Knee pain is common in obese people and older adults. But in these cases, it is difficult to point out a single diagnosis without a profound look at the structure of the articulation and the symptoms. Conversely, some types of knee pain are easier to identify and diagnose. When it is triggered in one single position or circumstance, it gives doctors an important clue to make appropriate tests and reach a diagnosis faster.
If you report sharp pain triggered by kneeling down, you are giving your doctor two important clues that will narrow down your most likely diagnoses to three medical entities. In this article, you will understand where does the pain come from, and the reason why kneeling down becomes so painful.
Where does my knee pain come from when kneeling?
To understand where your knee pain comes from, we need to know a bit more about this articulation. It is one of the most complex articulations in the body, but for educational purposes, we are narrowing down the explanation into three key components usually involved in knee pain when kneeling.
- Knee bones: An articulation always has two or more bone ends meeting each other with a cushion-like structure in between. In the case of the articulation of the knee, they are the femur, the tibia, and the patella. The fibula is also important, but it is further down and not in direct contact with the femur. Any damage to these bony structures can cause knee pain.
- Knee bursae: They are structures located in the knee, and have the function to act as a cushion and reduce friction between the bone ends and other parts of the knee. There are three bursae, called suprapatellar, prepatellar, and infrapatellar bursa, each one located above, in front, and below the patella, respectively. When they become inflamed, the pressure increases in the area, and it causes knee pain.
- Knee tendons: They connect the muscles of the leg with the articulation of the knee. As such, they are essential for the movement of the articulation. We can highlight the quadriceps tendon, which connects the anterior muscle of the thigh to the patella, and the patellar tendon, which connects together the tibia and the patella. The latter is usually referred to as a tendon, but it is technically a ligament.
Three likely diagnoses to consider with your doctor
Based on these structures, we can have three different diagnoses that give a similar type of knee pain, usually described as a sharp pain when kneeling down. They are as follows:
- Osgood Schlatter’s disease: It is the first guess the doctor will suspect when this sharp pain triggered by kneeling is reported in children. It is more likely after 9 years of age and before 16 year-olds. This is a problem in the bone tissue when there is one tuberosity forming in the front of the tibia. This tuberosity causes tenderness in the area of the shin, and when the patient kneels down, the pressure of the articulation, the tendons, and other structures causes the sensation of sharp pain. This disease is more common during growth spurts, and patients stop feeling pain when they stay up.
- Knee bursitis: In adults, this is the most frequent cause of sharp pain in the knee when kneeling down. As mentioned previously, there are three bursae in the knee articulation, and each one of them can become inflamed. They normally reduce friction between bony structures, but when they are inflamed they increase the internal pressure of the knee and trigger the nerve terminals that cause pain in the knee. During kneeling down, the affected bursa squeezes against soft structures and bones, causing sharp pain. After standing up again, patients may feel dull knee pain while standing up because the bursa is still swollen. It is more common in people who stay kneeling for a very long time due to sedentary behavior or work.
- Patellar tendonitis: This is the second most common diagnosis when patients report pain when kneeling down. This type of pain is caused by the patellar tendon, which is below the patella, connecting this structure to the tibia. Thus, patellar tendonitis pain is located below the kneecap, and it is caused by inflammation of this structure. It causes sharp pain and tenderness when you touch the patella, and you can sometimes feel a palpable lump right in the spot where it hurts the most. This diagnosis is more common in active people who play sports, especially when they require constant kicking and jumping. For this reason, it is also known as jumper’s knee.
What else could it be?
There are many other possibilities, and depending on your age, your doctor may need to perform a few exams to rule out arthritis, gout, and similar joint problems.
There are many types of arthritis, and some of them cause pain in a single articulation. You can have arthritis at any age, even in young patients with overuse injuries. And gout problems are more common in men, associated with a high level of uric acid in the blood.
Keep in mind that, if you recently endured a fall, this sharp pain after kneeling down may be associated with trauma. In most cases, pain associated with trauma improves after a few days. But if you are not improving or feel instability in the articulation, consider the possibility of having a ligament rupture, a meniscus tear, or a kneecap injury.
References: Duri, Z. A., Aichroth, P. M., Wilkins, R., & Jones, J. (1999). Patellar tendonitis and anterior knee pain. The American journal of knee surgery, 12(2), 99-108. Draghi, F., Corti, R., Urciuoli, L., Alessandrino, F., & Rotondo, A. (2015). Knee bursitis: a sonographic evaluation. Journal of ultrasound, 18(3), 251-257. Gholve, P. A., Scher, D. M., Khakharia, S., Widmann, R. F., & Green, D. W. (2007). Osgood schlatter syndrome. Current opinion in pediatrics, 19(1), 44-50.