Buckling of the knee

Buckling Knee

Q1. My left knee buckles occasionally. When it happens I can’t put weight on the leg, and it is very painful. The X-ray showed some calcium pieces in the knee. Please tell me what this means and if there is a name for it. I have been referred to an orthopedic surgeon. Thank you so much.

It seems that you have a piece of calcified cartilage that has come loose and is floating freely within the joint space. Also called a “loose body” or “joint mouse,” this can become caught in your joint, causing your knee to buckle and even “catch.”

The buckling you describe may be caused by instability of the knee due to weakened ligaments. Loose bodies can form because of trauma, because of a broken-off osteophyte (bony spur), or because of osteochondritis dissecans, where part of the bone loses circulation and fragments. In all these cases fragments of bone or cartilage come loose and float inside the knee joint. These fragments can be removed by arthroscopic surgery, which can be done as day surgery. The orthopedic surgeon makes two incisions, one for an instrument with a light to visualize the joint, and one to insert an instrument that can be used to remove the loose body.

There are other causes for calcium in joints. A type of arthritis that is called pseudogout (“false gout”), or chondrocalcinosis, can cause fine calcium deposits on the cartilage of the knees and other joints. Pseudogout can cause chronic or acute arthritis with inflammation, and special calcium crystals can be identified in the joint fluid. Pseudogout is treated with medications, not with surgery. Your orthopedic surgeon should be able to tell you what’s going on inside your knee and the best way to treat it.

Q2. I am 15 years old going on 16. I had knee surgery due to a sports injury, but even after all the post-surgery therapy I can’t bend my right knee like my left during stretches in track practice. It has now been a year, and when I do certain stretches before track it hurts for me to bend my knee. Do you think this could be linked to bone loss at my age?

— Jalezia, Connecticut

I appreciate your question, but I have several of my own below. Judging from your first name, I assume you are a girl, and at the age of 15, I assume that you have started menstruating. Your answers to the following questions would help me to better answer your question:

  • Do you menstruate every month?
  • How much do you exercise now?
  • What part of your knee was injured?
  • Was your surgery arthroscopic or open?
  • Do you have any difficulty stretching your knee?
  • How far can you bend your knee? Halfway, a third of the way?
  • Does your knee lock, catch, or give way?

The reason for the first two questions is that young women who exercise too much, known as “exercise junkies” or “obligate athletes” may have one or more of the following problems: menstrual dysfunction, eating disorders, and low bone mass. These problems are known as “the female athlete triad.” Menstrual problems range from irregularity of periods to no periods at all (“amenorrhea” in medical lingo). This is more common in thin athletes, because when body fat is less than 20 percent of body weight, the ovaries do not function normally (do not ovulate). Another reason is that vigorous, regular exercise produces endorphins in our brain, which are molecules active against pain, and creates the feeling associated with the term “runner’s high.” Endorphins inhibit the action of pro-hormones, resulting in suppression (decrease) of the function of the ovaries.

Estrogen is a female hormone produced by the ovaries that is very important in the formation and maintenance of our bones. When a girl or a woman does not have periods, as in obligate athletes and postmenopausal women, then bone is lost and we end up with osteopenia (slight loss of bone) and even osteoporosis (more profound and potentially serious) loss of bone. Osteoporosis increases one’s risk of fractures — in fact, ankle fractures are often seen in female athletes who have amenorrhea, while hip, spine, and wrist fractures are commonly seen in postmenopausal women.

Regarding my next two questions, if your sports injury was extensive, and a lot of work had to be done by the surgeon to repair it, you would have more of a chance to form scar tissue inside your knee. Scar (connective) tissue is what the body produces during the healing process. Excessive scar tissue could interfere with your ability to bend — or extend — your knee. Similarly, if open surgery was necessary, there could be more scar tissue formation along the incision with similar bending problems. Some patients tend to form more scar tissue than others.

Difficulty stretching the knee could result if surgery (or other treatment) was delayed, or if physical therapy exercises were not done as prescribed. In this case, there is scarring that causes a flexion contracture, with inability to extend the joint. Thankfully, this is not your problem.

My sixth question is an attempt to quantitate your level of difficulty bending the knee. Flexion to 90 degrees is generally adequate to carry out most activities. If you can flex to 90 degrees you should not have much of a problem, though you should continue physical therapy with exercises and warm compresses so that your flexion will increase. After exercise, however, cold compresses are more helpful, in case any inflammation is going on at that time.

And finally, if you have any feeling of your knee locking or catching when you walk or stand, you should let your doctor and trainer know — it may mean that a piece of cartilage or bone is loose inside the knee and catches with certain movements. If the knee gives way during activity, it usually means that the joint is not stable because the ligaments that reinforce it or the capsule that contains it are compromised in some way. Rupture (tear) of ligaments or of the capsule can cause instability.

Bone loss does not cause problems with knee flexion.

To summarize, please make certain that you:

  • Exercise within reason, so your ovaries function properly.
  • Eat nutritious, well-balanced food that also provides you with calcium and vitamin D, both being essential for strong bone development.
  • Avoid any fad diets.
  • Continue your exercises to increase knee flexion.

Q3. My knee has been X-rayed, and does show arthritis. My doctor has given me a muscle relaxer and pain pills, but it doesn’t seem to be getting any better. It felt like a spring popped in my knee when it started hurting. Do I need to get a MRI to see if something else might be going on?

— Debra, Texas

The popping sensation you describe could have been caused by a number of problems, including:

  • a tear in the meniscus
  • a tear in one of the cruciate ligaments
  • impingement of the synovial plica.

