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.

  • Kristen

    Every time i sit on my knee, right one, to tie my shoe or clean something up from the ground, my knee stiffens and I can’t move it into a normal position. It is like it is stuck in a bent position and I can’t move it. Eventually, I have to lay down and have a friend or a trainer straighten it but it hurts too much for me to do on my own. Also, when I straighten it after this happens, it pops and then hurts for about 10-15 minutes so much so that I can’t walk on it. I don’t know what is happening but any insight to this would be extremely helpful!
    Thanks!

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

      Sounds like you need to go to a doctor and get a proper diagnosis and treatment. One possibility could be patellofemoral syndrome “Theater Goer’s Knee.” Here’s a link for more info on that. http://emedicine.medscape.com/article/308471-clinical

  • Will Simajaya

    i landed awkwardly and heard pop on my knee. i cant get it straight and it hurts below a knee cap like when you have bruise.

  • Harry

    Hey there. I’m 14 and hurt my knee during an accident at the skate park about a week ago. I was going at a high speed and crashed into someone and my knee hit his scooter. At first it was not very painful, but then the pain started increasing until about 15 minutes later I found it very hard to bear weight. This continued for the rest of the day and there was also a lot of swelling in my knee. The pain seemed to decrease in the following days. I have been taking medication and icing my knee. For the past few days it has been OK for me to walk but when i try to return to my daily activities, my knee starts hurting again and throbs. I hope it will get better soon but i am just wondering if there is any way to speed up the healing process or if I should see a doctor? Thanks!

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

      Don’t do activities that cause pain. Have one of your parents check it out. Maybe, also, a nurse or coach.

  • Justin

    I was playing basketball about 12 days ago and Dislocated my knee cap. It stayed out for a few minutes before it went back in on it’s own. I now have a lot of swelling and some bruising on the inside of my knee and I can’t bend it. I can put pressure on it and it feels pretty stable with very little pain. I had both an athletic trainer and doctor look at it. Both thought the tendons and legiments felt good and the soc wants to X-ray when swelling goes down. My concern is that I haven’t gained any movement since it happened. Could there be something keeping me from bending it that I havent mentioned?

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

      After a complete dislocation and reduction most people are soon able to bend their knee at least 40-45 degrees or so. Completely dislocating a kneecap usually requires physical therapy for rehab. Here’s a post http://www.thesurvivaldoctor.com/2012/10/09/dislocated-kneecap/

      • Justin

        Thank you. The only thing in there I didn’t see mentioned is why I can’t bend it back. It is straightened. One thing the trainer who looked at it said was he thought I might have done something to the patella retinaculum? Could this explain why it won’t bend?

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

          Sure. Hope you’re following up with your doctor.

  • Chris Abney

    Well I was playing basketball the other day and I landed on my leg straight down. It hurts whenever I bend the knee and try to straighten it. It’s not a severe pain but it does hurt and bother me enough to where it hurts to walk. Any ideas what could be wrong?

  • John

    5 to 6 weeks ago I was standing next to my bed with the right side of my right leg against the bed. My desk is near that corner of my bed and I was just about to sit down on the chair behind me. All of a sudden my right knee buckled and I heard what I immediately told my wife sounded like a 2×4 piece of lumber snapping. On later reflection, I think a better way to describe the sound would be stepping on a large open bag of Doritos potato chips – a quick loud crunch. My wife was in the room and did not hear it.

    If it helps any in figuring this out, my lower right leg was touching the box spring and the mattress was pushed slightly back. I looked at it after just trying to figure out what happened. My best guess is that my foot was firmly on the floor, my right calf was against the box spring and maybe my body weight shifted a little more to the right as I was about to sit on the chair. Maybe my knee was extended inwards or something. I really don’t know.

    It was late at night when it happened. I thought I would need to go to the ER right away. But taking the weight off my leg helped, so I laid down and my wife got some ice. I should add that I had a fever from the flu around that time so had been alternating tylenol & advil to break the fever that day. I suppose they might have helped as an anti-inflammatory as well.

    After sleeping I was able to walk on my leg, it was a bit sore and I was careful. Laying on my back on the bed, though, I was unable to extend my right leg towards the ceiling. I would feel a pinch and some pain in the area under my kneecap while doing that. I could extend my leg outwards while sitting on the side of the bed but not with the additional weight on the joint towards the ceiling. By around 48 hours I was able to extend my leg to the ceiling.

    For the first 10 days or so I wore a cheap elastic knee support brace. Took it easy on my knee for basically the first 4 weeks. I don’t think I went up/down a few steps until week two and even then I tried not to. Week 4 I attempted going up/down stairs to the 2nd floor, which was ok but a little sore doing it.

    Now, 5-6 weeks after the incident, I feel as though I am walking better on my right leg, favoring my left leg less than I had been. Stairs are a bit easier, too, although I take it easy on the way down as I feel a slight pull/pinch below my kneecap if I lead with my right leg on the way down.

