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.

  • Quantumnerd

    I just lifted my right leg up to brush something off under my foot, when I put my leg back down I kind of put it down a little sideways and the pain was excruciating, I almost passed out and threw up at the same time! I immediately sat down and elevated it and put ice on it. For 20 minutes, then followed the instructions above, I carefully tried to stand, it’s not swollen and I can bare weight on it and walk. It hurts more above the knee in the back and above in front? It’s not swollen. I also wrapped it right now. I feel a popping on the left side when I bend it, but it’s not painful and I can’t hear it popping. Does this sound like something minor? Or should I go to ER? Thanks! The popping is at the side in the middle of where the knee cap is.

  • Reza

    Not sure if you’re still answering questions but…

    About three weeks ago someone kicked my left knee and I felt a sort of paralysing pain. I couldn’t move for a minute but afterwards when I regained sensation I could get up by I would hobble when I walked and my knee was very unstable and it gave it sometimes.

    Three weeks later I can walk at a normal pace and run at normal pace too, however my knee always feels somewhat stiff and there if still effusion at the front and back of the knee, however it is not so significant that it is very noticeable. I can bend my knee in all ways except for when I bend down. When I squat right down I feel a stiffness in the left knee, as it if something is stuck there and it makes it hard to move it around normally. On days when I have to move around a lot, I find sometimes the knee becomes so stiff and just a bit sore, so it hurts to bend down more so than usual. The effusion had gone down quite a bit after the first two or three days since the injury, but since then it hasn’t really reduced.

    I also find my knee feels more normal in movement the more rest or sleep I get a night, but it still feels a bit strange, as if it’s a bit heavier than the other knee.

    I did see a doctor who told me to wait at least two or three weeks, and while I can walk I still cannot move my knee further back. If I try to do so, there is a dull pain and stiffness and I simply cannot move it backwards. I’m wondering if this means it is healing or something else. I’ll go see my doctor again but I thought asking here wouldn’t hurt.

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

      Sprains can take 4-6 weeks to heal but should be progressively getting better, as yours seems to be. But, after a repeat exam, your doctor can give a much better individual prediction. Please let us know how it turns out.

  • Margo Bell

    Twisted my knee and it popped, no swelling or bruising, but now my calf hurts….knee doesnt really

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

      Possibly you strained that area during the twist?

  • Matt

    Hello. I’m not sure if you are still replying to this thread but it would be great to get your opinion if possible.

    I managed to hurt my knee a month ago playing football where I was on receiving end of a crunching challenge directly on my knee whilst at full stretch. Whilst in some pain at the time I actually played on albeit not particularly well! There was no real swelling that day or evening but the following morning I was in real pain and struggled to walk. To compound matters my knee would give way with no warning causing me to fall as I was unable to brace myself. My knee would go to a sharp pain for 10 minutes or so and then revert to the same lower level as before. I also appear to now have an incredibly loud click in my knee when it bends which certainly wasn’t there before!
    Stupidly I left it for a week without doing anything and the pain certainly did subside a bit but there was a constant feeling of “looseness”/lack of stability in my knee and at least once a day it would collapse under me. Eventually I was pressured into seeing a doctor but was unable to get an appointment for 2 weeks as it was deemed not critical. Luckily I was able to use my wife’s work insurance and after a triage call was reverted to a physio who proclaimed it patellar tendonitis and gave me some excercises to do before sticking pins in my knee! I was assured the clicking was due to a muscle imbalance.

    Am I wrong to be sceptical about the diagnosis? I understand that condition is common in basketball players but I thought that was generally brought on by constant use rather than an impact injury. Would the muscle imbalance also be the cause of clicking too? I’m not discounting the possibility but I find it odd that it would happen for the first time after being hurt. I’d have thought it would be something that cropped up beforehand if that was the cause. Everything I have dredged up so far have implied I might have a slightly torn ligament hence asking. My knee is definitely in progress a month on but is still very weak, unstable and loud! It’s not given way for a week now though which is encouraging.

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

      Sounds like a second opinion would be a good idea. I’d get an appointment with a doctor you trust even if it’s a couple or 3 weeks before they can see you–possibly an orthopedist or sports medicine specialist if possible.

      • Matt

        Thanks for replying! I actually booked the GP app despite the long wait so I have that to look forward to next week and hopefully they’ll be able to confirm exactly what’s up or at least refer me to someone who can.

  • jasmine reddick

    I feel on my knee a couple of months ago while I was in cheer leading and it hurt after .a and the doctor told me I couldn’t cheer and I had to see a chiropractor .. I did one of those thing but I have yet to see the chiropractor. A few months had passed it was okay .. But it seemed like when I wore heels I couldn’t bear them for more than ten minute .. Just a day ago I had to walk somewhere far and the day after my knee was in pain . I feel like its gonna give at any moment when I walk its not swollen.. every time my knee bone or knee cap moves it hurt it more on the side of my knee. I really have no clue whats wrong.

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

      Sounds like it’s time to have it rechecked, perhaps by an orthopedist.

  • Jay

    Hi, about 2 and a half weeks ago, I hurt by knee while playing basketball for a couple hours, though normally I am a runner. The pain wasn’t immediate, because I only noticed the difference after standing for about 30 minutes after the fact. I noticed that I couldn’t straighten my knee all the way (my right knee straightens about 2 inches further back than my left one). That evening, I had a physical therapist take a look at my knee, and after an examination he said that there wasn’t any real issue, just that I was doing more activity than normal, and should decrease the amount of athletic activity I was doing. Now, I am still unable to fully straighten my knee, and there hasn’t been a whole lot of progress. There was never much pain, just minor discomfort at the beginning. It feels like there is something restricting my kneecap from fully “locking” into place. I can walk normally without a limp. Is this a serious injury, or just minor discomfort that will eventually correct/heal itself? Thanks.

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

      Sounds like you should have a doctor look at it.

  • Karen Orr Massoni

    4 weeks ago I slipped on stairs and hyper flexed my knee with all my weight on it. The pain at first was horrific. I RICEd it for a few days, and it’s better, but still troublesome. Any thoughts on what I might have injured?

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

      Karen, there’s no way i could tell you without an exam. Sounds like you need to get one to make sure your didn’t damage any ligaments or cartilage.

  • Tracey Sbrocca

    I went running 6 miles yesterday on very uneven and hilly road, and half way through the run the back of my knee started hurting me, but I had to keep going and by the time I got back I was in severe pain, and I sat down and I cannot bend my leg now, when I walk on it I cannot bend it, and if it goes from a bent position that I get it in to a straight position it also kills, should I see a doc or just brush it off and wait till it heals on its own?

  • 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.