I’ll address each of these in turn. Menisci are two pieces of cartilage that we have in each knee joint. They act as “shock absorbers” and are prone to tearing or degeneration. In older surgical practice, doctors removed the torn meniscus, but it was later found that osteoarthritis frequently developed in the knee, so, the current practice is to repair the torn meniscus.

Inside the knee there are two very important ligaments that cross each other, forming an “X.” For this reason, they are called cruciate ligaments. Tear of either of the cruciate ligaments can cause instability of the knee (wobbliness). Tear of the anterior cruciate ligament tends to be more frequent. Both anterior cruciate tears and meniscal tears tend to be common athletic injuries and sometimes occur in the same knee.

Synovial plica is a fold, a piece of tissue inside the knee that can be caught (“impinged” is the medical term) during joint motion.

For these three conditions, which are commonly associated with osteoarthritis, the best diagnostic test is an MRI (magnetic resonance imaging), and the best treatment is early surgery. The earlier the surgery is performed, the better the result. This surgery is typically performed through arthroscopy, where two small incisions are made — one to insert a small tube with a light, and the other for cutting or sewing instruments as needed.

So, you are absolutely right! You do need an MRI so you can get a correct diagnosis, and then proceed to get the best treatment for your diagnosis. Muscle relaxants are not likely to help you. Antiinflammatory medications are a better choice for now.

Q4. I am 34 years old, weigh 220 pounds, and am 5 foot, 3 inches tall. I have been working out lately in an effort to lose weight. I use cardio sculpting classes, the treadmill, the elliptical trainer, or walking DVDs. I’m starting to feel pain in my knees after exercising. Is there a way to avoid it?

— Mamta, Illinois

At your weight and height, it is conceivable that your weight is causing undue stress on your knees — which can be relieved by weight loss. I suggest a weight-loss plan where you can lose two pounds per week with the use of a low-fat, low-calorie diet, and exercise. Consult a dietitian to develop such a plan. You should also consider seeking advice from a personal trainer about exercise, as there are safe ways to lift weights and exercise without injuring yourself. The results will be fantastic!

In the meantime, swimming may relieve the stress on your knees and allow you to burn some calories through exercise. Try the stationary bike and the elliptical machine until you can get a trainer to help you. If your pain doesn’t subside, make an appointment with a physical therapist — they can help tremendously with knee pain.

Learn more in the Everyday Health Knee Pain Center.

Knee Buckling

By Dr. Russ Riggs • June 21st, 2016

It’s probably happened to you at least once; you’re walking along just fine, maybe headed up a flight of stairs and your knee suddenly gives out. This phenomenon is referred to as “knee buckling”. Many orthopedists believe this is a protective response by your body to protect the knee joint from damage. However, if you’re experiencing this issue often, or in combination with popping and locking of the knee joint, there may be a more serious issue going on, such as an acute injury to your ACL or degenerative joint damage in the form of osteoarthritis (OA).

What causes it?

There are a variety of reasons why your knee may regularly be buckling. The most common are an acute injury such as tears in the meniscus, or ACL. Or chronic inflammation and cartilage damage has started to take place in the knee joint.

Unfortunately, it’s likely your lifestyle and activities are adding to the issue. If you are involved in high-impact sports such as long-distance running or skiing, you might repeatedly be spraining or injuring your knees, which can damage or tear ligaments and the meniscus. Over time, these injuries erode the stability of the knee joint as well as initiate the inflammation cascade of OA. In addition to soft tissue injuries, bone spurs can occur and bone fragments can get broken off that then float around the joint which can lead to knee buckling.

Why is it a problem?

In most cases, knee buckling is an indicator of a more serious issue such as an ACL tear. But for some individuals, especially the elderly, knee buckling itself can cause even bigger problems. Clinical research indicates that knee buckling may cause falls and fractures and could help explain the risk of hip fracture in people who suffer from osteoarthritis.

“One U.S study, which looked at over 2000 people with osteoarthritis, found that about 12 percent experienced at least one knee-buckling incident in the past three months. Out of these people, 13 percent fell when the buckling occurred. It also turned out that knee pain, muscle weakness, as well as poor physical function were related to the buckling.”

How can it be treated?

A physical therapist or doctor is usually able to diagnose the cause of your knee buckling through a series of mobility tests, a manual exam, and imaging such as ultrasound. Once they’ve determined the cause of the buckling, they’ll be able to devise a treatment plan to fix the issue.

For minor acute injuries, often the R.I.C.E (rest, ice, compression, elevation) method is utilized. Physicians may also recommend NSAIDS for short-term pain control and to reduce swelling in the knee. If compensation patterns or joint weakness and stability need fixing, a knee brace might also be utilized.

Some stretches and exercises can often help with minor weakness and stability issues:

  • Calf Stretch
  • Straight Leg Raises
  • Hamstring Curls
  • Double Leg Squats

In some severe cases, surgery may be necessary if conservative treatments are not successful in addressing the issue. If you’re experiencing chronic knee pain, or your knee is frequently popping, locking, and giving out you should get an exam to determine what’s causing it and treat the underlying cause.

Going “weak in the knees”—that is, having your knees give way when you put weight on them—is a sign of knee instability. Knee buckling increases your risk of falling, and it’s particularly common in people who have arthritis or knee pain. But you don’t have to have arthritis to have a knee give way.

You may have had a knee buckle at one time or another. If you were lucky, you were able to regain your balance and steady yourself before you took a tumble. But you might not be so lucky next time around: Your risk of falling, and possibly incurring serious injuries, when your knee unpredictably buckles could increase within two years of your first knee-buckling incident, according to a new study.

