In this article, you will find out everything you need to know about pain when kneeling and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Understanding Stinging Knee Pain When Kneeling
Experiencing a sharp, stinging pain on the outside of your knee when kneeling is a common complaint, especially among active individuals, gardeners, and those who spend time on their knees for work or hobbies. An overuse injury is a common reason for this type of pain, often resulting from repetitive strain on the knee structures. A common overuse injury is called runner’s knee, which can also cause this type of pain. Identifying the underlying cause is crucial for effective treatment and long-term relief.[1]
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Common Causes of Stinging Pain on the Outside of the Knee
- Anterior Cruciate Ligament (ACL) Injury: A tear or sprain of the anterior cruciate ligament, which connects the thigh bone to one bone of the lower leg, can cause pain and instability, especially after trauma or sports injuries. Symptoms often include sudden pain, swelling, and difficulty bearing weight.
- Bursitis: Inflammation of the small fluid-filled sacs (bursae) and the connective tissue around the knee joint, such as the fibular or subcutaneous bursa, can be particularly painful when kneeling and cause stinging pain when pressure is applied.
- Nerve Entrapment: Compression or irritation of nerves near the knee, such as the peroneal nerve, can cause sharp, shooting, or stinging pain. Compression of nerves running near the kneecap or between one bone and another can result in stinging pain.
- Osteoarthritis: Degeneration of the knee joint, including the thigh bone (femur) or the connective tissue between the thigh bone and shin bone, can lead to painful symptoms and sometimes present as lateral knee pain, especially in older adults.
- Iliotibial Band Syndrome (ITBS): Inflammation or irritation of the iliotibial band, a thick band of connective tissue running along the outside of the thigh and knee, is a leading cause of lateral knee pain, especially in runners and cyclists.
- Runner’s Knee: A common overuse injury that causes pain in the front or outside of the knee, especially in runners. Runner’s knee is often linked to patellofemoral pain syndrome or iliotibial band syndrome, causing pain that worsens with activity.
- Lateral Meniscus Tear: Damage to the cartilage on the outer side of the knee can cause sharp pain, especially when kneeling or twisting. A tear causes pain by disrupting the smooth movement of the knee joint, making activities painful.
- Lateral Collateral Ligament (LCL) Injury: Sprains or tears of the LCL can result in pain and instability on the outside of the knee. A partial tear can be less severe but still painful and causing pain on the outside of the knee.
Iliotibial Band Syndrome and Lateral Knee Pain
Iliotibial band syndrome is one of the most frequent causes of pain on the outer side of the knee, especially in active individuals. The iliotibial band is a thick band of fibrous tissue that runs along the outside of the thigh, extending from the hip down to the knee joint. Its main function is to provide stability to the knee during movement and to assist the leg in activities like walking, running, and cycling.
When the iliotibial band becomes tight or overused, it can start to rub against the outside of the knee joint, leading to a condition known as iliotibial band friction syndrome. This repeated friction causes irritation and inflammation, resulting in a burning pain or stinging sensation on the outside of the knee. Swelling and tenderness may also develop, particularly after activities that involve repetitive knee bending or prolonged periods of running or hiking.
The inflammation associated with iliotibial band syndrome can make it difficult to kneel, squat, or even walk without discomfort. If left untreated, the pain and swelling may worsen, making daily activities and exercise challenging. Addressing iliotibial band syndrome early with rest, stretching, and targeted strengthening exercises can help reduce inflammation and restore pain-free movement in the knee joint.
Symptoms to Watch For
- Sharp, stinging, or burning pain on the outside of the knee when kneeling
- Swelling, tenderness, or warmth around the knee
- Clicking, popping, or locking sensations
- Instability or weakness in the knee
- Numbness or tingling (may indicate nerve involvement)
- Pain that worsens with activity or direct pressure
- Pain worsens with continued movement or repetitive activity, especially in conditions like iliotibial band syndrome or runner’s knee
If you experience severe pain, inability to bear weight, or signs of infection (redness, fever), seek urgent medical attention.
