Why does my knee feel stiff after I sit for a while?

Your knee feels stiff and aches after you’ve been to a movie or resting for more than twenty or thirty minutes – why? In the past, this has been affectionately called ‘theater knee’, as you’ll see people who have been in the theater stand up slowly, maybe rub their knee, and walk – very slowly at first – until their knee loosens up. This knee stiffness is a symptom often experienced if you have osteoarthritis in your knee joint.

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What is osteoarthritis of the knee?

Osteoarthritis is sometimes called ‘wear and tear’ arthritis. Nobody is sure exactly why, but we know in some people it may be caused by previous overuse or abnormal use, or due to an injury in the past which damaged the cartilage. Over months or years damage to the cartilage cushions in the knee worsens, and symptoms start. In the case of knee osteoarthritis, the smooth cartilage covering the bones of the joint becomes damaged, rough, torn or thin. Injury or abnormal pressure on the joint compartments over time may lead to osteoarthritis. If the kneecap is not in alignment osteoarthritis in the front of the knee can develop. The muscles around the knee support and protect the joint, and injuries or weakness in these may increase the chance of osteoarthritis developing.

What do knees with osteoarthritis feel like?

The increasing pain and stiffness of osteoarthritis is usually a gradual process. Usually your pain is worse with standing and walking, but can be reduced after several steps if it is in the early stages. When your knee is at rest there is less pain, but it usually will feel stiffer after a period of rest or inactivity. When moved again, it is more painful. In advanced knee osteoarthritis you may feel (or hear) grinding or creaking noises when your knee is moved. It may lock or give way if the ligaments are not intact, or if there is a tear in your meniscus. You may be able to find out if you are at high risk for knee osteoarthritis or other knee conditions by going to PainSpot.com and taking the knee pain quiz.

How does a doctor know you have osteoarthritis?

Along with a history about knee symptoms, a thorough knee examination often suggests osteoarthritis is the diagnosis when pain is felt as the knee is moved and rotated. Your normal knee range of motion may be reduced. X-rays are helpful in showing osteoarthritis, and an MRI usually is not needed. The x-ray often shows narrowing of the space between the bones.

How is the knee joint put together?

The knee joint is a hinge-type of a joint. The thigh bone (femur) attaches to the shin bone (tibia) with the oval kneecap in the front. The joint may be thought of has having three compartments; the inner, outer and front compartments. There also normally is a thin, smooth covering of cartilage over the bones in the joint that allows normal, smooth and painless motion. There are two larger cushion-like oval cartilages in the knee, which help to stabilize the knee joint; each is called a meniscus; the one on the inside is the medial meniscus, and the one on the outside is the lateral meniscus. In addition to these meniscus cartilages, four strap-like ligaments also support and stabilize the knee joint. The ACL and PCL ligaments stabilize the knee against forward and backward pressures. On each side of the joint (medial and lateral) are the collateral ligaments and provide side-to-side stability. The kneecap protects the front of the joint, and also acts as a pulley for the large thigh muscles (quadriceps) which straighten the leg at the knee joint.

What kinds of treatment can help your knee pain?

The treatment of knee osteoarthritis depends upon the severity of your pain as well as how dependable the joint is when you walk on it. Efforts to rebuild joint cartilage are still in the early research stages. Initial treatment to reduce pain often consists of weight loss (if necessary) and exercises to strengthen the knee muscles and reduce the stiffness in the joint. Water exercise classes may be especially helpful. For more severe pain, medications may be recommended. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. Various prescription medications which belong to a group of medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin, Naprosyn, Mobic, Voltaren, Relafen and Lodine. (a complete list is available at the reference below). More recently, a medication of a different class called Cymbalta has been approved to treat the pain from osteoarthritis.

How about knee injections or knee joint replacement?

More severe pain may be treated with injections of either cortisone-like medications, or lubricating fluids called ‘viscosupplements’ (such as Hyalgan, Orthovisc, Supartz, or Synvisc) into the joint. If the arthritis is severe, the knee joint may be partially or entirely replaced with surgery.

About Doug Roberts MD

Board certified practicing rheumatologist and founder of PainSpot.com
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