Jim Newman looks at possible causes of knee pain when kneeling, and some potential solutions.
There are lots of possible reasons you might suffer pain when kneeling and the specifics can often depend on age, profession and whether you’ve had a knee replacement or not.
If you are relatively young and don’t spend your days working on your knees (we’ll get to joiners, carpet fitters and gardeners in a moment), pain at the front of the knee isn’t normal.
The main point of contact when you kneel is the kneecap joint, otherwise known as the patellofemoral joint. Inside the joint sit the kneecap, the kneecap tendon, the fat pad underneath the kneecap, the quads tendon and more. When you kneel all of them are stretched – so placing any pressure on them (which is what happens when you kneel) will accentuate any problems. Degeneration of the joint is the commonest problem in this group of patients, although tears at the front of the menisci can also cause problems in rare instances.
Wearing padded kneelers can help to protect the knee and prevent aggravating the problem. Stretching exercises and physiotherapy may also help degeneration issues, but if the problem persists you should see your GP at first instance.
Arthritis sufferers and kneeling pain
With osteoarthritis (wear and tear of the joint), pain when you kneel is very much par for the course, although kneeling is likely to be far from the only occasion you’ll feel joint pain. Osteoarthritis can cause particular problems if you work in a trade where kneeling is an occupational necessity, but a knee replacement – often the last resort for osteoarthritis sufferers – may not be the solution to kneeling pain.
To be clear, a knee replacement (whether total or partial) can be transformative in terms of pain in general. It can also restore a huge amount of function that you had lost. But the knee replacement operation involves entering the knee at the front – precisely where you kneel. There isn’t an alternative to this and it’s why, even after an otherwise entirely successful knee replacement operation, kneeling may still cause problems.
One thing knee surgeons can do to reduce the risk of kneeling pain, however, is to protect the fat pad that sits beneath the kneecap. This lump of fat is often taken out during a knee replacement as retaining it can make the procedure more complex. Yet there are benefits to keeping it as it provides a natural cushion between implant and kneecap. The pad also has a strong blood supply and removing it can cause tendons to shrink. There is some evidence that retaining the pad alleviates kneeling pain for those with knee implants which is why I’ll always aim to retain the pad. Clearly, that’s particularly important if you’re planning a return to a job that requires lots of kneeling.
So if you don’t have osteoarthritis but suffer pain when you kneel, seek medical advice.
If you do have osteoarthritis, a knee replacement could be a big help generally, but may not solve kneeling pain (although retaining the fat pad could help).
Consultant Knee Surgeon at the Yorkshire Knee Clinic
“I’m walking normally now - no sticks or anything. I’d like to thank Mr Newman for what he’s done for me. It’s been life changing.”
Paul Morgan, YKC patient
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