Until recently, the consequences of knee buckling had not received much attention in the medical literature and scientific research. But the new study, in last February’s Arthritis Care and Research, takes a closer look at knee instability and its role in causing falls. The authors conclude that doctors should be paying closer attention to patients’ complaints of knee weakness.

Fear of falling

Knee buckling may be a result of balance difficulties and muscle weakness, particularly in the quadriceps, the group of muscles that runs down the front and sides of the thigh. Some studies estimate that knee instability during weight-bearing activities, such as going up or down stairs or simply walking, occurs most commonly in people with knee osteoarthritis or knee pain.

To measure the little-studied consequences of knee buckling, researchers asked 1,842 people, ages 55 to 84, who either had, or were at high risk for, knee osteoarthritis if they recalled an episode of knee buckling any time within the past three months. Nearly 17 percent of the participants recalled their knees buckling, and 20 percent of those participants reported they fell as a result.

The researchers checked back with the participants two years later to determine whether they had experienced any additional knee-buckling episodes. They found that those who reported knee buckling at baseline were four and a half times more likely to have fallen at least once more during the previous year, twice as likely to be significantly injured from a fall, and three times as likely to be injured enough to cause disability. Those who had a knee-buckling incident but didn’t fall were twice as likely to fall within two years because of a knee giving way.

Of major concern among the researchers was the number of people—69 percent—who told them that, after they fell, they lost confidence in their balance and gained a fear of falling—so much so that they compensated by limiting their daily activities. But curtailing activity to avoid falling isn’t a good solution: It will most certainly lead to a downward health spiral.

“Avoiding physical activity can result in further decline in muscle strength and general overall physical condition, putting you at even greater risk of falling,” says John A. Flynn, M.D., M.Ed., medical director of the Spondyloarthritis Center at Johns Hopkins University School of Medicine in Baltimore. “This deconditioning will eventually lead to loss of mobility and function and will likely have a psychological impact in the form of depression, anxiety, dependency, and social isolation.”

Such consequences, say the researchers, are preventable in people whose buckling knees are caused by muscle weakness or poor balance with interventions that include quadriceps-strengthening exercises and balance and agility training. Doctors must do their part in first identifying these patients and patients should bring up the subject if their doctors don’t.

Unless prompted by their doctors, most patients don’t mention incidences of their knees giving way. The researchers suspect that doctors don’t always consider knee buckling and its consequences in their arthritis patients because they’re more focused on pain relief and regaining function. As a result, the researchers are encouraging doctors to routinely ask patients whether they’ve experienced any knee buckling or instability.

“Don’t wait for your doctor to ask about these symptoms,” Flynn says. “Since pain is the most common knee-arthritis symptom, other symptoms like buckling can sometimes be overlooked. Ask your doctor about options that can help you stay active and reduce your fall risk. In addition to recommending exercise, he or she may suggest losing excess weight that could be putting strain on your knees; upgrading your footwear to shoes or slippers with low heels and thin, slip-resistant soles; and using a walking aid such as a cane.”

Exercise to get you steady on your feet

Ask your doctor to refer you to a physical therapist who can develop an exercise program for you. A typical exercise program should include:

• Range-of-motion exercises, such as yoga or tai chi (an exercise that involves gentle stretching movements), to keep your joints and muscles flexible.

• Aerobic exercise that’s easy on the joints, such as swimming, walking, and bicycling, to keep your heart and lungs healthy and control your weight.

• Strengthening exercises, especially ones that target your quadriceps.

• Balance and agility exercises to reduce your risk of falling.

(Originally published Aug. 25, 2016; updated Feb. 24, 2017)

7 reasons your knee gives way: symptoms, diagnosis and treatment

Imagine running to catch that bus your late for and your knee gives way! Or you playing your favourite sport and when the knee buckles underneath you.

Having your knee give way can be a scary thought. Not many people think about the reasons why your knee gives way until it happens to them. It’s at this point that knowing what’s going on and how to fix it becomes very important.

This article is about highlighting the main reasons your knee gives way. I’ll start with the most common reasons and work down to those that may not occur so frequently.

My aim is not only to inform you, but to help you do what you need to overcome this condition.

So, let’s start from the top and look at the number one reason that your knee gives way.


The Joint Clinic

ACL injuries are very common and can have lasting effects on your knees. The Medical Journal of Australia reports that in Australia, there are upwards of 17,000 injuries per year.

Looking at the statistics you can see that the rate of ACL injury is only increasing with increased population and participation in cutting sports such as netball and soccer.

The amount of reconstructions being performed are also increasing, with Australia currently having the highest amount of ACL reconstructions in the world.


Common symptoms:

Acute ACL tears are usually obvious. Some people describe a loud snap that can be heard from several meters away. Within 30 minutes there will be swelling which could make the knee twice its normal size.

Normal symptoms of an ACL tear include:

  • Knee swelling
  • Knee giving way
  • Loss of range into knee flexion and extension
  • Pain during walking

Giving way of the knee occurs because the ACL’s main function is to stop the shin bone from sliding forward during twisting movements. Without the support of this ligament, the shin will move forward and cause the knee to buckle.

How do I fix it:

I have noticed a change in trends for in the management of ACL injuries as further research emerges. From the not so distant future we would operate on all ACL tears to restore normal function of the knee.

Now a trial of non-surgical management is recommended for at least 3 months before a decision about surgery is made. This is because there are now high-level studies that show even athletes can return to high level sport without an ACL.