Diagnosis: How Is Lateral Knee Pain Evaluated?
Accurate diagnosis is essential for effective treatment. Your healthcare provider will ask about your medical history, including any previous knee injury, to help guide diagnosis. They will take a detailed history and perform a physical examination. Diagnostic steps may include:
- Physical Exam: Assessing tenderness, swelling, range of motion, and ligament stability.
- Imaging: X-rays, ultrasound, or MRI to identify structural problems, cartilage tears, or inflammation.[2]
- Special Tests: Maneuvers to assess the iliotibial band, meniscus, and ligaments.
- Nerve Studies: If nerve entrapment is suspected.
Case Study: Stinging Knee Pain in a Recreational Runner
Patient: 42-year-old female, recreational runner.
Symptoms: Stinging pain on the outside of the right knee when kneeling and after long runs; overuse injury is a common risk factor for this type of pain in runners.
Diagnosis: Iliotibial band syndrome confirmed by clinical exam and MRI.
Treatment: Rest, physical therapy, foam rolling, and a course of prolotherapy.
Outcome: Complete resolution of pain and return to running within eight weeks.
“I thought I’d have to give up running, but ProHealth Clinic helped me recover quickly and naturally.”
Treatments for Knee Pain: What Really Works?
- Rest and Activity Modification: Avoiding aggravating activities and kneeling until pain subsides.
- Physical Therapy: Targeted exercises to strengthen hip and knee muscles, improve flexibility, and correct biomechanics. Stretching and strengthening exercises should focus on the calf muscles, leg muscles, and thigh muscles to support knee recovery.
- Foam Rolling and Stretching: Especially for IT band tightness and muscle imbalances.
- Anti-inflammatory Medications: NSAIDs may help reduce pain and swelling.[3]
- Ice Therapy: Applying an ice pack can help reduce inflammation and improve pain by alleviating discomfort and managing swelling.
- Supportive Devices: Knee braces or straps may provide stability and reduce strain.
- Corticosteroid Injections: For persistent inflammation or bursitis.
- Surgery: Reserved for severe cases with structural damage or failed conservative management.
A comprehensive strengthening program is essential for long-term recovery, focusing on restoring muscle stability and support. Once pain has improved and inflammation is controlled, a progressive return to activity, such as running, should be implemented to ensure safe and effective rehabilitation.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat knee pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with knee pain.
As prolotherapy is helping to treat the root cause of knee pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Prevention Tips for Knee Pain
- Warm up before exercise and stretch regularly
- Strengthen hip, thigh, and knee muscles
- Use proper technique when kneeling or squatting
- Wear supportive footwear
- Gradually increase activity intensity
- Listen to your body and rest when needed
Frequently Asked Questions
What causes stinging pain on the outside of the knee when kneeling?
Common causes include iliotibial band syndrome, lateral meniscus tears, bursitis, ligament injuries, and nerve entrapment. A thorough evaluation is needed for an accurate diagnosis.
Can I exercise with knee pain?
Gentle, low-impact exercises and physical therapy are usually safe, but avoid activities that worsen your pain. Consult a healthcare professional for a tailored program.
How long does it take for knee pain to heal?
Recovery time varies depending on the cause and severity. Mild cases may resolve in a few weeks, while more severe injuries may take several months.
When should I see a doctor for knee pain?
Seek medical attention if you have severe pain, swelling, instability, numbness, or if you cannot bear weight on your knee.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating knee pain, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with knee pain and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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References
- Fairclough J, et al. “The iliotibial band: a complex structure with variable function.” J Anat. 2006;208(3):309-316. Read
- Baker BE, et al. “Knee injuries and diagnostic imaging.” Clin Sports Med. 1994;13(3):581-604. Read
- Zhang W, et al. “EULAR evidence based recommendations for the management of knee osteoarthritis.” Ann Rheum Dis. 2007;66(3):377-388. Read