The complaint of knee stiffness is commoner among the elderly and inevitably even among the active individuals, especially after sixty years of age and this can be a result of imbalances occurring in the muscle and disuse in the elderly.
Although there are numerous causes of knee stiffness arthritis and injuries to the knee joint happens to be the leading causes of knee stiffness today (1). This article will be discussing the various causes of knee stiffness and their effective management regimens.
What Are The Causes Of Knee Stiffness?
Knee stiffness is almost always secondary to an underlying condition and most times it is a result of injury to the joint. Below are the causes of knee stiffness:
- 1. Trauma
Most of the stiffness accompanying trauma to the knee does not surface immediately which is because the pain from the trauma is very severe at the time, and on some rare occasions, stiffness manifests almost immediately after the trauma.
The traumatic events that lead to knee stiffness are fracture and sprain
In fracture, patella fracture especially in adults is the most common cause of knee stiffness which most times are due to falls. The knee is stiff and swollen in most cases where the fracture is the cause of the stiffness
A sprain occurs when there is a twisting of one or all of the ligaments of the knee joint. This can result from any activities that will cause a forceful impact on the joint especially sports injuries like track events, the knees sore from running and subsequently, stiffness evolves. Knee stiffness and pain is the most common clinical manifestation in this case (3).
- 2. Fibrosis
The type of fibrosis common around the joint is referred to as arthrofibrosis, which occurs as a result of scar tissues forming around the joint from previous injuries or surgeries to the knee. The common manifestations are knee stiffness and pain, knee swelling and differential warmth at the affected knee joint, and affected posture (1).
- 3. Meniscal injury
The meniscal injury occurs from tears to the cartilages that are situated between bones. Commonly they are seen in sports injuries where the athlete had to stop suddenly or make a sudden turn.
Osteoarthritis is also one of the commonest causes of meniscus injury making the knee sore inside. The meniscal injury will result in joint pain, edema, and difficulty in moving the knee joint. This causes the knee to stiff (2).
- 4. Rheumatoid arthritis
Rheumatoid arthritis usually occurs due to the immune system having an attack on the normal body system. In most cases, the bilateral knee joints are affected. It manifests with synovial membrane swelling. Consequently, this swelling and pain from the synovial membrane result in knee stiffness (1).
- 5. Inflammation of the bursae
Inflammation of the bursae is medically referred to as bursitis. The bursae contain a fluid that lubricates the bones of the joints to prevent friction between the bones, and there are more than one bursae in one joint.
When the knee joint is being overused maybe from continuous exercise, bursitis can occur and this will cause the knee to be stiff, and in such cases, the knee is stiff after sitting for a long period (3).
- 6. Post-surgical stiffness
Oftentimes, knee stiffness also occurs after surgical procedures are done on the knee and this is a similar case to arthrofibrosis.
Common surgical procedures complicated by knee stiffness are Repair of injuries to the tendon, excisional surgeries, partial or total knee replacement surgeries, and repair of ligament injuries (4).
- 7. Injuries involving the ligaments
Ligamentous injuries often cause the patient to experience severe pain. The ligaments of a joint connect the bones and these are the femur, the tibia, and the fibula. They help to ensure the stability of the knee joint.
Commonly in sports injuries, injuries to the ligaments can affect any of the three ligaments in the knee, that is, the anterior, posterior, and medial cruciate ligaments.
Road traffic accidents from high forces can also result in ligamentous injuries.
Patients presenting with injuries to the ligaments often present with the following feature:
- – Pain in the knee that is always very severe
- – The pain is present while moving
- – Noise in the knee sounding like crepitus
- – Instability or difficulty in movement
- – Edema of the knee joint
- – The knee is sore on inside causing stiffness (2).
- 8. Osteochondritis dissecans
This is a joint disease characterized by inadequate blood flow beneath the cartilage located at the end of a bone. Insufficient blood flow causes ischemia of that particular layer of bone which eventually will lead to the death of the bone and destruction of the cartilage as well.
The cause of this is mainly idiopathic but it has been associated with forcing infants to move their immature bones right before maturity causing insufficient blood flow. It commonly affects the knee joints, although any other joints of the body can also be affected. After the initial swelling, knee stiffness and pain are other common manifestations of osteochondritis (3).
- 9. Systemic lupuserythematosus
This is an autoimmune disease and just like rheumatoid arthritis, it causes the immune system to fight against the normal body system as if it is attacking a microorganism or a disease agent. Lupus manifests in different forms when different organs of the body are affected, its manifestation will be dependent on the affected body system or organs.
Some of its clinical manifestations are Lupus rash which normally takes the pattern of a butterfly, weakness, photosensitivity, migratory polyarthritis, pains in the chest, discoloration of the toes and the fingers when cold, slow mentation, and lots more. As the joint pains continue, it gets complicated by stiffness. Any joint of the body can be affected, including the knee joints (3).
- 10. Fractures
Fracture to the knee joint occurs when there is a discontinuity in any one of the bony components of the knee joint and this can cause immobility and stiffness of the knee.
And after the repair of the fracture or its healing, the stiffness remains for a while and some normally require physical therapy to fix them.
Therefore, patients recovering from knee fractures are always advised to be diligent with their physiotherapy appointments o help resolve the stiffness and accompanying swelling too (5).
