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What Type Of Knee Pain Do You Have?

Our knees are one of the most important joints in our body. The knee may experience some of the highest amounts of stress when compared to other joints in the body thus making knee injuries very common. The knee joint is also one of the most complex joints with 4 bones and an extensive network of ligaments and muscles that provide structure and movement.  Also, there are many different nerves that feed the knee and each one can potentially cause pain.

Acute Knee Pain

Acute knee injuries are defined by short-term pain that typically lasts no longer than 3 to 6 months.  Normally, an episode of acute knee pain is one that resolves as tissues heal.  Often, no true source of pain is even found!   There are many structures or reasons that could cause acute knee pain.  Here are a few.  

Fracture – Fractures to the bones that comprise the knee joint are not just painful but also debilitating. These are most typically caused by direct trauma to the knee. Fractures should immediately be seen by a medical professional to prevent further damage and allow for proper healing.  Fractures can happen to the patella, the femur, the tibia or to the fibula.  Also, there are a few times that there is an osteochondral fracture; this is when the surface of the bone where the cartilage lives is damaged.  

Ligament injuries – Ligament tears are very common in sports-related injuries with the most common being MCL (medial collateral ligament) and ACL (anterior cruciate ligament) tears. Ligament injuries will often leave the joint feeling loose and will prevent you from putting any weight on the knee initially.  Most MCL tears will heal on their own with just conservative management.  Although ACL tears usually don’t heal on their own, not everyone needs surgery when they occur.  

Meniscus – The menisci are the cartilage shock absorber pads between the bones that make up the knee joint structure. Injuries to the meniscus usually occur after the knee is twisted.  The menisci are not just important with regard to supporting compressive load.  They also contribute a great deal to the rotational stability of the joint.  

Dislocation – Knee dislocations need immediate medical attention as they can compromise blood flow to the leg and cause other problems if left untreated for an extended period of time.  These are extremely high energy injuries and usually occur with contact sports such as football. 

Condition Related Knee Pain

Several medical conditions can affect the knee and cause pain.

Rheumatoid arthritis – RA is an autoimmune condition that affects joints in the body including the knee. It can cause severe pain and swelling.

Gout – You may be familiar with that gout affects the big toe but it can also affect the knee. Gout pain is caused by a build-up of uric acid crystals that results in intense pain, redness, and warmth in the joint.

Chronic Use & Overuse Pain or degenerative conditions

Patellar tendinitis – This condition occurs when the tendon connecting the kneecap (patella) to the tibia (shin bone) becomes inflamed or painful. This is a chronic condition from repetitive motion, especially in runners and cyclists.  For others, patellar tendinitis will happen naturally just from overall degeneration due to chronic low-grade inflammation and oxidative stress changes in the collagen of the body.  

Osteoarthritis – OA is a condition defined by the wearing down of cartilage in joints due to overuse and/or age. This is the most common form of arthritis and can affect any joint in the body. It most commonly affects the knees and many people seek knee replacement surgery.  OA is a very complicated condition and involves the entire joint structure to include the capsule, ligaments, tendons and internal structures of the knee.  OA is basically a systemic non-communicable chronic condition and is a result of chronic low-grade inflammation and oxidative stress.  While replacement surgery is quite common, there are many other way to mitigate the symptoms of osteoarthritis.  

Prepatellar bursitis – A bursa is fluid-filled sac that reduces friction and cushions pressure points in and around joints. Bursitis occurs when the bursa becomes inflamed.  There are bursal sacs at the hip, the elbow, the shoulder, the ankle and the knee.  The patellar bursa sits on top of the kneecap (patella) and allows for the large flexion and extension movements of the knee joint.  Occasionally this sac will become acutely inflamed and fill with fluid.  Often it also becomes hot and painful.  

INR stands for the International Normalized Ratio. This is a calculation based on a prothrombin time (PT) test that measures how long before a clot starts forming in a blood sample. These tests are performed most commonly on those with abnormal blood clotting and to test the effectiveness of the blood-thinning medication Coumadin (warfarin).

Why Don’t Antioxidants Play Nice With Warfarin?

The main enzyme for processing coumadin is CYP2C9. If a substance inhibits this enzyme (CYP2C9), then it will increase the levels of warfarin in the blood and the opposite is true as well. If you take an herb, eat a plant, eat anything really that changes the activity of that enzyme, it will cause changes in your bleeding times. This is why many physicians choose more modern anticoagulant medication

Ginkgo at a 24% concentration is known to interfere with coumadin. Green tea inhibits CYP2C9 as well. St. John’s wort does as well. Quercetin, scutellarein, baicalein, morin, apigenin, chrysin, and catechin-3-gallate are some more flavonoids that can interact with this enzyme.  Turmeric can have an effect on levels of Coumadin in serum as well.  

This enzyme is affected by oral sulfonylurea hypoglycemics, NSAIDs, COX-2 inhibitors, angiotensin II receptor inhibitors, antidepressants, and antiepileptics as well.

Frequent Blood Tests Are Important

Fortunately, most people on warfarin have blood checks weekly or multiple times per week. If something that you ate or another medication that you took changes the activity of the drug, you will know quickly and be able to modify things.

As you can understand, hundreds of substances could potentially interfere with the CYP2C9 enzyme. You will need to discuss this and your entire diet with your treating physician before taking any health-enhancing substances.  

Natural Supplements That Do Not Effect CYP2C9 Enzyme

Some great supplements that can still be taken while on the blood thinner coumadin include tart cherry extract, omega-3 fatty acids, PEA (palmitoylethanolamide), and resveratrol.  These powerful natural antioxidant supplements do not interact with the CYP2C9 enzyme and should be safe to take in conjunction with coumadin.

Tart Cherry Extract is a great anti-inflammatory that we believe works as well as NSAIDs without all the side effects. It helps reduce inflammation and pain in muscles and joints while fighting off free radicals. 


Dr. Meredith Warner is the creator of Well Theory and The Healing Sole. She is a board-certified Orthopedic Surgeon and Air Force Veteran.

She is on a mission to disrupt traditional medicine practices and promote betterment physically, spiritually and mentally to many more people. She advocates for wellness and functional health over big pharma so more people can age vibrantly with more function and less pain.

At Well Theory, Our surgeon-designed products are FDA Registered and formulated to help people:

  • Manage the symptoms of musculoskeletal pain
  • Recover vibrantly from orthopedic related surgeries
  • Fill the gaps in our daily diets
  • Manage pain associated with inflammation