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.

  • Isabelle Whiting

    Last year I injured my knee playing softball this time the same thing happened just different sport I was playing volleyball Thursday night when my knee popped and I fell to the floor luckily my coach has crutches with her just in case something like that happens but I still had to be carried of the court there was not an emergency room for three miles but I already knew what to do I have been on crutches but when I played my instrument at a football game last night I was very unstable. I have also been wearing a brace but this is all very confusing to me as I am 20 years old.

  • Amy Stevens

    I suffer from Patellofemoral Pain Syndrome (chondromalacia) that was initially misdiagnosed as an ACL sprain. It seems to have been caused by a combination of frequent squatting over 7 months of working as a personal carer in a nursing home and semi-professional dancing on top of that. If I am too inactive, it stiffens up, and if I am too active (such as if I am forced to use stairs or if I take more than 8000 steps per day) the knee goes slightly puffy and anterior medial pain occurs when weight bearing or if I apply any sort of pressure to the patella. After 10 months of compensating for the injured knee, my good knee is beginning to show signs of the condition. Three months of physiotherapy failed to improve my PFPS and probably contributed to making it worse. It now seems to be a condition I simply have to live with, but it cost me both my job in the nursing home and my life as a dancer. I can no longer jog, run, skip, cycle or take stairs, or walk more than 5 minutes at a time. I am in my early 30’s, so it’s awful feeling so disabled at such a young age.

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

      Physical therapy is the treatment of choice. Some therapist also tape the knee which can help as well. I’d ask your doctor if you’re a candidate for surgical alternatives or seek a second opinion by a knee specialist. If your close to a large town or medical school you may find a doctor that has a special interest in PPC. Also, stay tuned. Over the next few years, cartilage transplants may become feasible.

      • Amy Stevens

        Thanks very much for your response, Doctor. I neglected to mention a couple of things – the physiotherapist taught me the McConnell taping technique and it is because of this that I was able to commence working in the less physically straining home and community care sector after 5 months off work. Unfortunately, I develop an allergic skin reaction to the hypoallergenic tape after wearing it for 24 hours and I am then forced to take a break from taping to let my skin calm down. Also, I saw an orthopaedic specialist 6 months ago (5 months after the problem developed) and he advised me that surgery is not appropriate in my case since my patella appears to track normally and the only advise he could give me was to avoid bending the knee more than 45 degrees and to avoid all activities that aggravate the condition, which takes away everything I enjoyed doing and most of my functionality as well. It seems from my personal research that PFPS often becomes a chronic problem that carries on for years.

  • ana ar

    I ve had 2 knee surgeries in my right knee first acl and meniscus on 2011 and the second one tore both of my meniscus again the femur cartilage and patella cartilage both injuries happened while playing soccer i Am 21 years old, and a week ago in a soccer game , i straighten my right leg to reach a high soccer ball while my left leg was plantes, suddenly a girl on the other team ran to me and in some way my right Leg ended on her tummy and twisted and over flexed it hurted a lot but i kept playing, then it got swollen but i didnt go to the doc , yesterday i was training and felt exactly thesame pain without doing any twisting and i dont know If i should go to the doc i dont want another injury nor surgery

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

      You should

      • ana ar

        Im going tomorrow i ll let you know the outcome

  • Usman Akbar

    I twisted my knee badly in a soccer game and i didn’t heard any pop but my knee got swollen in the back and front place as some fluid got into it after 6 weeks of rest i came back to soccer game and it again it twisted not badly this time i fell my knee wants to pop and possibly i feel its locked and i have some rashed skin behind the back of knee what can it be please replay ASAP

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

      Sorry, I’ve been out of town. But if it’s still hurting you should have it checked to make sure you don’t have torn cartilage.

  • Sarah Davis

    Is rest always best if you’re worried because you think you may have torn or ripped your knee ligaments? I am in a great deal of pain when standing and can’t weight bear. I have strapped it up with a stretchy jumper but am unsure of resting completely because I start university lectures Monday so neeed to be mobile. Is R.I.C.E the only right answer??? I need medics’ opinions please!

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

      Rest for the injured area is best for at least a day or two or until the pain gets better or unless you have someone like a physical therapist working with you. At some point you do want to make sure you keep your range of motion. It’s most important to rest if there is any suspicion at all of a broken bone. Rest may include using crutches and a brace. You’re best bet would be to get it checked out today at an urgent care clinic.

      • Sarah Davis

        biit late to now but will tomorrow because it hurts. Thank you for answering.

  • Taylor Willis ⚽️

    my knee was slammed into at soccer by another girls knee and it feels unstable when I walk it hurts and when I put pressure on it it hurts.
    Should I see a doctor?

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

      I’d have a trainer and your parents check it first.