Many clinicians now advocate for conservative therapy because there is a big chance it will be successful. Even if conservative therapy isn’t a success, (meaning your knee continues to give way) you can always have the surgery later with no increased risk of damaging the knee.

Rehabilitation for ACL injury is unique as every person will present differently. However, there are some core elements which will remain the same, these involve:

  • Lower limb and core strengthening
  • Running and cutting drills
  • Lower limb control during jumping and single leg tasks
  • Sport specific drills as you improve
  • Education on safe return to sport and load management

For further information on ACL injuries, please see our ACL injury page.

#2 – Osteoarthritis

With the baby boomer generation coming of age, we are seeing a rise in the total number of people with knee osteoarthritis.

This is a condition that generally progresses as we age and is characterised by the break-down of healthy cartilage in your knee. Other signs include the formation of osteophytes which are little bony spurs on the outside of the joint and the breakdown of ligaments in the knee.

Keep in mind, some people will have arthritic changes on X-ray and NO pain. This brings me to explaining some of the common symptoms for arthritis

Symptoms of arthritis will progress as the condition worsens (this may take years, there is no way of knowing medically), they typically include:

  • Morning pain and stiffness
  • Stiffness and pain when standing after prolonged sitting
  • Cracking, grinding
  • Swelling and gradual loss of range
  • Locking and giving way can be rarer symptoms

Although having your knee give way is a rarer symptom of osteoarthritis, it is important to take note. Mechanical symptoms like giving way means the knee is not stable and these symptoms warrant a referral to your local orthopaedic surgeon.

How to fix it:

Unfortunately, there is no long-term cure for knee osteoarthritis currently. The best solution we have, is to eventually replace the knee with an operation called the total knee replacement.

But don’t think that all hope is lost, because there is good evidence that exercise and weight loss can reduce symptoms by up to 50%.

#3 – Torn Meniscus

Meniscal tears can be associated with giving way of the knee. There are many different types of meniscal tears, but the ones associated with giving way of the knee are usually the bigger ‘bucket handle’ type tears.

Meniscal tears are usually sustained with twisting movements under load. They can occur with forceful movements, but sometimes they can result from something as simple as getting up from sitting.

Usually acute meniscal tears will happen to younger people, and these are more likely to be bigger bucket handle tears. As we age, our meniscus are more prone to tearing, but these are more degenerate tears as a result of osteoarthritis.

If the tear is sizeable, then it is possible that locking and giving way of the knee occur. Other symptoms will involve, pain with weightbearing, swelling, inability to fully straighten the knee.

For large bucket handle tears, surgery is usually required to mend the tear and try to preserve as much of the meniscus as possible. If the knee isn’t giving way and locking, then it is appropriate and safe to trial physiotherapy and see how it goes.

A ligament tear can take up to 12 months to heal because of the poor blood supply to the meniscus to don’t be concerned if it’s not better in a couple of weeks. By 3 months you should be make progress but may still have pain associated.

#4 – Ligamentous tears of the knee

The knee has four major stabilising ligaments that give it stability through range. One I previously mentioned is the ACL. If you have tears in the other 3 ligaments, you may also experience giving way of the knee.

PCL (posterior cruciate ligament)

Right next to the ACL, on the inside of the knee, we also have a PCL. This ligament helps to stop your shin bone from hyperextending.

This ligament is usually injured with dashboard car injuries, where the shin is forced into the dash and the knee hyperextends.

If your PCL is torn, you won’t feel stable when you fully straighten the knee and the knee can give out backwards and buckle.

MCL (medial collateral ligament)

The major inside stabiliser of the knee is your MCL. This ligament stops the knee from buckling inwards.

The MCL is damaged when your knee is forced inwards. As you are forced into being knock kneed, the MCL is stretched and can partially or fully tear.

LCL (lateral collateral ligament)

Much like the MCL, your LCL stops the knee from bowing outwards. It is put under strain when there is a force that pushes the knee out, like a kick to the inside of the knee.

The solution to ligament injuries heavily relies on how much of the ligament is torn. For most of these the first step would be to get appropriate imaging like an MRI to assess the damage.

Small and medium sized tears can usually be helped with bracing the knee first, followed by physiotherapy and progressive exercises.

If the ligaments are fully torn they will usually require surgery to fix it.

#5 – Patella instability

Patella instability is defined by constant dislocations of your knee cap. It can be difficult to manage, and I have had patients whose knee will dislocate up to two and three times a day.

This condition affects between 7-49 people out of every 100,000. The knee cap usually dislocates outwards and after your first dislocation you are much more likely to dislocate again.

Common Symptoms:

The most problematic part of patella instability is the knee cap dislocating. This will usually happen in the early phase of knee bend as there is not much groove for the knee cap to sit in.

Sometimes as your knee dislocates, your knee gives way at the same time. This is due to the sudden loss of power of your quadriceps muscle as it attaches onto the knee cap.

Other symptoms could include grinding, clicking and discomfort or pain in the knee.

How do I fix it;

If the knee is constantly giving way, then surgery may have to be considered. I would still always give strengthening a go first, because if this works it will save you money and potentially prevent any problems resulting from surgery.

If you want to try strengthening, you need to make sure your knee control is just right. Online physiotherapy will be perfect to help in this journey as we can construct an exercise program that will be perfect for your needs.

Some basic exercises to start with would be squats and side bridges. From here you would move closer to single leg strength exercises and motor control around the hip.

