What causes knee pain that radiates down the leg. How is a pinched nerve in the knee diagnosed. What are the most effective treatments for knee-related leg pain. When should you seek medical attention for knee and leg pain.

Understanding Pinched Nerves in the Knee

A pinched nerve occurs when surrounding structures exert excessive pressure on a nerve, impacting its function and causing symptoms in the areas supplied by that nerve. While often associated with back issues, nerves in various body parts can become pinched, including the knee. The peroneal nerve, a branch of the sciatic nerve, is particularly vulnerable to compression as it passes around the outside of the knee.

This nerve is responsible for sensation and movement in the outer lower leg and top of the foot. When compressed, it becomes inflamed, leading to a range of symptoms that can significantly impact daily activities.

Anatomy of the Peroneal Nerve

The peroneal nerve originates from the sciatic nerve and travels:

• Around the outside of the knee
• Down the outer part of the lower leg
• To the top of the foot

Its position near the skin surface at the bottom of the knee makes it susceptible to external pressure and trauma.

Common Causes of Knee-Related Nerve Pain

Several factors can lead to compression of the peroneal nerve, resulting in pain that shoots down the leg to the ankle. These include:

1. Crossing legs for extended periods
2. Prolonged squatting
3. Bone fractures (tibia or fibula)
4. Knee ligament injuries
5. Tight lower leg casts or knee braces
6. Knee-high boots
7. Complications from gynecologic or abdominal surgery
8. Extended bed rest
9. Thigh-high compression stockings
10. Tumors or cysts near the nerve
11. Rare complications from knee surgery

How does crossing legs cause nerve compression?

Crossing legs places direct pressure on the peroneal nerve from the opposite knee. This is the most common cause of nerve compression in the knee area. The prolonged pressure can lead to inflammation and subsequent symptoms along the nerve’s path.

Recognizing Symptoms of a Pinched Nerve in the Knee

Identifying the symptoms of a pinched peroneal nerve is crucial for proper diagnosis and treatment. Common symptoms include:

• Weakness in lifting the foot (dorsiflexion)
• Difficulty turning the foot outward
• Numbness or tingling on the outside of the lower leg and top of the foot
• Burning sensations
• Pain along the nerve’s path
• Loss of sensation in affected areas

One of the most noticeable and troublesome symptoms is foot drop, where weakness in lifting the foot causes it to drag while walking. This can significantly impact mobility and increase the risk of falls.

Can symptoms vary in intensity?

Yes, symptoms can be intermittent or continuous, depending on the source and severity of nerve compression. Some individuals may experience mild, occasional discomfort, while others might have persistent, severe symptoms that interfere with daily activities.

Diagnosing a Pinched Nerve in the Knee

Proper diagnosis is essential for effective treatment. Healthcare providers use a combination of methods to identify and confirm a pinched peroneal nerve:

1. Medical history review
2. Physical examination
3. Tinel’s sign test (tapping on the nerve to elicit symptoms)
4. Imaging studies (X-rays, MRI)
5. Electromyogram (EMG)
6. Nerve conduction tests

How does an MRI help in diagnosis?

An MRI provides detailed images of soft tissues, allowing healthcare providers to visualize the nerve and surrounding structures. It can reveal:

• Masses within or pressing on the nerve
• Fractures or other bone abnormalities
• Soft tissue injuries affecting the nerve

This information is crucial for determining the underlying cause and planning appropriate treatment.

Treatment Options for Knee-Related Nerve Pain

Treatment for a pinched nerve in the knee focuses on addressing the underlying cause, reducing pain, and improving mobility. Options include:

Conservative Treatments

• Over-the-counter anti-inflammatory medications (ibuprofen, naproxen)
• Heat or ice therapy (15-20 minutes at a time)
• Physical therapy exercises
• Lifestyle modifications to reduce pressure on the nerve

Medical Interventions

• Prescription pain medications or muscle relaxants
• Corticosteroid injections to reduce inflammation
• Orthotics or braces to support proper foot and ankle alignment

Surgical Options

In severe cases or when conservative treatments fail, surgical intervention may be necessary. Procedures might include:

• Nerve decompression surgery
• Removal of tumors or cysts pressing on the nerve
• Repair of damaged ligaments or tendons affecting nerve function

How effective is physical therapy for treating a pinched nerve?

