Knee pain when sitting (Page 1)

I have same problem. I was in the car the other day sitting in traffic and I had to actually pull off an exit to pull the car over just to get out to relieve the pain. When in pain when i stand up there is NO clicking sound, cracking, nothing....The pain just goes away....it's kind of like a burning throbbing pain in my knee....I can't take it anymore, SOMEONE PLEASE HELP

Did either of you ever get a diagnosis for this pain?

Have you now recovered?

I have a condition which sounds incredibly similar.

acupuncture might helps.

i have it too. Its called lots of things I think - chondromalacia patella, runners knee, movie theatre knee. Think of a big elastic band over your kneecap. when your knee is bent the elastic stretches over the knee pressing down on the kneecap and causing pain.

I have been recommended surgery because i have other problems but sometimes, physio or orthotics help

I have exactly the same problem, can't sit through a movie, can't drive more than half an hour and can't sit at my desk more than 15-20 minutes. I get up walk around and it goes away. Had knee surgery it didn't help, going through pt and massage therapy, no help at all. It is miserable

Dan9969,

It sounds like you have patellofemoral syndrome (PFS). Also called retropatellar knee pain, anterior knee pain, and chondromalacia patella (this is actually an incorrect term, but it has been used for so long by many of the older physician, you can still find it being used).

PFS is most commonly seen in adolescents and young adult, but can affect anyone. It may be that the older population just isn't as active any more.

Most patients complain of pain under and around the patella (kneecap). This is worse with walking down stairs/ladders, sitting with the knees bent (called a positive theater sign), squatting, kneeling, and using the knee extension station on the weight machine.

It tends to wax and wane. Some patients have it once and it never comes back. Others tend to have periodically.

The actually etiology for it is not known. Playing sports when it is acting up does not damage the knee at all, if the patient is willing to put up with the discomfort.

There is no surgery to cure it. If it is associated with malalignment of the patella, then surgery may be done for the malalignment, but this is different from the run of the mill PFS.

Surgery to shave down the undersurface of the patella was tried in the past, with disastrous results. It just caused the cartilage to wear out faster, without helping the pain at all. When the arthroscopy came about, orthopedic surgeons hadn't learned their lesson, and though that they could use to 'scope to shave down the cartilage better. No, the results were the same. Didn't help the pain, and the thinned down cartilage wore out faster. So, surgery for PFS is no longer done.


Treatment for PFS is basically aimed at avoiding things that bother the patient. So, squatting, kneeing, and sitting for prolonged periods should be avoided. If a patient has to sit through a lecture or a movie, it is recommended that they sit on the aisle, so that the knee can be extended and moved every 5 to 10 minutes.

The knee extension station on the weight machine should not be used. This just crams the patella back into the femur, making the pain worse.

Instead, short arc quad exercises should be done (no more than 30 degrees of flexion). This selects out the VMO quadriceps muscle. If the VMO is kept strong, it tends to decrease the knee pain.

Use of a neoprene knee sleeve helps some patients. Some patients like the ones with a cutout for the patella. Key thing, it is comfortable to wear.

Ice before and after activity. Heat for soreness in the evenings.

Acetaminophen or one of the NSAIDs can be tried, if the patient has no contraindications to them.


But, other than that, there is not much else to do for the disorder. Just know that if it is PFS, it is not going to be crippling or cause arthritis. It is just one of those things that you have to put up with to be human.


So, do not keep the knee bent for so long that it starts to hurt. Flex and extend it 3 or 4 times, every 10 minutes of so, to prevent it from hurting. Take advantage of every rest break to get up and walk around a little.

Good luck.

Gaelic-
Thanks for the helpful info!
I have similar pain, however, I can sit for long periods of time with no pain. It's when I get up from sitting and get up in morning that I have the bad pain, along with stairs... If I am active, the pain goes away until I am unactive in the evening. Am I experiencing the same syndrome, only having luck that it doesn't hurt when it's bent for long periods of time?

noknees,

Your discomfort sounds more like that which comes from an inflammatory condition.