Surgical options would include a repair of your MPFL (medial patella-femoral ligament), a tibial tuberosity transfer or a lateral retinaculum release.

# 6 – Quadriceps insufficiency

Your quadriceps muscle is located on the front of your thigh. It’s the major muscle responsible for straightening the knee.

Sometimes your knee gives way because of a lack of strength in this muscle – also called an insufficiency. There can be numerous reasons for this muscle being weak:

  • Pain inhibition (if your knee is very sore, your brain can switch of the quadriceps muscle)
  • Weakness post-surgery – ACL or TKR, or meniscus repairs
  • Nerve impingement in the back
  • Deconditioning from lack of use – with people who are very sedentary

With quadriceps insufficiency you will feel like your thigh muscles are weak. You may not really trust your leg and would prefer to use crutches or other walking aids.

If you have weakness due to pain inhibition, there may be associate injuries with your knee causing your quadriceps to not work as well.

How do I fix it?

The major treatment for quadriceps insufficiency is strength training. Now your body is very good at cheating as your attempting to strengthen weak muscles. I remember having a young fit guy who could still climb stairs with no use of his quadriceps!

The key in early strength training is isolation. You want to really isolate the quadriceps, so they can’t get out of doing the work.

I have attached a video for my favourite exercise to begin with in quadriceps training below:

When your quadriceps strength is improving its often good to begin a more generalised strength program. We have some exercises to strengthen your calves in our Achilles Tendinopathy ulimate guide.

# 7 – Synovial Plica Syndrome

These are folds in the membrane around your joint in the knee. They are thought to be left over material from the development stage of birth. Kind of like your appendix, they don’t serve much of a purpose except to get irritated in some people.

Usually the plica will get caught in the front and inside part of your knee. It can get caught rubbing against your knee cap through movements which involve bending the knee.

Synovial plica syndrome is more common in the younger years of life up to about 30 years old. There is wide variation in the exact prevalence of this condition, however it’s thought to occur in about 10% of the population. (I think it could be less than this)

Your knee giving way is not a common symptom of this condition. The reason I included this diagnosis is people will report a ‘pseudo-locking’ where the knee feels like it locks. This is also often described as giving way.

Other common symptoms include:

  • Knee pain
  • Clicking, clunking, catching
  • A popping sensation with squats or loaded knee bends

These symptoms will usually be activity dependent, however there may be an aching that remains after.

This condition will commonly occur due to a lack of quadriceps strength and control around the knee joint. I have included below a video for an exercise to help get your quadriceps strength back.

Often this will respond well to Physiotherapy, including taping, exercise, load management (load mx blog) and some over the counter pain killers. This condition can be treated via online physiotherapy as the mainline treatment will involve exercises on hip and knee control.

If physiotherapy isn’t giving full pain relief the next option would be a cortisone injection. I would recommend only trying one of these as there is no further benefit to try additional doses and they can affect tendon integrity over time.

The Bottom Line

Your knee gives way due to all sorts of ailments. We went through some of the main culprits, but there are still more like multiple sclerosis that can give you knee buckling symptoms.

If you have knee giving way, feel free to book your consultation with Click Physiotherapy for a video conference and we can discuss treatment of this with you in person!

Frequently Asked Questions:

Giving way in the knee caused due to a number of different reasons including; meniscal damage, weak muscles, arthritis, ligament damage and more.

How do I prevent my knee giving way?

This will depend on the reason for your knee giving way. Giving way can be treated with physiotherapy to strengthen muscles in conditions like ACL injuries or arthritis, however the knee may need surgical management if there is major instability in the knee.

When do I see a doctor if my knee gives way?

If you are concerned about your knee, it is a good idea to see your doctor. They can help diagnose the cause of giving way and then refer you for the most appropriate treatment.

7 Signs Your Knee Injury Is Serious

Any athlete’s worst fear—professional or amateur—is injuring themselves to a point that prevents them from continuing to work out. But, the reality is, exercise injuries are far more common than we think.

According to the Centers for Disease Control and Prevention (CDC), hundreds of thousands of exercise injuries occur each year. Among these, knee injuries are the most common.

However, experts agree that the best thing to do if you fall victim to a knee injury is to seek help (or use an effective topical cream like this one) and to know the signs that signal something serious.

Knee Injuries

You’re on a run and trip over a crack on the sidewalk, or you’re playing tennis and your knee turns at an unnatural angle while the rest of your leg stays in place. If you play any sport, particularly contact or collision sports, you’re no stranger to knee injuries.

You’re also in good company because according to a study published by the Society for Academic Emergency Medicine, the knee is the most commonly injured joint among athletes.

Knee injuries are caused by trauma or damage to the underlying structure of the knee, which could include ligaments, tendons, cartilage, or bursa (a fluid-filled sac that protects the joint from friction). Together, these tissues surround the bone and allow the knee to move with ease. Because the knee is such a complex series of mechanisms, a lot can happen to it.

The most common knee injuries include the following:

  • Anterior cruciate ligament (ACL) damage is usually the result of sudden changes in direction, jumps, abrupt stops, and high-speed impact.
  • A torn meniscus usually happens after a sudden twist in the leg.
  • Knee bursitis, a condition in which the bursa becomes inflamed, is often a result of constant kneeling.
  • Patellar tendinitis happens when the tendons that connect the front of the thigh to the shin become inflamed. The impact of running and jumping tends to cause this injury.
  • Fractures, i.e., broken bones, are often the result of a fall or a car accident.

