October 17, 2021

Causes of Knee Pain in Young Adults

Written by: Amanda Cheong, M.D.

When I was younger, I imagined this part of my life to include less creaky joints. Who has knee pain at 25 years old?! That always felt like problems of our parents’ age-- that the groan of stiff joints came after the dad jokes had time to ferment and become embarrassing to our teenage kids.

 

But the problem of knee pain in young adults may be more prevalent than expected.

 

Prevalence of knee pain in young adults

 

When students and staff of a university were surveyed, researchers found that as many as 37.2% of them reported having knee problems. In those who did, nearly 70% said they experienced knee pain.[1] Among teens and pre-teens, 22.7% reported having knee pain within the last week.[2] These knee pains can come on their own or as part of a larger diagnosis.

 

Osteoarthritis remains the most common diagnosis for visits about knee pain in general practice.[3] Those who suffer from obesity, joint injury, and unfortunate genetics are more susceptible to this disease. And make no mistake, this can be present in active, and athletic young adults.[4] The wear and tear of joints isn’t reserved for old age.

 

Aside from osteoarthritis, a different entity known as patellofemoral syndrome (PFS) is also common in the younger population.[5] Also known as ‘runner’s knee,’ most who have this complain of pain when the body’s force is exerted on a bent knee. Think of running, squatting, or even just trying to get to the second floor. The primary reasons for PFS include muscular imbalance, overloading the joint, or injury.[6]

 

But these entities may not be so different from each other with some studies showing a potential link between the two diseases.[7] Still, not all knee pain would fall neatly into these two categories. Some of them happen on their own and for, perhaps, surprising reasons.

 

Common causes of knee pain in young adults

 

We’ve already mentioned the diseases-- osteoarthritis and patellofemoral syndrome. But let’s hop back to the things we can change before it progresses to that. Or at least try to-- because the choices may not always be as straight forward.

 

When they studied children ages 10-17 years old, those who participated in their physical education classes in school were less likely to experience knee pain than those who didn’t.[2] However, in older university aged students, the trend seems to reverse.[1]

 

Ibeachu and colleagues[1] found that the prevalence of knee pain increased in students and staff with every 10kg/m2 increase in their BMI, when they spent more hours sitting down, and when they had higher physical activity. And which did they realize was the most significant? The higher physical activity-- and with a linear relationship. That means, the more active one is, the higher the risk for knee pain. Undergraduates who engage in sports recreationally report less knee pain compared to those who participate in competitive sports.[8]

 

A larger and more recent study also reached similar conclusions. Whitaker and colleagues[9] followed individuals who were sedentary or engaged in low intensity or moderate-to-vigorous intensity exercises over the course of 10 years. They found that those who engaged in moderate-to-vigorous intensity exercises, and even the ones who did light exercise, were more likely to experience knee discomfort, pain, and stiffness.

 

Related Article: Guide To Best Knee Scooters in the Market

 

Risk versus benefit of increased physical activity

 

So, do we just stop exercising to save our knees?

 

Both of these studies have raised the issue that the findings pit two opposing public health concerns against each other.[1,8] On one hand, knee pains can cause a significant hindrance in physical functioning. On the other hand, a sedentary lifestyle is associated with several comorbidities including obesity-- which, in turn, increases the risk of osteoarthritis. The guidelines on how to stay heart-healthy include moderate-to-vigorous intensity exercises.[10]

 

Personally, between knee pains and increasing my risk factors for a heart attack, I would keep up with my exercises.

 

This is not to accept that knee pains are a fact of life. But it does recognize that for everything we do, there are risks and there are benefits. It’s all a matter of weighing them against each other. Like any machine that needs to continue functioning, our bodies will experience a certain amount of wear and tear. We need to be mindful of these small aches and pains to know when to give our bodies some rest as well-- there are still exercises that require a lot less jumping than others!

