Osteoarthritis, knee pain after an injury, and pain that turns out to come from the hip or back.
What it is
Knee osteoarthritis is very common. How bad it looks on X-ray does not match the pain well.
In a crash, the knee can slam into the dashboard. That drives it backward and injures the joint and ligaments.
Knee pain can also be referred (felt in one place but coming from another) from the hip or the L3-L4 nerve root. That is why we examine those too.
What does knee pain usually feel like?
- Pain when you put weight on it, climb stairs or stand up from sitting.
- Stiffness after sitting still.
- Swelling and giving way.
- Night pain in later-stage arthritis.
How do you get rid of knee pain?
- Corticosteroid or hyaluronic acid injection under guidance.
- Physical therapy. For knee arthritis it is truly one of the most effective treatments there is.
- Metabolic management, because load and inflammation both matter.
- Referral to a surgeon when needed.
To be seen, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
Hip problems send pain to the knee often enough that we have a standing rule. We examine the hip in anyone with knee pain, especially when the knee exam looks normal. The L3 nerve root does the same thing.
The other common mistake is treating the X-ray. How bad osteoarthritis looks on X-ray does not match the pain well. People with severe joint space loss can be comfortable. People with mild changes can be disabled.
Does exercise help knee arthritis pain?
A structured exercise program improves pain and function about as much as many procedures do. It is the single most reliable treatment for knee osteoarthritis.
Where injections stop working and surgery is not an option or not wanted, genicular nerve blocks and ablation treat the pain. They do it without touching the joint. That is a real option for patients who have been told there is nothing left to try.
How do I tell if my knee pain is serious?
A hot, swollen, extremely painful knee with fever is a septic (infected) joint until proven otherwise. It needs emergency care the same day. Not being able to put weight on it after an injury, or a knee that locks and cannot be straightened, also needs a prompt visit.
Orthobiologic treatment options
Many of the knees we see belong to people who stand all day: line work, retail, nursing, warehouse floors. When the knee has stopped answering to steroid shots, platelet-rich plasma (PRP) is the next step for mild to moderate arthritis. Dose matters. A 2025 review of 18 trials found that high-platelet PRP gave real pain relief over salt water that lasted to a year, while low-platelet PRP did not. Bone marrow concentrate placed into the bone under the cartilage is an option when imaging shows a bone bruise.
Related reading: osteoarthritis and ankle arthritis, which often travels with knee pain in people on their feet all shift. Procedures are done awake with local numbing medicine at our regenerative clinic, 4477 Woodson Rd in St. Louis. PRP is not covered by insurance, and HSA and FSA funds can generally be used.
For every condition we treat with orthobiologics, see our PRP injections in St. Louis page.
What are the main causes of knee pain?
Knee pain comes from several separate sources, and the exam sorts them out. These are the joint surfaces in osteoarthritis, the kneecap and how it tracks, the menisci (the cartilage cushions), the ligaments, and the bursae and tendons around the knee. Pain from the hip or from a lumbar nerve root (in the lower back) can also show up at the knee. It gets missed when only the knee is examined.
What it gets confused with
Meniscal tears found on scans in middle-aged and older patients are often a side finding. Treating them as the cause is a common detour. The real question is whether the tear explains mechanical symptoms — true locking or giving way. Or does the pain pattern fit degenerative change (the joint breaking down) instead?
How we approach it here
The first job is to name the part causing the pain, not just the symptom. That means an exam built around bringing on and easing your pain. It means reviewing any imaging for what it does and does not show. And when the picture points somewhere specific, a targeted block to confirm it. Treatment follows the answer instead of coming before it.
Frequently asked questions
Are injections bad for my knee?
Repeated corticosteroid injections close together are not wise. Spaced out properly and paired with rehab, they are a reasonable part of treatment.
See Osteoarthritis.
My scan shows a meniscal tear. Is that why it hurts?
Not always. Degenerative tears are common in people with no symptoms. Mechanical locking is what suggests the tear matters.
What can be done if I am not ready for a replacement?
Options include guided joint injection. There are also genicular nerve blocks with ablation, when the blocks confirm the nerves carry the pain.
The detail is in Genicular Nerve Block.
What would cause knee pain without an injury?
Osteoarthritis is very common and a frequent source. The kneecap and how it tracks, the menisci, and the bursae and tendons around the joint can also hurt without any single injury. Knee pain can even start somewhere else. The hip and the L3-L4 nerve root in the lower back both send pain to the knee. That is why we examine the hip and back in anyone with knee pain.
Why does my knee hurt more than my X-ray suggests?
Because how bad arthritis looks on an X-ray matches pain poorly. People with severe loss of joint space can be comfortable. People with mild changes can be disabled. That is why we treat the person and the pain, not the film. It is also why we check the hip and lower back when the knee exam does not explain the symptoms.
Can knee pain come from the hip or back?
Yes. Hip problems send pain to the knee often enough that we always examine the hip in anyone with knee pain. We do it especially when the knee itself looks normal on exam. The L3 nerve root in the lower back does the same thing. Treating the knee alone in those cases misses the real source.
Sources
- Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 2020. PubMed 31908149
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 2019. PubMed 31278997
- Bichsel D et al. Cross-sectional Analysis of Recommendations for the Treatment of Hip and Knee Osteoarthritis in Clinical Guidelines. Archives of physical medicine and rehabilitation, 2022. PubMed 34411512
- Raghava Neelapala YV et al. Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature. Journal of geriatric physical therapy (2001), 2020. PubMed 30407271
- Bensa A et al. PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials. The American journal of sports medicine, 2025. PubMed 39751394
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.