After you’ve sustained a knee injury, it’s natural to feel concerned. How do you know if you should walk off your injury or rush to the doctor’s office for an examination? Will a few days of rest be enough for your knee to heal naturally, or do you need to start evaluating options for knee surgery?

Here are seven reasons that should prompt an immediate visit to your doctor’s office.

You’re experiencing swelling.

One of the most obvious signs that a knee injury has occurred is excessive swelling that you can see or feel. This CBD pain freeze cream has helped thousands of people feel relief from their nagging pain. It’s the most effective on the market.

Swelling is most indicative of a serious cartilage or ligament injury to the knee, according to Taylor Brown, M.D., an orthopedic surgeon at Houston Methodist in Texas.

The amount of swelling that is considered “serious” is subjective. A small amount of swelling may not be cause for concern. If you notice a subtle difference between the sizes of your knees, you probably don’t need to sound the alarm just yet. It’s only extreme swelling you need to worry about.

When we talk about extreme swelling, what we mean is when one knee is significantly larger than the other. According to Dr. David Geier, a doctor specializing in orthopedic surgery, significant swelling “could be a sign of a torn ACL or a patella dislocation with a little piece of bone knocked off, and it should be checked out.”

If your knee doesn’t immediately appear swollen and you’re unsure, “feel the injured and normal knee at the same time, with a hand on each knee to compare the two,” he says. “A swollen knee will feel like a large, warm, fluid-filled balloon.”

If you experience any of the above, he recommends a highly reviewed topical cream or the RICE principle. Rest with crutches and activity reduction, ice for 20 to 30 minutes several times a day.

Compression with a soft knee sleeve brace (like this top seller) will help, and elevating your knee above the level of the heart. Over-the-counter pain medication can also provide relief until the swelling goes down.

Aaptiv has workouts specifically to help work around your knee injury. Learn more about Aaptiv here.

If your swelling is minor, you might be tempted to reach for the ice and Advil, but research suggests that some amount of swelling could be good for you. A Cleveland Clinic study confirmed that swelling is caused by a rush of cells called macrophages to the affected area.

Macrophages help repair your injury by ingesting damaged cells. This process results in swelling as fluid rushes into the holes in the tissue left by the macrophages, and this is key to muscle regeneration. Pain and swelling are an adaptive body response. While we often view them as an inconvenience, they are natural signals that we need to slow down.

When an injury causes swelling, the pain and stiffness prevent the athlete from using the injured part of their body. This is where the first part of PRICE – protection – comes into play. By protecting your knee from further injury, you have a better chance of minimizing the damage.

In addition to the severity of the swelling, the speed with which the swelling occurs could indicate a serious injury. If the knee immediately blows up and becomes the size of a grapefruit, then you’ve probably sustained a severe injury.

If you’re unsure or you have swelling that doesn’t subside after 72 hours, please consult with your doctor.

You notice an obvious deformity.

If you notice your knee jutting outward in a way it never has before, take note. A dislocated or fractured patella (kneecap) can cause injuries like this, explains Brian Schwabe, C.S.C.S., board-certified sports physical therapist based in Los Angeles.

While some deformities occur over time, when the deformity is a result of an injury, it could be the result of a fracture or chronic wear on the knee joint. If you are already experiencing any kind of misalignment in your lower extremities, then you could be more prone to this type of injury.

If you notice a bone deformity after an injury, he recommends seeking the assistance of an orthopedic doctor immediately. The doctor will likely take x-rays as well as perform a visual diagnosis to determine if you need surgery.

You felt or heard a “pop”.

Sometimes, a “popping” sound after a movement can indicate something is out of place.

“Oftentimes this type of sound upon injury is indicative of a ligamentous injury,” says Schwabe. Not all ligamentous injuries are full tears, though, and not all require surgery.

However, if you also experience excessive swelling and instability, get it checked out by an M.D. “If you only have a mild sprain then you will be able to rehab it with physical therapy,” he says.

The pop is what you hear as a result of a ligament tear, a meniscus tear, strained tendons, or a dislocated kneecap. Usually what happens is you’ll simultaneously hear and feel the pop.

If you’re not familiar with the meniscus, it’s the cartilage in the knee that functions as a shock absorber. Each knee has two menisci, and they’re shaped like horseshoes. The medial meniscus is on the inside of the knee, and the lateral meniscus is on the outside.

The popping sensation can be difficult to explain, but you’ll certainly know it when it happens to you. Though the sound originates in the knee, you’ll hear it as though it was directly in your ear. It’s as if the sensation travels up your body, and when it gets to your brain, it becomes audible.

Depending on the severity of the tear, your age, and your overall health, you may able to heal on your own. You could start by using a brace and keeping your knee elevated and protected until you can get in to see a sports medicine doctor. However, a pop will almost always bring you down to the ground, and it’s not recommended that you put any weight on it until you can stabilize it.

If the pain is severe, you’ll want to visit a doctor as soon as possible. Surgery is often the recommended course of action, but physical therapy and other non-invasive remedies may be prescribed as alternatives.

You experience greater than normal movement.

If you feel like your range of motion in the knee is higher than usual, something might be out of place or injured. This is known as joint instability.

You may feel like your knee will buckle or fold with walking, twisting, or weight-bearing.

“The sensation of the knee giving away may occur with simple daily activities or upon return to sport following what was thought to be a minor injury,” explains Dr. Brown.

“Additional episodes of joint instability may worsen the condition of a knee after an injury.” Tears of the ACL or MCL and patellar (kneecap) dislocations could also create joint instability, he says.

Hundreds of thousands of exercise injuries occur each year. Among these, knee injuries are the most common.

