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.

  • Jake

    Hi, I am really having problems with my knees. I am only fourteen and the pain is quite unbearing at some points. I have taken medicine and rested and my parents push it off like it is nothing, but I believe there is something more. my knees have been giving me problems for about the past two years to a year. They spike up worse than other times. They get very sore, achy, very unstable(leg gives out). I have been very active in sports and am not in any way overweight. I play catcher for baseball, run a lot, and play soccer. It just hurts a lot and I could use some help

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

      This is the most common problem in teens knees. Do you have a trainer or nurse who could check you out? Did you sit down and talk to your parents about how much trouble they are giving you? Perhaps they could check them when you’re having a flareup.

  • Tracy

    Hi there. I have been a dancer my whole life and always looked after my knees. Im no stranger to torn meniscus as I did that to my right knee 11 years ago. About 2 years ago I twisted my left knee at a friend’s house. I just rested it and the pain went away. However I had noticed pain when dancing sonetimes nothing to bad. On Wednesday night we had a long rehersal and yesterday my inner knee was incredibly tender to touch or move especially in a bent turn out position. Its still really sore today. I have a 5 hour rehersal tomorrow. Should I see a dr

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

      Yes, and before you do 5 hour rehearsal.

  • Chaser06

    I’m 29 and played a pick up game of touch football yesterday! Everything went good with my ability to play… I can not recall one instance of hurting or any impact to my knee!! Today I woke up and have a sharp pain while bending my knee toward my left leg on the the inside of my right knee… Slight pain when I retract and extend my knee…

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

      If it continues to bother you, you should have it checked out.

  • murm

    I had an ACL reconstruction done about 3 years ago. and for the past six months or so i hurt my knee pretty often but it would feel fine the next day or so. 2 week ago i hurt my knee again pretty bad i couldn’t put any weight on it could not bend it or put it straight it was swollen. it pretty much felt like the first time i tore it. i no longer have insurance and would not be able to afford and MRI. i just want to gain full range of motion again but i cant remember any of the exercises i did before. i walk with a limp what would help get rid of the limp?

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

      One of the big questions is whether you tore anything 2 weeks ago. Also are you developing some arthritis. Even without an MRI you should have it checked. Perhaps an injection might help. As far as exercises, you could call and ask whoever gave them to you or google “acl rehab exercises.”

  • Josh

    I injured my knee today, I think it over extended or something. I was skiing and it hit off the ground, after that I could feel pain and I felt a “pop”, this same day I have iced it twice and can walk on it without moving it straight, I must keep it in certain position range for me to walk. If I straighten it, it hurts so I can’t walk properly. Should I go see a doctor?

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

      Sounds like a good idea.

  • Autumn Allen

    I went to turn and felt pain really bad and fell in the ground at first I thought I broke something then I stood up and it still hurt and it hurts when I walk a little and in a certain area it hurts when I push on it and there isn’t a bruise in that spot and whenever I sit with my leg bent for too log then strech it out it hurts a little I think i sprained it but not too sure my dad is one of those run some dirt on it kinda guy what should I do?

  • Ryan Stephen

    Two days ago I was running, I am training for a marathon, and I felt a little pain in my knee so I continued at a slower pace, soon enough I felt a sharp pain in the side of my knee. I stopped immediately and walked home. I am not sure what happened. I can stand on my leg and it isn’t sore, no swelling. I am afraid to run again. The one thing I noticed is when I walk up and down stairs it is sore and hurts. I walked down stairs two days ago and it hurt, today I tried walking down stairs and it only hurt a little bit. I don’t know if I have a sprain or a torn ligament. I feel like if it was a torn ligament I would have extensive pain. When I bend my knee I can feel a small pop kind of.

    What is your opinion? I want to run again but I know I should rest.

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

      Unless you see a doctor and get an OK, or you know exactly what the problem is and you’re not going to make it worse, you should never try to work through pain. There’s no way I could tell you what’s wrong with you specifically without an exam and, possible X-rays. I do know that, sometimes, you can just overdo exercise. That can lead to “overuse” injuries such as various areas of tendonitis, or even inflammation of the joint. If overuse is the problem, rest is the solution. And, sometimes, ice, heat or anti-inflammatory medicines can help. For other possibilities, here’s another post http://www.thesurvivaldoctor.com/2013/02/25/knee-diagnosis/ Oh, as car as pops, they can be from many things such as inflamed tendons, broken bones, and often, especially if it’s not painful, they can be just part of life–tendons moving a little, etc. In other words, non painful pops-audible, felt, or both–really don’t tell you much. With painful pops, it’s generally a good idea to have it checked.

      • Ryan Stephen

        Thanks Doc, appreciate the advice

  • Cristian

    Please respond. I hust my knee llast week at baseball practice. There was a good amount of pain and a pop when it happened. Now there is no pain when I walk or bend it. Its actually just sore. What would you think this is.

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

      Cristian, I can’t make a specific diagnosis without, at least, an exam. If it’s much better, perhaps a bruise or sprain? I’d have the coach check it.

  • Julie

    I’ve been dealing with knee problems for years but nothing has come of it, slight popping. Two months ago, out walking heard a pop with slight pain. Didn’t really bother me until the next day when it became shift and swelled up. Finally saw a knee doctor as a recommendation from the walk-in clinic. He said I have patella problems. I’ve been doing PT for about a month, my knee has increasing gotten better. The other day as I was standing up, I hear a pop, pop, pop, followed my pain on the inner side of my knee. I have slight swelling, tenderness, and shiftiness. I can still bear weight and move around for the most part, slightly uncomfortable. Nothing as bothersome as before. Should I be worried?

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

      Sounds like it’s time to check back with the ortho to see if further tests are in order.

  • Kathleen

    I was dancing, having a good time, and I felt something in my knee, so I just played it safe but kept dancing. Upon leaving I had to limp to the car. Got home went to bed and when I woke up it was difficult to stand on my right leg, my knee let me know it did not want any weight on it. Have been home all day doing RICE and using crutches. I think I need to have xrays to make sure.

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

      Sounds like you need to have it checked out.