It is a hallmark for inflammation of the joints to cause “gelling” of the joints, in which they become stiff and painful after a period of inactivity. Then, the joints feel better once they have been “warmed up” and moved around some.

For example, patients with rheumatoid arthritis wake up in the morning, very stiff and sore. About 45 minutes after rising, after they have taken their morning shower, they feel much better. But, they do not like to rest, because the soreness and stiffness returns, until they are active again.


Thus, you can tell the difference between the pain from a degenerative process and an inflammatory process:

Inflammatory: Pain after period of rest, which gets better with activity.
Degenerative: Feels better after rest and gets worse with activity.


Though this is a symptoms associated with an inflammatory process, that does not mean that you have a full-blown case of an inflammatory arthropathy. You could try some nonsteroidal antiinflammatories medication (NSAIDs), to see if they help with your symptoms. The idea behind these medicines is not to mask the pain, but to actually treat the underlying inflammation. So, if may take a little time for them to work well.

If you continue to have these symptoms, or you develop further symptoms (swelling in the joints, warmth, redness), then you might want to see your orthopedic surgeon or a rheumatologist.

Good luck.

Gaelic-
I also have similar pain and I cannot sit for very long periods of time. I am an athlete who does a ton of running around and a fair amout of jumping for the sport I play. I don't have much of a problem when I am playing but when I get in the car the pain is almost unbearable. When I get out of the car and start to walk around the pain kind of goes away but my knee feels extremely weak and I feel like it's going to collapse. Have any ideas as to what is going on?

Frisbee34,

Sounds classic for patellofemoral syndrome (PFS).

Patients with PFS usually start to develop discomfort behind and around the patella after about ten minutes of sitting with the knees bent to 90 degree. If they stretch out the legs, putting them through a range of motion, the pain goes away.

This is called a "theater sign", as patients would complain that they could not sit through a movie (lecture, car ride, etc) without their knees hurting.

Thus, it is always recommended that these patients sit on the aisle, so that they can stretch their legs out once in a while. It is recommended that the range of motion be done about every ten minutes or so, and before the discomfort starts.

Unfortunately, it is very hard to do this is the current cars, with the bucket seat penis-pits. There just isn't a lot of room to stretch out (especially if you are really tall). Many patients with PFS, if they are going on a long road trip, will put the car on cruise control, so they can put the seat back and stretch their legs. City driving won't allow this, of course.


The reason for the aching behind the patella is not completely understood, but the theory is this: The articular cartilage on the underneath side of the patella sits against the cartilage of the femur, when the knee is held at 90 degrees of flexion. Because the cartilage surfaces are touching, and not being moved, the synovial fluid (joint fluid) cannot flow over the surfaces. Thus, the cartilage becomes dry and “thirsty”. The only way for the cartilage to get nourishment is by imbibing it from the fluid. When the joint is ranged, the fluid once again baths the cartilage and the discomfort decreases.


PFS is not dangerous to the articular cartilage in the knee. It will not cause future arthritis or other problems. It is just a “pain” to deal with. Some patients have it off and on for their whole lives, while in others it goes away after adolescence or young adulthood.


Unfortunately, other than ranging the knees once in a while, there is not a whole lot else to do for this. For patients who are bothered by PFS during activity, it is recommended that they build up their quads (the VMO specifically), stretch the hamstrings, use ice/heat as needed, judicious use of acetaminophen/NSAIDs, and a neoprene sleeve for comfort. (The neoprene sleeve is not recommended for long car rides, as it can compromise circulation in that situation.)

Good luck.

I am fortunate to found this blog! For past four years, I suffered with painful knees especially the right. Progressively worsen. BTW, I am retired military and use to run 3-4 times a week. All of the comments in this blog have confirmed what doctors could not (I am healthy and active 61 age female). Thank you for advice to wear an open-knee brace. And, I thank our Almighty that painful knee is my only health issue.