  • Cody Baldwen

    I don’t know what i did, but my knee is killing me and i can’t walk on it. It has been filling up with some type of fluid or puss, then it drains into my lower leg. It started hurting again and it has only been a few days since it stopped hurting. It feels like someone is squeezing it very hard, or like it needs to pop. I can’t put pressure on it, and I can’t bend it without a very sharp pain. I would like if you could tell me what you think is going on because on can’t be sitting down and crippled. I have things to do and my knee is holding me back. Thank you for you time try to get back with me if possible, it would be greatly appreciated.

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

      If pus is coming out of the area around a knee, that can be very serious and you need to see a doctor.

  • trina

    Hello. I am pretty much out of options so i figured posting here wouldn’t hurt. About. 3 months ago my left knee started hurting. I was working two jobs so placing exact point of injury is difficult. At first my base of quads swelled up and there was pain in medial side of knee, along with popping when twisting knee to the left,(is left knee). Saw two orthopedic doctors. I have no insurance and they seem to be bothered by this. Anyway, first doctor said to go to gym and work my muscles. Only took an xray. My leg and knee still hurt so i got a second opinion, this doctor assumed meniscus tear and sent me for mri. Mri results showed mild/moderate edema in superior-lateral region of hoffas fat pad. Mild/moderate poorly defined increased T2 signal intensity involving superior-lateral region of hoffas fat pad. Small left knee joint effusion. And midly increased intracapsular synovial joint fluid. It states there is no definite evidence of intracapsular loose bodies. The anterior and posterior cruciate ligaments, the medial and lateral collateral ligaments, the Iliotibial band, biceps femouros tendon, popliteus tendon, infrapatellar ligament and visualized region pf quadriceps tendon are intact. All three compartments of left knee joint are well maintained. And there is no evidence of either medial or lateral menisci tears. When i returned to doctors to go over this he said the mri was normal. Sent me for ultrasound for blood clot check camr back negative. I wrote all this to give you the best understanding i could. Another week haf passed i had complained to doctor about the back of kbee and calf. I have been trying to work, i waitress. Within a five hour shift i am limping from pain. My veins from medial and posterior of knee joint down to my ankle have popped out and blood vessels havw broken. It has not gotten any better. I ice it every day and sleep with ice pack and ace bandagw. Along with hot Epsom salt baths. I have tried some quad streching just in case but it seems to cause more pain. Wheb i wake in the morning the stiffness is unbearable. Eventually after movement it turns into pain and includes popping which feels like ita from the center of my knee. The veins at the top of calf near back of knee are most prominent and i have a bruise on my lateral calf that has been there for three weeks with no fading. I now am feeling sharp pains in shin bone at patella tendon ending and even in the bottom of my foot. I am concerned not only because of pain but i can’t work enough to pay Bills. I have gone down to 4 shifts a week with an extra day off in middle. And no help. On top of it when he had suspected a meniscus tear i was out for 14 days with brace. And still on last day went grocery shopping and could bearly bear standing for even that. I have forced myself through thw pain just to help pay bills. Do you have any suggestions with this type of situation. Trina

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

      Trina, sorry, I’ve been off a few weeks. Hope you’re better. All I could suggest is a cane or crutches if you’re not. It sounds like you’ve had a pretty good workup. If you’re not better, I’d follow up with one of the doctors you’ve already seen. They’ll better know how you were the first time they saw you and what has already been ruled-out.

  • Jenn Christiaens

    24 year old mom: I injured my knee a few weeks ago at my moms house. I was trying to build my niece a tree fort in a VERY rocky area. I leaned up against an old dead tree (lesson learned, look before you leap!) and my left knee slammed into some jagged rocks (got a good scrape on knee) and I also scraped up my arm. My whole body weight was applied to my knee as I fell (nothing to grab onto). It hurt pretty bad and I was in shock/dazed for a few minutes because I didn’t think I was actually going to fall. My knee swelled almost instantly an when I looked at it the left side looked like it was dented for quite a while. Stubborn as I am I didn’t put any ice on it until the next day because I had a job to do and was really busy up until bedtime. Weight bearing hurt and I limped around up until a week ago. I still haven’t made it to the doctors yet. Well the knee pain is still there and I keep feeling a popping/cracking feeling when straightening my knee and almost like a pinching burning pain at times as well as its still swells a bit unless I put ice on it. Could this be a fracture or torn muscles or both? I really have to get myself in to see my doctor but I was hoping it’d go away on its own.

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

      Could be anything from a bad bruise to a break. Please let me know what the doctor says.

      • Jenn Christiaens

        Okay thanks, will do!

  • Jay

    hey doc, got my leg twisted felt like the fibula popped out of place a bit. only hurts when I sit cross legged
    it’s been a few weeks already. Went to my doctor he said it’s most likely a sprain. Kinda worried it’s more than that. When could I go back to wrestling practice?

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

      That’s something to ask the doctor who checked you. And if you’re still having trouble tell him about that also.