The best plan of action is to make an appointment with an orthopedic surgeon.

Wear a compression-sleeve-type brace or a knee brace with hinges in the interim, says Dr. Brown.

This may provide some comfort or level of support. Use crutches if you feel like you could fall and suffer additional injury because of knee joint instability.

Another type of hypermobility can occur when the kneecap moves out of place. This condition is called a patella dislocation. It’s usually painful when it happens, and it might be sore the next day. If it pops back in by itself, the injury might not be serious. The true test is whether you feel confident that you can resume regular activity later that day or the next day.

According to Dr. Geier, if the knee resituates itself naturally or if you can put it back in place with little effort, then you may be able to “see how it goes” and avoid a visit to the doctor.

However, if it’s difficult to get the knee back in place or you need assistance to do so, then you’re bound feel pain and most likely swelling as well. If this is the case, Dr. Geier recommends consulting with a doctor. If anything, he says, you’ll get peace of mind.

When the kneecap dislocation is accompanied by swelling, this could indicate that a piece of cartilage or bone got knocked out of place. If the knee feels “loose” when you resume activity, a visit to the doctor may be in order. Your doctor may take x-rays, recommend an MRI, or suggest a visit to a physical therapist.

Knee instability is often caused by weak surrounding muscles. Working on balance and isolation exercises can significantly strengthen the knee and prevent injury. Aaptiv has hundreds of workouts on the app that can build a strong base for your core and lower body. Sign up for Aaptiv today and get a free trial.

You can’t put weight on it.

If it’s immensely painful to stand or put any weight on your injured knee, there’s definitely something serious going on.

“Inability to bear weight after a knee injury could be caused by a fracture, bone contusion, cartilage injury or ligament tear,” explains Dr. Brown. “Initial treatment includes using crutches or a steerable scooter to take pressure off the injured limb and minimize additional damage to the knee.”

If this sounds like you, listen to what your body is trying to tell you. Dr. Brown warns that the old adage of “no pain, no gain” doesn’t apply in this situation.

He advises seeking orthopedic evaluation as soon as possible—even that same day if you can.

After a minor injury like a twist or fall, you might not be able to put weight on your leg immediately. That’s not necessarily a cause for alarm, but if you don’t feel like you’ve recovered within a few minutes, this could indicate something more serious.

It’s similar to when you injure a wrist or ankle. If you fall on your wrist or twist your ankle, you may experience searing pain for a moment or two. When the injury isn’t severe, you’re able to shake it off and resume your life after a few minutes at the most. However, if you’ve experienced a sprain, the pain doesn’t subside. Instead, it gets worse.

Think of a knee injury in the same way. You may experience agony for a moment, but pay attention to how long it takes to go away. If it doesn’t go away within minutes and you’re not able to put any weight on the knee without feeling excruciating pain, then you might need a doctor to help you consider treatment options.

Also, watch out for numbness after the injury. This could be a result of a pinched or damaged nerve and blood vessels. William Blahd Jr., M.D., reports that this symptom could indicate an ACL or MCL tear, a kneecap dislocation, a fractured kneecap, or loose bone.

You can’t straighten your knee or leg.

If you have trouble straightening your leg or it hurts to do so, you probably have a serious knee injury.

To test this, start in a seated position and try to lift your lower leg using your own leg muscles. “You may still be able to bear weight and walk slowly and carefully without assistance, but will probably require assistance to lift your lower leg and fully extend your injured knee,” says Dr. Brown.

“Patella fractures, quadriceps tendon tears, and patellar tendon tears all tend to be associated with an inability to straighten the leg.”

Use a knee immobilizer to hold the knee in a straight position and help with pain relief. This also makes it easier to move about until your appointment with an orthopedic surgeon, he adds.

Another test is to lie down and try to straighten your leg. The goal is to get your knee to lie flat. This might be difficult or impossible to do due to the pain, but what you should watch out for is a total inability to straighten your knee.

Some of the problems that could cause a locked knee include meniscus tears or a torn ACL. The key is to determine whether you can’t straighten your knee due to sheer pain or physical blockage. If you feel blocked, then we recommend getting in touch with a doctor sooner rather than later.

On the flip side, you might have trouble bending your knee. If your knee feels stuck in any way, and the feeling doesn’t go away within a few hours, you could be experiencing something more severe.

Your knee keeps buckling.

When you got hurt, did it feel like your knee gave way underneath you? We’re not talking about a temporary sensation of weakness or some wobbliness, but more like your shin and thigh bone weren’t connecting or staying in place. A buckling knee could signal an ACL tear or a cruciate ligament injury.

It could start with a small pop or crack, or you could feel it after a strenuous exercise session or a soccer game.

Either way, your knee feels unstable or weak. Your knee may give out momentarily, which is scary because you might not trust yourself to walk safely when this happens. According to Dr. Howard Luks, an orthopedic surgeon, this could indicate a tear in the patella or the quadriceps tendon.

These tendons are on the front of your knees and offer a lot of support to keep you upright. If they’re not in top form, you’re bound to feel weak in the knees (cue the terrible SWV song from the ‘90s), and you might not be able to walk at all. If this is the case, you could need surgery.

On the other hand, the weakness could be temporary, caused by wear and tear, improper footwear, or a strain. If you’re a weekend warrior or you’re over the age of 30 (sorry!), you might experience this symptom on a regular basis.

However, if the weakness is recurring and happens every time you exercise, it’s possible you have a time bomb that’s waiting to happen. When in doubt, seek advice from a physician.