    The entire time I never really noticed any swelling. On the inner side of my right leg, just above the knee joint, there’s an area that is often just slightly sore. A bit tight as well, which I’m wondering if the slight tightness might just be from trying to favor my left leg and generally trying to take it easy all this time (no running around or up/down stairs, etc).

    Other than the slight soreness and rare pull/pinch feelings that I described, one other thing I have noticed is that my right knee usually feels warmer than my left knee.

    I suppose part of my issue now is that I’m nervous about it happening again even though I can’t really see why it happened at all and my knee feels stable to where I would not expect it to have another similar incident.

    This week I plan to start using a stationary bike to basically help rehab the muscles a bit. Not sure how that will go but I’m planning to start at just 15 or so minutes each day with light/moderate cycling.

    I feel that I’m making progress so will just keep on this route for now. Lack of insurance is why I have not gone for a medical consultation.

    —-

    Any chance you could help me better understand what happened to my knee? Other thoughts and/or suggestions would be appreciated as well.

    • John

      Sorry about the double post, I did not see it went through the first time. The above can be deleted.

  • John

    5 to 6 weeks ago I was standing next to my bed with the right side of my right leg against the bed. My desk is near that corner of my bed and I was just about to sit down on the chair behind me. All of a sudden my right knee buckled and I heard what I immediately told my wife sounded like a 2×4 piece of lumber snapping. On later reflection, I think a better way to describe the sound would be stepping on a large open bag of Doritos potato chips – a quick loud crunch. My wife was in the room and did not hear it.

    If it helps any in figuring this out, my lower right leg was touching the box spring and the mattress was pushed slightly back. I looked at it after just trying to figure out what happened. My best guess is that my foot was firmly on the floor, my right calf was against the box spring and maybe my body weight shifted a little more to the right as I was about to sit on the chair. Maybe my knee was extended inwards or something. I really don’t know.

    It was late at night when it happened. I thought I would need to go to the ER right away. But taking the weight off my leg helped, so I laid down and my wife got some ice. I should add that I had a fever from the flu around that time so had been alternating tylenol & advil to break the fever that day. I suppose they might have helped as an anti-inflammatory as well.

    After sleeping I was able to walk on my leg, it was a bit sore and I was careful. Laying on my back on the bed, though, I was unable to extend my right leg towards the ceiling. I would feel a pinch and some pain in the area under my kneecap while doing that. I could extend my leg outwards while sitting on the side of the bed but not with the additional weight on the joint towards the ceiling. By around 48 hours I was able to extend my leg to the ceiling.

    For the first 10 days or so I wore a cheap elastic knee support brace. Took it easy on my knee for basically the first 4 weeks. I don’t think I went up/down a few steps until week two and even then I tried not to. Week 4 I attempted going up/down stairs to the 2nd floor, which was ok but a little sore doing it.

    Now, 5-6 weeks after the incident, I feel as though I am walking better on my right leg, favoring my left leg less than I had been. Stairs are a bit easier, too, although I take it easy on the way down as I feel a slight pull/pinch below my kneecap if I lead with my right leg on the way down.

    The entire time I never really noticed any swelling. On the inner side of my right leg, just above the knee joint, there’s an area that is often just slightly sore. A bit tight as well, which I’m wondering if the slight tightness might just be from trying to favor my left leg and generally trying to take it easy all this time (no running around or up/down stairs, etc).

    Other than the slight soreness and rare pull/pinch feelings that I described, one other thing I have noticed is that my right knee usually feels warmer than my left knee.

    I suppose part of my issue now is that I’m nervous about it happening again even though I can’t really see why it happened at all and my knee feels stable to where I would not expect it to have another similar incident.

    This week I plan to start using a stationary bike to basically help rehab the muscles a bit. Not sure how that will go but I’m planning to start at just 15 or so minutes each day with light/moderate cycling.

    I feel that I’m making progress so will just keep on this route for now. Lack of insurance is why I have not gone for a medical consultation.

    —-

    Any chance you could help me better understand what happened to my knee? Other thoughts and/or suggestions would be appreciated as well.

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

      Loud pops can be anything from a broken bone to a torn muscle or ligament to a sprained muscle or ligament. Of course sprains get better with rest and time but the pain from tears does also. Some torn ligaments cause more problems than others. Warning signs of long-term problems are continued pain, stiffness and instability. But especially if your knee seems unstable, you should definitely see a doctor.

      • John

        Thanks a lot for the quick reply. I think what I’ll do is give it a bit more time for healing along with some light rehab exercise at home. If there’s still some lingering soreness/stiffness/etc after a while then I will go for a medical consult as soon as I can afford to. Stability seems fine at this point although I think I do need to regain some confidence because I worry about the same injury happening again, even though I think it was a fluke.

