Tear Vs. Knee-Sprain Symptoms

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8 Tips for How to Treat a Knee Injury and How to Know If It’s Bad

by James Hubbard, MD, MPH

It’s football season and prime time for knee injuries. But truth be told, I see them all year long—in athletes and the rest of us.

They happen at home, at work, and during any recreation at any age. Sometimes they happen when you’re just standing still and twist the wrong way.

When you hurt your knee, it may be evident you’ve done major damage. Often, though, it’s not so clear. Knee-sprain symptoms can be the same as symptoms from something more serious.

Even we doctors sometimes have a tough time telling a sprain from a tear. One reason is it’s hard to try to move a swollen, painful knee.

So what can you do when no one medical is around? There are a few things, but first, it helps to know the anatomy.

An Inside Look at Your Knee

In this plastic replica of the right knee, the kneecap, muscles, and tendons have been removed. The femur (thighbone) sits on top of the tibia (big bone of the lower leg.) You can see the fibula (smaller outside bone, lower leg) has little to do with supporting your weight. Now here are the parts of the knee you’ve probably heard about being injured in sports: Between the femur and the tibia are the cushioning left (lateral) and right (medial) meniscuses, also called cartilage. The lateral collateral ligament (LCL) is brown and to the extreme left. The medial collateral ligament (MCL) is to the extreme right. The brown piece in the middle is the anterior cruciate ligament (ACL.)

The knee is a hinge joint. It uses tendons attached from muscles to bones to flex and extend your lower leg.

Ligaments connect bone to bone, and the knee has four. Without them, your knee would buckle with the least little shift in weight.

A thick cartilage, called meniscus, separates and cushions the thighbone (femur) and lower leg bone (tibia) so they won’t crunch together and wear down.

Both how you get injured and your symptoms help indicate which part of the knee you’ve damaged.

A twisting of the knee or a direct hit on the side can tear the cartilage. This can cause pain and swelling. Walking may be difficult. Sometimes the torn cartilage can twist out of position and cause your knee to lock.

Tearing a ligament usually takes more force, either with a direct hit or falling awkwardly. It, too, can cause pain and swelling, and sometimes the knee feels unstable.

In addition, with any of this trauma, you can fracture a bone. The most common fracture would be a crack in the upper tibia.

And of course, you can sprain a knee ligament, tendon, or muscle without tearing it.

 

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Fracture Vs. Tear Vs. Knee-Sprain Symptoms

 

Symptom/Sign Possible Injury
One area aches, knee feels stable, there’s no swelling. Sprain.
Knee feels unstable. Torn ligament (the stabilizing bone-to-bone connection).
Knee locks up. Torn meniscus (the cartilage cushion between your upper and lower leg bones).
Area has a lot of swelling (especially if it comes on quickly). Something serious (fracture, tear, or dislocation; probably not a sprain).
You feel a lot of pain with weight bearing, even when the leg is straight. Fracture.
Bone or joint looks distorted. Fracture, dislocation, or both.
Area looks distorted and you can’t feel a pulse in the foot. Injury to an artery. This is an emergency. Get help immediately. If that’s impossible, at least put the joint or bone back in place, or you may lose a limb. (I’ll need to do a separate post sometime to show how to do that.)

Any time you have these symptoms or the pain is bad even without weight bearing, you need to see a doctor. (See “When Should I Get to a Doctor?”)

Treatment for When There Is No Doctor
How to Stabilize a Knee

Here are four ways to stabilize a knee when you have a tear, break, or dislocation:

  1. Use a brace (preferred).
  2. Use an elastic bandage.
  3. Make a knee immobilizer with two Sam Splints, one on the outside and one on the inside of the knee. Bandage them in place with the leg straight. If you don’t have two Sam Splints, you could use sticks.
  4. Wrap the knee with a sweater or a blanket or anything that will keep it extended.

If getting to a doctor is impossible, here are some things you can do until it is possible.

1. Get off your knee. Sit or lie down where you are. The first steps with any sprain or tear are RICE (rest, ice, compression with an elastic bandage, and elevation).

Next, evaluate what may be wrong.

2. Look at the injury. If the area looks distorted, you’ve broken a bone or dislocated your knee joint, and you’re going to need to stabilize and stay off of it. Get to a doctor if at all possible.

3. Feel around the joint and the bone. If there’s one spot of exquisite tenderness there’s a good chance you’ve broken or torn something.

4. Move the knee around by flexing it and extending it. If you can’t or it hurts really badly, you’ve probably got a significant injury.

In these next steps, you’ll keep evaluating the injury but also deal with your mobility.

5. If the leg is not distorted, slowly get up to see if weight bearing hurts badly or the knee feels unstable. If it does, don’t try to walk. You’re going to need help or a makeshift crutch or cane.