This could also signal a torn ACL or a large meniscus tear. These two common injuries are both serious and could cause this symptom to occur, says Aideen Turner, physical therapist and CEO of Virtual Physical Therapists.

“If your knee buckles under you when you are walking, then it usually indicates instability,” she says.

“A lot of people have ACL tears, but if the knee still has functional stability, then surgery is not necessarily needed. But the buckling indicates damage to the cartilage, which means surgery should be performed.”

No matter what you’re going through, remember that a setback is a setup for a comeback. Whether your knee heals on its own, you need some rehab, or you have to resort to surgery, the key is to keep your entire body strong to ensure that your knees have the support and structure they need to keep you moving.

Don’t let your knee stop you from working out. Join Aaptiv today and get classes for meditation, stretching and more.

To help prevent knee injuries in the first place, we recommend taking the following precautions:

  1. Warm up before exercising. You can try one of our stretching routines on the Aaptiv app.
  2. Use proper gear designed for your chosen activity. Many sports have shoes designed specifically for playing them, and we recommend using those specialized shoes.
  3. Keep the muscles surrounding your knees strong.
  4. Use the correct exercise techniques. Subscribers to the Aaptiv app get the benefit of having virtual trainers guide them through workouts, ensuring that they’re doing the exercises safely.

There’s no magic formula for preventing knee injuries, but taking some precautions before you step out onto the field or the court and knowing the signs of serious injury can help protect your joints.

Treatments that reduce knee buckling may help prevent falls in older adults

Knee buckling, often described as a knee “giving way,” is a symptom of knee instability that frequently affects older individuals, in particular those with knee pain and knee osteoarthritis (OA), and may be caused by muscle weakness and balance difficulties. If knee instability leads to frequent falls and fall-related injuries, exercises and other interventions that stabilize the knee may help maintain older individuals’ health and quality of life. To investigate this potential link, Michael Nevitt, PhD, of the University of California, San Francisco, and his colleagues prospectively studied 1842 participants in the Multicenter Osteoarthritis Study (MOST) who were an average of 67 years old at the start and who had, or were at high risk for, knee osteoarthritis.

At the end of 5 years, 16.8 percent reported knee buckling, and at the end of 7 years, 14.1 percent had recurrent (?2) falls. Bucklers at year 5 had a 1.6- to 2.5-times higher likelihood of recurrent falls, fear of falling, and poor balance confidence at year 7. Those who fell when a knee buckled at the start of the study had a 4.5-times, 2-times, and 3-times higher likelihood 2 years later of recurrent falls, significant fall injuries, and fall injuries that limited activity, respectively, and they were 4-times more likely to have poor balance.

“Falls, injury from falls and poor balance confidence are extremely common and debilitating problems in older people. The present study has demonstrated for the first time that knee instability and knee buckling are important causes of these problems in the very large segment of the older population suffering from knee pain,” said Dr. Nevitt. “Fortunately, it may be possible to treat knee instability and prevent knee buckling with targeted exercises. Joint replacement surgery can also improve knee stability.” He added that pain is the predominant symptom of knee osteoarthritis, and symptoms of instability such as knee buckling and falls may be overlooked by treating professionals. The most important immediate impact of these findings on patient care is that health professionals should query their patients with knee OA about instability, buckling, and falls, and work with them to take preventive actions, including proper use of walking aids, leg strengthening, and appropriate footwear.”

Don’t Ignore Buckling Knees

Going “weak in the knees”—that is, having your knees give way when you put weight on them—is a sign of knee instability. Knee buckling increases the risk of falling, and it’s particularly common in older people who have weak leg muscles (particularly the quadriceps, on the front of the thighs), poor balance, or chronic knee problems(from osteoarthritis, for example). It’s a warning sign that shouldn’t be ignored, as noted in a NIH-sponsored study published in Arthritis Care & Research in August.

Researchers interviewed 1,842 people, ages 55 to 84, who had knee osteoarthritis or were at high risk for it and found that 17 percent had experienced knee buckling (with or without falling) during the past three months. Interviews two years later revealed that these participants were two to four times more likely to have fallen during the previous year, compared to who hadn’t experienced prior buckling. (Falls resulting from being knocked down by a person or vehicle, falling off of a bicycle or while playing a sport, or falling from a height, like off a ladder, were not included.)

Of major concern, about two-thirds of these participants who fell reported that they lost confidence in their balance and feared falling again, so much so that they limited their activities. But that only leads to further loss of muscle strength and overall conditioning, which can in turn lead to greater loss of mobility, isolation, dependence on others, and possibly depression.

Speak up before you fall down

Such consequences, say the researchers, can often be prevented in people whose buckling knees are caused by muscle weakness or poor balance if they undertake quadriceps-strengthening exercises and balance and agility training.

If you have experienced knee instability or buckling, tell your health care provider. Patients often don’t bring this up. Your health care provider can advise some basic exercises or refer you to a physical therapist. If you are overweight, this is an added incentive to lose some extra pounds, which put added strain on your knees. Discuss other fall-prevention measures, such as wearing slip-resistant shoes and using a cane, if necessary.

A typical exercise program should include

  • Range-of-motion exercises to keep your joints and muscles flexible.
  • Strengthening exercises, especially ones that target your quadriceps, such as walking up hills or stairs.
  • Balance and agility exercisessuch as yoga or tai chi.
  • Aerobic exercise that’s easy on the joints, such as swimming, walking, or bicycling, to keep your heart and lungs healthy and control your weight.

This article was adapted from Health After 50.

Also see Best Pain Relief for Knee Arthritis.

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