Knee pain: causes, relief and a video doctor visit

Your knee carries your whole weight, so it can hurt for many reasons. The most common are:

• Injuries and overuse: sprains, ligament or meniscus tears, tendonitis and bursitis.
• Knee bursitis: inflammation of the small fluid sac that cushions the knee; common in people who spend a lot of time kneeling.
• Arthritis: wear-and-tear osteoarthritis, rheumatoid arthritis and gout.
• In active teens: Osgood-Schlatter disease, a pain just below the kneecap.
• Less common: a cyst behind the knee (Baker cyst) or an infection.

If you are visiting, a hike in El Yunque, beach sand or the cobblestones of Old San Juan can be enough to twist a knee. See our care for visitors.

Video doctor visits 24/7 — book online and choose your time right away.

A doctor visit has the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. A doctor’s note is included. We do not bill insurance; the pharmacy, any X-ray and any therapy charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

Notice these symptoms, because they help the doctor find the cause:

• Pain when walking, climbing stairs or squatting
• A swollen knee
• Stiffness or trouble bending or straightening the knee
• A feeling that the knee gives way, clicks or locks
• Pain and tenderness when you touch the front of the knee

For mild, recent knee pain, MedlinePlus recommends the RICE approach:

• Rest: avoid what causes pain and keep weight off the knee.
• Ice: 15 minutes every hour on the first day, then at least 4 times a day, always wrapped in a towel.
• Compression: wear an elastic bandage or an elastic sleeve.
• Elevation: keep the knee raised as much as possible to bring the swelling down.

For pain you can use acetaminophen or an over-the-counter anti-inflammatory such as ibuprofen or naproxen, as the label directs. Check first before using anti-inflammatories if you have high blood pressure, heart or kidney disease, or past ulcers. If you have a fever and dengue is possible, do not take ibuprofen or aspirin; use acetaminophen and read about dengue. If the knee pain is from osteoarthritis and continues, the doctor may consider a prescription NSAID such as meloxicam after checking your heart, kidneys and stomach.

Once the doctor says you can exercise again, gentle hip mobility exercises can help you stay active; start with the chair options and skip the squat and kneeling moves if they bother your knee.

Get seen if the pain or swelling lasts beyond 3 days of home care. If the doctor suspects a fracture or a meniscus or ligament tear, we refer you for the X-ray or MRI and to an orthopedist.

The doctor sees children and teens of all ages by video; patients under 21 need a parent or legal guardian on camera for the whole visit, with ID. In teens who play sports, pain just below the kneecap can be Osgood-Schlatter disease. For their safety: a child with a fever and a hot, swollen knee who limps or will not put weight on the leg needs the emergency room.

For your safety, go to the emergency room or an in-person urgent care center if you have any of these signs. Call 911 if it is severe.

• You cannot put weight on the leg or take a few steps
• The knee looks deformed or out of place
• The knee locks and you cannot bend or straighten it
• The knee is hot, red and very swollen, with a fever (possible infection)
• The calf is swollen, warm or tender (possible blood clot)
• Severe pain even when you are not putting weight on the leg