I am fortunate to found this blog! For past four years, I suffered with painful knees especially the right. Progressively worsen. BTW, I am retired military and use to run 3-4 times a week. All of the comments in this blog have confirmed what doctors could not (I am healthy and active 61 age female). Thank you for advice to wear an open-knee brace. And, I thank our Almighty that painful knee is my only health issue.

Glad to see this forum, I have had the same problem for several years the doctor diagnosed it as arthritis and administered cortizon injections under the patella, and the pain only subsided for 2 weeks so I never went back. I can run and play hockey and it doesn't bother me. Only when I am sitting or sleeping.

I have this problem. Driving my car hurts my knee worse than walking does. When the pain finally got so bad it was bringing me to tears, I went to the ER, where they told me I had no cartilage left in my knee. I was referred to an orthopedic. There I was informed I need to have a total knee replacement.

Keep in mind my pain was so severe it hurt down my shins and even into my ankles...... My entire leg was swollen not just the knee.

Wow this is exactly what I have... I play both singles and doubles tennis at least 5 or 6 hours a week (sometimes up to 15 or 20 hours) and my knees kind of hurt while I'm playing sometimes worse than others.

But they never hurt as bad as they do when I'm sitting at my desk or I'm driving or sitting in a movie theater or at a sporting event or restaurant. I can't drive further than 30 minutes without excruciating pain.

Ice and Advil certainly help but I'd love a permanent solution to this if there was one. I'm going to try and strengthen my quads which I've heard before from others too.

I searched this cause I have the exact same
Problem. I just find it strange we all have it in the right knee only

I have it in my left knee. Fifteen minutes of sitting and the pain is nearly unbearable. When I stop the car and stretch it out I'm pain free.

Is there any way it could be tied to how much caffeine in the system? Lately I find myself drinking more coffee or Coke. Lifestyle change. Just wondering if there might be a connection.

simcoe,

Some people feel that there is some connection between anterior knee pain and caffeine. This mainly comes from the fact that caffeine can cause some dehydration, and dehydration can affect the articular cartilage.

As to caffeine having a direct effect on cartilage, that is still being studied, but as of yet, not too much has been found.

As you have noted, patients with this condition need to stretch out their knees frequently. Try to do this at least every ten minutes or so. Also, try to do it before the pain set in. You know it is going to occur, so try to prevent the problem, if possible.

It is kind of difficult with the newer cars, which have bucket seats and nowhere to really stretch the legs. But, do try.

Good luck.

Try Kenizio Tape for the knee pain while sitting or driving. It stabilizes the Patella or knee cap and helps promote blood flow the knee cap area....no more pain!

alot of times with weakness of the VOM, the patella won't track right and it is very subtle, hard to find on exam, but causes enough pain, especially at night, with sitting, and sitting in the car with foot on gas, that the pain can be extreme. taping the knee cap gently up and slightly outward, or tweak it a bit to see which direction works best for you, icing, and then taking 250 mg of niacinamide 4 times a day (with or without food it doesn't matter), helps a lot. stretch hamstrings gently, piriformis and gluts gently, and make sure feet aren't pronating in so wear shoes in house with inserts for pronation to protect patellar position. if you do this and it helps to a degree right a way, you got more important input and more move toward healing. the body and knees are designed to heal if we figure out what is continually the weak link wearing them out, and shore that up, and i say, look to these things and give them a gentle try.

Another quick point that is usually over looked is what you are consuming for food. If you have a high starch, complex carb, high saturated fat, or high sugar daily intake than this may contribute as well. All of the foodstuff that I just wrote have properties that aggregate the bodies inflammatory response. Not an expert but I tried removing sugars and processed carbs from my diet and it helped a lot. It took a few months before I noticed a difference but it helped tremendously. Not to mention I lost about 12 pounds, so it was a win win.

Great post guys I've learned a lot!! I'm stoked it's just pain and nothing degenerative.

It is an inflammatory problem, and as such, I agree with the guy above me for the most part... I like saturated fats and dislike polyunsaturated but I digress back to my initial point.