Symptoms Of Knee Stiffness
Irrespective of the cause of the knee stiffness, the patient always has other symptoms with the stiffness. These are:
- – Swelling
- – Pain
- – Differential warmth
- – Presence of fluid in the joint
- – Immobility
- – Crepitus sounds
- – Deformity
- – Inability to bear weight
Symptoms can go worse over time and there is to see a specialist. When the patient experience any of the following, it is time to see the doctor:
- – Difficulty in bearing weight on the affected limb
- – Other signs of inflammation like fever and redness
- – A very severe pain
- – Deformity of the affected leg
- – Immobility
However, the patient should visit the doctor as soon as there is any injury involving the knee joint.
Diagnosis Of Knee Stiffness
To make a definitive diagnosis of knee stiffness your body will ask certain questions from you to have a thorough history of what happened after which some investigations will be done.
However, knee stiffness is always a primary diagnosis secondary to something. It doesn’t just occur on its own. Here are some of the investigations to be done to diagnose the causes of the knee stiffness:
- 1. Blood tests: Blood tests are usually done to detect the blood level and see inflammatory changes in the blood. Most times, a blood test is done to rule out arthritis.
- 2. X-Rays: X-rays to detect a possible fracture or identify certain changes in the joints that may also be pointing toward arthritis
- 3. MRI scan: This is usually done to identify damages to the soft tissues surrounding the knee joint and this is usually the ligaments and the tendon (4).
Treatment Of Knee Stiffness
The treatment of knee stiffness is always dependent on the cause of the stiffness. Treatment can either be long-term or short term and the good news is that there are multiple home remedies available for patients with knee stiffness for treatment.
Home Care Methods
The majority of the things required or available for the patient to be done at home are basely lifestyle modifications that will largely help to improve the underlying condition of the patient which consequently, will treat the stiffness.
- 1. Following the RICE principle: RICE is an acronym for Rest, Ice, Compression, and Elevation.
- – Rest: This involves gentle positioning of the leg or just soft or mild moving activities but with little or no stress on the affected limb. Also, the use of crutches is advised to minimize weight on the leg.
- – Ice: The use of ice is to minimize swellings to the knee joint. Ice packs can be used or put the leg into ice water.
- – Compression: Most times, compression serves dual purposes, to prevent excessive movement of the limb and to also relieve the swelling. There are compression bandages or braces available for this purpose.
- – Elevation: This has to do with raising the knee joint to reduce the downward flow of fluid thereby reducing edema of the affected knee joint. Elevation can be done by raising the lower edge of the bed or simply supporting the knee with a soft pillow for improvisation (3).
- 2. Avoid sitting up in one place for a long time: The knee is stiff after sitting the majority of the time in those with a sedentary lifestyle at work or home. Mild to moderate moving around for like thirty minutes can be done at intervals in a situation where an individual is always confined to a place.
The use of exercises like yoga has also proven to be of help in such patients.
- 3. Cold and warm compresses: No individual should do this except by being trained by the physiotherapist to carry out such. But, this method has also been proven to help with knee stiffness at home.
- 4. Weight loss: Weight loss is one of the remedies for osteoarthritis. This will however help to relieve knee stiffness in such patients (2).
The Use Of Medications
This management largely involves the use of parenteral steroids and drugs.
- 1. Pain relievers: The type of pain relievers recommend here are the topical ones which involve direct application over the skin of the affected knee joint. It makes side effects minimal and it can be used many times in a day and when required too.
- 2. Steroids: Recommended steroids for knee stiffness secondary to arthritis is the triamcinolone acetonide based on its effective action from studies and it has also been approved by FDA. It is a slow-release steroid that works for up to three months when injected into the knee. It has lesser side effects like steroid-induced diabetes and cushion syndrome when compared to other steroidal uses (2)
Knee replacement surgery and osteotomy are the two surgical procedures commonly performed on account of knee stiffness not resolving
In younger patients, an osteotomy is largely done to avoid rushing in for a knee replacement and this has to do with reforming and cutting off parts of the bone to solve misalignment problems and also to relieve pain.
Knee replacement is either total or partial knee replacement. A total knee replacement is done if the entire knee is damaged with no other remedy. While a partial knee replacement is opted for when it involves only a part of the knee (2).
Other Treatment Modalities Are:
- 1. The use of supplements: There are numerous supplements available today both online and in pharmacies claiming to work well for knee stiffness. But the popularly approved ones are the use of glucosamine and omega -3. Chondroitin has also proven to be effective as well (5).
- 2. Use of assisted devices: If the knee stiffness is large for arthritis, the physiotherapist will help recommend the use of assisted devices to help aid mobility (2).
Knee stiffness is large as a result of injury, activity, or secondary to disease. To prevent this, one should avoid a sedentary lifestyle and exercise the legs as often as possible. There are cases where knee stiffness can occur on its own without an underlying disease or inactivity and there are situations where the knees are stiff after sitting. Such cases usually resolve easily following the RICE principle discussed above (4).
- 1. https://www.medicalnewstoday.com/articles/327499
- 2. https://www.healthline.com/health/causes-of-severe-knee-pain-leading-to-knee-replacement#ligament-injuries
- 3. https://www.buoyhealth.com/learn/knee-stiffness#treatment-and-relief
- 4. https://www.verywellhealth.com/stiff-knee-after-sitting-5094756
- 5. https://www.knee-pain-explained.com/stiff-knee.html