6. If you’ve stabilized the knee in the straight position (per step 2) and it still hurts to bear weight, a bone may be broken. You need a crutch or crutches so you can walk without bearing weight on the injured leg. (Putting weight on it may make things worse.)

7. If it only hurts badly when you try to walk with the knee flexing, and the knee seems stable, something still may be torn. (A lot of swelling is another sign of a possible tear.) It’s not as essential, but a brace, even an ace bandage may help.

8. If you’ve stabilized the knee and it doesn’t hurt to bear weight, you may still benefit from some sort of cane. Use it in the hand of the unhurt side, swinging the hurt leg forward and bracing with the cane on the opposite side to keep your balance as you walk.

Tearing a cartilage or ligament is not in itself an emergency. Most people end up having surgery, especially if the knee is unstable or severe pain continues, but I know many who do just fine without ever succumbing to the scalpel.

What’s been your experience with knee injuries? How did you injure your knee? What were your symptoms? What was the treatment? What was the outcome?

** UPDATE: Got Questions? I’ve answered four FAQs here. **

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Photo of knee splint by Andrea Lofthouse on Flickr. Photo of plastic knee by April J. Gazmen on Flickr.

  • Jennifer D.

    I injured my knee, right leg, inner part near knee cap but not on knee cap. I hit it pretty hard, and went into extreme pain, hours after, I was unable to bend or walk on it without having a lot of pain. Went to ER they said fluid was on the knee took x-ray no breaks. Referred me to a sports doctor. However unable to get in to see Doctor until June. I am still experiencing pain, to the touch, if I were to hit it again, the pain would be so great. It take a minute to stand and walk, bending is an issue right now well trying to walk, it hurts, as well as straightening the leg, it feels like it is going to collaps. Can’t Jump, walk fast, automatically I straighten leg well walking for pain, if I bend it and walk I don’t feel stable. Sleeping is difficult without a pillow between my legs because if my knee touches the mattress it hurts. In 2007 I had an MRI, they determined I had osteoarthritis, I am 54 years old. Is the Arthritis causing the constant pain or do you think it is something else?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      One possibility is a bone bruise which can hurt really bad with pressure and go on for many weeks. Certainly a flare up of the arthritis could be playing a role also.

  • Ashton

    I’ve been working out for the past two months. Recently, my right knee has started hurting. It is not terrible pain; I can still move and walk on it. I do, however, constantly feel a slight burn on the top on my knee and it does hurt when pressure is being applied to it. There always is a slight pain and burning sensation as well but like I said before it is not unbearable since it is a dull pain. I’ve been doing some research online and I am beginning to think that I have Runner’s Knee. What I want to know is what steps I need to take so I am not making my knee worse in the process of trying to heal. I want to still be active while it is healing but I don’t want to overdo it. Should I go to a Dr. about this? Any advice you have I greatly appreciate! Thank you!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      In general, you’d not do any activity that makes it hurt worse. That may very well include either not doing your work out or changing it to activities that don’t hurt. If you don’t do this you’re not allowing it to heal. Sometimes, heat and nsaids help. Many injuries take 2-6 weeks to heal. If the pain doesn’t get better with rest or if it is affecting your regular daily activities, you should have it checked out.

  • P. Cardenas

    I frequently stand with my knees locked, I’ve done it since I was a child and standing, or attempting without at least one of knees locked feels uncomfortable to me. I recently was standing in one position for about 30mins or so and when I moved on to continue my work my knee was suddenly in pain. Since then (about 48hrs ago) it is still very sore and is painful when both bend and extend. I notice it is most tender on the inside of need where there is softer tissue. Will ice help? or is a warm bath a better idea? any help is appreciated!

  • sumit

    Yesterday evening while playing football, i stood on my left foot while it was sideways, immediately i heard a popping sound from my knee, but after 10-15 mins of rest i was walking again, then after a while same thing happened again, second pop, and my foot collapsed. I came home and tied it with bandage, in the morning now, i can barely stand on it, i diagnosed it, there is no swelling as such, but its hurting on the lower right side of the knee, i have to make efforts to change my leg positions. Can somebody suggest whats the problem?, do i need to visit the doctor, or will it go away with time. I can bear the pain, but need to run.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If it’s still hurting see a doctor. Or you could have your coach or trainer check it first.