Here is an idea that I haven't heard yet. Speaking of diet, this counts kind of... Instead of acetaminophen, or other anti-inflammatories that are hard on your liver and kidneys, try Turmeric, it's a spice from the India with similar results. You could also use it in concert with acetaminophen, because it's essentially harmless and will most certainly inflammation.

In my experience, it's a beast of an anti-inflammatory and you've probably ingested on numerous occasions, it's used in curries frequently. You can eat a ton and be just fine and it helps so much!! It's worth a try at the very least and is very cheap at your local health food store. The other name is Curcumin.

All of you suffering with chronic pain, taking lots of Ibuprofen and the like, may want to give it a try for the rest of your bodies sake.

Hope this helps

Wow, i'm so pleased i found this post. I have all the same symptons in my right knee. I already have ostoearthritis in my left knee, but i knew this was entirely different as i can walk and run no bother, it's the sitting at my desk and in the car that causes the problem. I also get a pain at the inside bottom of the kneecap when in the car. Glad it's not more arthritis!

I to am glad i have found this post my problem started when i went for a 5 hour motorcycle ride .My right knee started to fill stiff and sore after 3 hours had to keep stopping and strecthing my right leg sometimes the pain was unbearable.Its been 4 weeks and the pain has gone a way when i stand and walk down stairs but when I sit the pain comes back after 10 minutes plus also when I ride my motorcycle which is a trailbike so my legs are not cramped up the postion of the leg would be 90 degree`s when riding .The right knee also gets painful when i am lying in bed with my leg straight the pain wakes me up every night and i find putting a pillow under my ankle and raising it helps i have not been to a doctor yet as i thought i had just pulled a muscle .I have just had my 45 birthday and thought i was a part of getting old I am surprised how commmon this seems but why is everyone getting it in the right knee strange ...

Shanus,

As to the right knee, it is actually common for patients to have a "dominant" and "nondominant" leg, just as they have a dominant and nondominant hand.

So, many patiets are "right legged", for example, given a choice, which foot would they kick a soccer ball with. It has been found that most right handed patients, are also right "footed".

So, it may just be that the right knee bothers patients more, because they use that leg more for activity.

No real science here, just an observation.

Hope your knee is doing okay, and you can continue to ride your motorcycle.

Good luck.

I have the same problem in my left knee (which I always considered my "weaker" knee.

Hi,

I went to the doctors again today about my knee (i have same problem) and they didn't have a clue, just arranged some blood tests and will look at it again in a few weeks. Im glad i found this page just now.

I get this problem on flights and driving, I rarely sit in this position at home or work because I fold my legs and sit in my own comfortable positions, I have no other problems with the knee at any other time even though I jog.

I like the information about the cartilage and the fluid, it sounds like a reasonable stab at the problem but for me I don't think it's a case of the legs just being at the 90 degrees angle and ill explain why.

When I used to fly to china, the 12 hour flight was hell, since then I put my hand luggage on the floor just in front of me and put my feet on the bag to raise my legs slightly off the seat, still 90 deg, this does the trick. I've also noticed I get the problem worse in some cars than others. My conclusion is that a nerve, muscle, tendon or vein is being pressed upon by the seat and not the cause of my knee being at a particular angle.

I will repost if I get anything more from my visits to the doctor or hospital, but, by the sound of things I'll be stuck with this problem without a solution, especially when they ask me the same questions and don't listen to my answers.

misterB,

It does not really matter what the angle of the knee is at, but rather that it is not being moved around very much.

It is just that at 90 degree, more of the patella is in contact with more of the femoral groove, so there is more cartilage not being bathed in the synovial fluid.

There is a condition which men (mostly) have when sitting on a large billfold in the back pocket in a long car ride (plane flight), where it presses on the sciatic nerve in the posterior aspect of the thigh/buttocks. But, this usually causes numbness/tingling in the lower leg/foot and pain radiating down the back of the thigh. It does not produce knee pain.

The same sort of thing can happen when people sit on a hard seat or edge (toilet seat). Many patients have to be carefull upon standing up after having a long "sit down", because their lower extremities have gone to sleep. If you watch american movies, this is what happen in one of the Lethal Weapon movies.