 

Knee pain treatment at home

 

Treatment of knee pain generally depends on what’s causing that pain. So if your knee hurts because it was injured during a football game, this section isn’t quite for you. This is for those small aches and pains-- not torn ligaments that need a doctor to perform a few physical maneuvers.

 

Oftentimes, knee pain that’s brought about by increased physical activity just requires some rest. Over the counter oral pain killers can be used to help relieve the pain in combination with specific physical therapy. Weight loss may be recommended where appropriate, often in individuals with a body mass index above 25kg/m2. But the most effective treatments boil down to exercise-therapy.[11]

 

Exercise therapy has been especially effective in short-term, activity related knee pain. This sort of therapy is geared at strengthening the muscles around the knee joint and, in turn, the stronger muscles would decrease the pressure on the joint. Exercise therapy showed reduction in pain felt and improved functioning as a result. Exercising both the hip and the knee joint has been more effective than focusing only on the knee joint.[12] Another recent study even showed that adding spinal manual therapy into the equation was more effective than a local exercise therapy-- though both were noted to reduce pain.[13]

 

While knee pain in adolescents or young adults may be surprising, we find that it’s not all that uncommon. The most common causes of knee pain in young adults often include the wear and tear of the joint brought about by strenuous exercises. Some rest and exercise therapy can help relieve this pain and improve functioning.

 

References

  1. Ibeachu C, Selfe J, Sutton CJ, Dey P. Knee problems are common in young adults and associated with physical activity and not obesity: the findings of a cross-sectional survey in a university cohort. BMC Musculoskelet Disord. 2019;20(1):116. Published 2019 Mar 18. doi:10.1186/s12891-019-2487-2
  2. Saes MO, Soares MCF. Knee pain in adolescents: prevalence, risk factors, and functional impairment. Braz J Phys Ther. 2017;21(1):7-14. doi:10.1016/j.bjpt.2016.04.001
  3. Frese T, Peyton L, Mahlmeister J, Sandholzer H. Knee pain as the reason for encounter in general practice. ISRN Family Med. 2013;2013:930825. Published 2013 Dec 26. doi:10.5402/2013/930825
  4. Amoako AO, Pujalte GG. Osteoarthritis in young, active, and athletic individuals. Clin Med Insights Arthritis Musculoskelet Disord. 2014;7:27-32. Published 2014 May 22. doi:10.4137/CMAMD.S14386
  5. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. Am Fam Physician. 2019;99(2):88-94.
  6. Bump JM, Lewis L. Patellofemoral Syndrome. [Updated 2021 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557657/
  7. Wyndow N, Collins N, Vicenzino B, Tucker K, Crossley K. Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med. 2016;46(12):1797-1808. doi:10.1007/s40279-016-0545-6
  8. Chan LLY, Wong AYL, Wang MH. Associations between sport participation and knee symptoms: a cross-sectional study involving 3053 undergraduate students. BMC Sports Sci Med Rehabil. 2020;12:20. Published 2020 Mar 23. doi:10.1186/s13102-020-00169-w
  9. Whitaker KM, Pettee Gabriel K, Laddu D, et al. Bidirectional associations of accelerometer measured sedentary behavior and physical activity with knee pain, stiffness, and physical function: The CARDIA study. Prev Med Rep. 2021;22:101348. Published 2021 Mar 9. doi:10.1016/j.pmedr.2021.101348
  10. Piercy K, Troiano R. Physical Activity Guidelines for Americans From the US Department of Health and Human Services. Circulation: Cardiovascular Quality and Outcomes. 2018;11(11). doi:10.1161/circoutcomes.118.005263
  11. Jones BQ, Covey CJ, Sineath MH Jr. Nonsurgical Management of Knee Pain in Adults. Am Fam Physician. 2015;92(10):875-883.
  12. van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;1:CD010387. Published 2015 Jan 20. doi:10.1002/14651858.CD010387.pub2
  13. Scafoglieri A, Van den Broeck J, Willems S, et al. Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):446. Published 2021 May 15. doi:10.1186/s12891-021-04310-9
Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

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