbated in response to very mild exercise, apparently unrelated to any injury. I went to a PT and among the stretching exercises they gave me to do was one that involved actually grabbing my kneecap while sitting on the floor and stretching the attached ligaments or whatever by pushing the kneecap to either side.

Which seemed weird to me at the time, and was somewhat difficult to do, but appeared to help the pain. So perhaps you can research whether this is still a legit physical therapy thing and see if it helps you.
posted by XMLicious at 7:46 AM on November 8, 2018

I’d go to a GP and wait for a specialist. In the meantime, I’d cut back on weight-bearing or resistance exercise that involves the knee bending. Cycling and rowing are both rough on knees if there’s any kind of mechanical issue or misalignment.

It may not be a tear at all; I get this same issue when doing a lot of leg work because my quads are much stronger on the outside of my legs and it pulls my kneecaps slightly out of alignment. That, in turn, irritates the soft tissue which swells internally (pressure) and hurts with lots of movement. It’s extremely not a big deal but it does require mindfulness about exercising my legs, strengthening my inner thighs, etc.
posted by Rock 'em Sock 'em at 7:47 AM on November 8, 2018

Also cycling can be good for knees as per above. But for some knee problems it needs to be done in a certain way using certain muscles, or it makes the problem worse. Going forward, it’s probably best to avoid anything that seems to contribute to pain or discomfort until you have a better idea of the problem.
posted by Rock 'em Sock 'em at 7:50 AM on November 8, 2018

I had a strange pressure on one side of my knee, which I went to see a GP for. They sent me for PT. The PT was stumped; I passed the Thessaly test easily, and they prescribed stretching and some exercises which were not useful. Approximately six months later, I was wrestling with somebody, bent my knee, and when I went to stand up, could no longer straighten the leg.

Ultimately, an MRI showed multiple loose bodies including a huge honking one right where I had been feeling pressure. A loose body had started to wander to a place where it would lock my knee. Surgery was required to remove them, and after that I felt completely fine again, though I am no longer allowed to squat or lunge.

A loose body is not the only thing that can cause patellofemoral pain (see this), but it was the thing in my case. I would take it easy on your knees if you decide to wait. Good luck to you.
posted by Comrade_robot at 9:05 AM on November 8, 2018

What assenav said. I had a miniscus tear, this was some 20+ years ago. After a strenuous day of sports, I was doing some unwise jumps, landed awkwardly and my knee would no longer open fully. I felt pressure behind the knee, the miniscus had torn in a way that was blocking the range of motion. Very disconcerting.
MRI, visit to the sports surgeon for the 49'ers who recommended some kind of laser cutter that reduced bleeding and swelling for the operation to trim back the protruding/curling flap, a few days hobbling around afterwards and back in business.
That's the short translation, your mileage may vary.
posted by diode at 4:49 PM on November 8, 2018

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