Usually, tendon, muslce, or bursal problems will present if very specific ways, for that particular structure. There aren't really any of these which produce a dull, aching pain inside the knee or around the patella. Most physicians are not very well trained in muscloskeletal examination or disorders (that is why there is the speciality of orthopedic surgery). Unfortunately, for some reason, when most primary care providers are presented with nonspedific joint aches and pains, they either say it is due to overuse type of syndromes or they send off for a whole bunch of labs (CBC, ESR, CRP, RA. ANA, etc, etc, etc) to see if the patient has "an inflammatory arthritis", even though the patient has absolutely no signs of an inflammatory disorder (boggy swelling of multiple joints, warmth, redness, and systemic illness).

Orthopedic surgeons have seen so many patients with the patellofemoral type of syndromes, unfortunately, they are kind of bored with it. But, also, there is not a whole lot they can do about the condition, but tell the patient that there is not a whole lot to do expect not to sit with the knee bent, avoid squatting or leg extensions on the weight machine, use NSAIDs prn, use a knee sleeve if it helps, and to keep the quads strong. That does not make them a lot of money, and since they are surgeons, they would prefer to be taking care of patients with surgical problems. But, they still see a lot of patients with PFS symptoms, because they are rampant in humans. Most people will have some PFS symptoms at one time in their life or another. Most adjust their lifestyles and change the way they do things, and get by living with the symptoms. Oh well.


Hope your knees are feeling okay.

Good luck.

Hi, i recently posted above and have since (28th Jan) had surgery to remove a section of torn miniscus in the right knee. I'm still getting the pain at the back of the knee but this is now accompanied by a need to click my knee at the back. This is very much a 'back of the knee' click though and is sometimes extremely painful when it happens, other times just a mild click. I'm not due back for follow up consultation until mid March - will this go when the swelling has completely gone. (it's not very swollen now really)?

ColW,

It is very common for patients to have pain in the posterior aspect of the knee (along with a feeling of it being tight) when there is significant swelling inside of the knee (called an effusion).

After surgery, there will be swelling inside the knee after surgery, not only from the trauma of the surgery and some of the residual arthroscopic fluid used, but also due to some build up of inflammatory fluid after the trauma of surgery.


Hopefully, after your surgery, your surgeon advised you to elevate your leg as a straight unit, rather than draping your knee over a pillow/pad. While it is usually more comfortable to drape the knee over a pillow, because in this position the volume inside the knee is at its largest, so if there is any fluid in the knee is will not feel as tight. The problem is that this can cause a contracture of the posterior capsule.

This contracture is what leads to the tight feeling in the back of the knee and discomfort in the long run. In some patients, just a few days of draping the knee can lead to such a significant posterior contracture that the patient ends up walking on his/her toes, because he/she can no longer get the knee straight.


Also, when there is an effusion present, some of the fluid can leak into one of the bursa in the back of the knee, just behind the head of the gastroc muscle. This, in some cases, can lead to the formation of a Baker's cyst in the back of the knee. The cyst does not need to be treated itseld, since it will go down when the swelling goes down. (In patients who present first with a Baker's cyst and swelling in the knee, they should be evaluated for a torn meniscus or other intra-articular pathology. But, you have already had the surgery to take care of any intra-articular pathology.)

This swelling within the bursa or formation of a Baker's cyst can cause a clicking or squishing sensation in the back of the knee is some patients. Again, this usually goes away when the effusion goes down.

Be sure to stretch out the knee everyday, making sure to get full extension. Flexion will usually come on its own, but if you do not get the extension, it can lead to a flexion contracture and walking on the toes (along with quad mechanism problems).


If you are concerned about anything going on, do try to contact your surgeon before your next appointment.

Good luck.

Many thanks G. the physio did mention about the leg remaining straight and doing some raises, but it's reassuring to hear the rear knee pain is not uncommon. I just need to be more patient in my recovery.