  • David

    Hello, hoping to get some help with my knee!
    I just returned from playing basketball, where I went up for a routine lay up, did not land or jump awkwardly at all but when I landed (on my left knee), I felt a sharp pain shoot up the front/left of my knee. The pain subsided pretty quickly but was pretty intense and afterwards, I could not extend my knee out without pretty bad pain.
    I was having troubles with runners/jumpers knee before for a few days, but nothing a good warm up didn’t fix.
    Any ideas what it could be? Perhaps a knee sprain?
    There is no swelling, I can bear some weight on it, but bearing weight on my toes puts more pressure on my knee which does cause pain. I can extend me knee to about 160 degrees, and then the pain starts. I can extend my knee with help (holding my leg up, etc.)

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

      David, odds are it’s a knee strain. Other possibilities are a cracked bone or a tear. The only way you’d know that for sure is see a doctor for an exam and tests. Meanwhile, remember RICES http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

  • hunger4justice

    Had plantar fasciitis so switched to Stairmaster, got positive theater sign, ache around patella, felt knee popping from time to time, figured it was runners knees, but knew started to feel unstable and like it would hyperextend backward. Suddenly, when walking felt a snap medially and posteriorly when walking after knew felt like it bent backwards. Had to go to ER where they said were not allowed to order MRI but X ray showed swelling and they said a rupture or tear of ligaments. Gave me knee immobilizer. Because the VA Ortho is so horrible, (long story) I will not be able to get any MRI. Can bear wt now with immobilizer and knee straight. I think it is an MCL and PCL tear. If I use immobilizer 8 weeks, with walker or crutches, then 8 months with flexible support and is it possible to heal w/o surgery? Only students do the surgery at the VA and very bad outcomes at our hospital.

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

      hunger, I’m sorry for your troubles. Ligaments don’t heal if they’re complete tears although, sometimes, it can be an incomplete tear of some of the tendon fibers and can get better with time. Like any hospital, some VAs are better than others. I don’t know the rules but perhaps you could get a second opinion at another one?

      • hunger4justice

        We are not entitled to a second opinion nor do we have any say or choice as to who our doctor or surgeon is. If it is to be an inexperienced student we either agree to that or forgo care. Vets whose only income is VA comp also get no subsidy under Obama care. I just have to try and elevate, ice, brace and hope it heals. Love your website. Thank you.

  • Bonnie

    Hello, I don’t know if you still read the comments but here goes. Some weeks ago my knee started hurting a bit when I either walked down the stairs, made a turn or stepped sideways. I play tennis and quick turning or stepping sideways is very important, whenever I do this now it feels like the outer ligament (lateral collateral ligament) is moving or scraping and I can actually feel it moving at the moment of the pain however when I then put my knee in a position which doesn’t hurt, the pain is also completely gone. I’m able to use the bike fine and I can walk but walking down the stairs does hurt sometime. It also seems like it’s hurting less when my knee is “warmed up” (also when I use a “warming” ointment or salve), I can then feel the ligament moving but it hurts less (still not a pleasant feeling though). Would you have any idea what could be wrong? It’s not swollen nor red.

    I’ve already gone to a doctor and she told me it might be Osgood-Schlatter but I’m a bit sceptical about this because it’s not visibly swollen or anything.

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

      I couldn’t attempt to diagnose you without an exam. Your doctor would be a much idea. You certainly don’t have to have swelling with Osgood-Schatter. Here’s a post on it. http://www.thesurvivaldoctor.com/2012/10/02/osgood-schlatter-treatment/

      • Bonnie

        Thanks for the reply, today I played tennis (yes I know, bad idea) I took some ibuprofen and during my singles, while I was running less than I usually do, I didn’t have too many problems. Then, I played another match after that (doubles and yes, I know, even worse of an idea) and I was doing fine untill the start of the third set (was an exciting game). I got up from the bench and all of a sudden the knee felt very heavy and I could not straighten it or bend it any further (also putting pressure on it hurt). Seems that something went wrong when I got up from the bench, before playing tennis I noticed that it helped to first thoroughly heathen the outer side of my knee with some muscle salve and then I put on an elastic brace which supported me enough during the singles. In the end I did finish the game without walking too much but right afterwards I went and put something cold on it. I couldn’t walk properly for about 5 hours however I could use my bike and right now, it doesn’t hurt (though it still feels a bit heavy) but I’m able to walk fine again.

        You’d advise to keep rest and not play tennis at all? The problem is that I’ve felt something wrong for a few weeks and I didn’t do anything too bad for my knee (did not run or play tennis) but the injury kept posing problems (also while sitting down at work). I’m an avid tennis player and it would be a shame if I really would need to keep rest for more than a week. Would you advise me to keep wearing the elastic brace all day? And what would be the best position for my leg when sitting down?

        Sorry if I’m asking a lot of questions but I’ve already gone to the doctor and she seemed to give me a hasty “Osgood Schlatter” verdict..

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

          Bonnie, perhaps you could get a second opinion. But, also, you’re no even trying to comply with rest at all. If it is Osgood, or even a sprain, all these question are nil if you don’t rest your knee. If you continue as you’re going, you can expect to only get worse.