  • Patience Harris

    On March 28 2015, I was playing around with my mate trying to get my cell phone from him. I started to slip back so to keep from falling I grab his shirt pulling him on me and his weight was on my leg which was stretched straight and then it popped so loud and I began to hollered and couldn’t bare to stand up on it, the pain was excruciating. So once the pain subside a little I began walking on it and then it popped again I screamed and cried like a baby I knew then I had to go to the hospital, the ambulance came and then my knee and leg swelled up instantly and it was stiff and I couldn’t bend it at all. They did an x ray and said it was a knee sprain and prescribed me Cyclobenzaprine 10mg and Meloxicam 15mg and a knee brace, the medicines was okay but there still was pain when I walked on and couldn’t bend as much. I did a follow up with my primary doctor 2 week later and he told me that he couldn’t tell what damage is done until the swelling leaves. I had an appointment yesterday for to check my knee but that early morning at 12am I got out the tub and got dressed for bed and then as I was walking down the hallway my knee popped again and I feel in excruciating pain my knee swelled instantly again and the swelling went on down to my ankle. So I endured that pain all night until that morning and went to the doctor and he said that I need a MRI to see what is going on inside my knee. So what do you think is going on because that bone seem to be rolling and the knee brace does keep it in place but I am still in pain and now my right leg ankle is popping constantly and calf are so tender and sore, I don’t know what’s going on with my legs but I am miserable. What you suggest is going on?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sounds like you’re going to need an MRI to check look for cartilage tears. Please, let me know what it shows.

  • Michael

    The popping sound is always on the way down …. when trying to put the knee down after the stretch ,…..

  • Michael

    I am 54 yrs old About 10 yrs ago before working out …. I was doing a quad stretch where you grab your ankle … bring it up to out butt and stretch your quad…… When I tried to lower my knee it got locked up .. then it made a popping sound…. like when you crack your knuckles … and my knee hurt … No swelling ….. did my work out …. then throughout the last 10 yrs every now and then … when I played golf… squatted down to look at the putt … and lifted my self back up … My knee would lock and pop …. Last evening …. during a quad stretch .. It did it again …..Locked and popped on the way down… My doctor said …. It’s like a bruise …. asked me on a scale of 1-10 ow did it hurt … I told him about a 3-5 ….. No swelling ….. just discomfort… Like wen you do bruise or fall on your knee….. He told me to wait 4-6 weeks …. and take it easy ….. I don’t know what to think ……

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Michael, you might want to look up a “buckle handle meniscus tear” and see what you think.

  • Annie

    I am 50 years old, female, slightly overweight -not obese. Restarted a 30 min. outdoor walk routine a week ago. My right knee now aches, feels tight – no swelling. There was no specific injury. Wondering if this ‘complainer’ is just from the new routine and I should keep up the slow walking (‘walk it off’) or if I should stay off it? Hate to get waylayed from the walking again…Thank you.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Annie, that’s a pretty common problem. You try to walk to help your health and decrease weight but the weight (and age, unfortunately for all of us) contributes to pain. First, all people are different. If you suspect any underlying knee problems, check with your doctor. Otherwise, maybe start off slower. Maybe start walking for 10 minute intervals and build up gradually. Even if 10 minutes is all you ever get to, it’s a lot better than none. But, by taking your time I’ll bet you’ll eventually get up to the 30. Maybe have that as goal to reach in couple of months. Stay on the 10 mins for a week or two, the go to 15 for a week or two, etc.

  • Carolina Noeggerath

    Please forgive my typos.. It is 2:30 AM and I am using my mobile device.

  • Carolina Noeggerath

    I truly hope this will earn a reply.. Mainly since this seems to
    not have been active for quite a while… Besides the point, I hope you can help.
    Just yesterday I was playing my beloved sport, soccer, and as I leaptoutwards for the ball -I am a goalie- I experienced a tremendous pain. Which caused three pops/cracks in what felt like the left/middle part of my left knee. (I was diving left for the ball). Immediately I fell to the ground on my own, no girl hit me nor ball. I am trying to figure out what exactly happened, and I am at a completely loss. I have never had an injury this bad to the point where I needed help getting off the field, and being unable to walk on my own. I am currently treating it like the rest of my previous injuries, which sounds a lot like RICE. Though I am concerned if I should get medical help. According to your chart it seemed like it could be a tear or a fracture.
    I hope to see a response soon, and thank you. :)
    (Ah, by the way I am 16.)

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Carolina, the chart is just for general information. Everybody’s injuries are a little different. It sounds like you may need to see a doctor but, first, tell your parents, have them check it, and they can give you a better advice after that.

      • Carolina Noeggerath

        My parents have already checked it, and at the moment we are following normal injury protocol. If my pain worsens anymore I guess we will schedule an appointment.
        In the meanwhile, could you tell me if it is safe for me to test the bounds of my injury? Such as attempting to bend it, stretching it flat on the floor, or applying some of my weight? Or would that likely worsen my condition?
        Thank you for the response.

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          In general, don’t do anything that makes it hurt more than a little more.

          • Carolina Noeggerath

            Okay, thank you.