Physical therapy can be highly effective in treating a pinched nerve in the knee. It helps by:

• Strengthening muscles supporting the knee and lower leg
• Improving flexibility and range of motion
• Teaching proper body mechanics to prevent future nerve compression
• Providing exercises to alleviate pressure on the nerve

Many patients experience significant improvement with a structured physical therapy program, often avoiding the need for more invasive treatments.

Recovery and Long-Term Outlook

Recovery from a pinched nerve in the knee varies depending on the severity of compression and underlying cause. Factors influencing recovery include:

• Duration of nerve compression before treatment
• Extent of nerve damage
• Patient’s overall health and adherence to treatment
• Success in addressing the root cause of compression

Most cases of pinched nerves resolve with conservative treatment within a few weeks to months. However, severe cases or those involving significant nerve damage may require longer recovery periods and more intensive interventions.

Can a pinched nerve in the knee lead to permanent damage?

While rare, prolonged compression of the peroneal nerve can result in permanent damage if left untreated. Signs of potential long-term damage include:

• Persistent weakness in foot and ankle muscles
• Chronic numbness or altered sensation
• Muscle atrophy in the affected leg

Seeking prompt medical attention at the onset of symptoms is crucial to prevent permanent nerve damage and ensure the best possible outcome.

Preventing Recurrence of Knee-Related Nerve Pain

Preventing future episodes of nerve compression is an essential aspect of long-term management. Strategies to reduce the risk of recurrence include:

• Maintaining good posture and body mechanics
• Avoiding prolonged periods of leg crossing or squatting
• Using properly fitted knee braces or compression stockings when necessary
• Engaging in regular exercise to strengthen supporting muscles
• Managing underlying health conditions that may contribute to nerve compression
• Being mindful of footwear choices, especially high boots or tight-fitting shoes

How can ergonomic adjustments help prevent nerve compression?

Ergonomic adjustments in daily activities and work environments can significantly reduce the risk of nerve compression. Consider:

• Using a standing desk or taking regular breaks from sitting
• Ensuring proper positioning during sleep to avoid leg rotation
• Adjusting car seats to maintain proper leg alignment while driving
• Utilizing ergonomic tools and equipment in physical jobs to reduce strain on the knees

These modifications can help maintain proper alignment and reduce pressure on the peroneal nerve, minimizing the risk of compression and associated symptoms.

When to Seek Medical Attention

While many cases of knee-related nerve pain can be managed with home care and conservative treatments, certain situations warrant immediate medical attention. Seek professional help if you experience:

• Sudden, severe pain in the knee or leg
• Significant weakness or inability to move the foot or ankle
• Numbness or tingling that doesn’t improve with rest
• Signs of infection, such as redness, warmth, or fever
• Symptoms that persist or worsen despite home treatment
• Any symptoms following a traumatic injury to the knee or leg

How do healthcare providers differentiate between knee-related nerve pain and other conditions?

Distinguishing knee-related nerve pain from other conditions involves a comprehensive evaluation:

• Detailed patient history to understand symptom onset and progression
• Physical examination to assess strength, sensation, and reflexes
• Comparison with symptoms of other conditions like sciatica or peripheral neuropathy
• Diagnostic tests to visualize nerves and surrounding structures
• Evaluation of other potential causes, such as vascular issues or referred pain

This multi-faceted approach helps healthcare providers accurately diagnose the source of pain and develop an appropriate treatment plan.

Understanding the causes, symptoms, and treatment options for knee pain that shoots down the leg to the ankle is crucial for effective management and prevention of long-term complications. By recognizing the signs of a pinched peroneal nerve and seeking timely medical attention, individuals can minimize discomfort, maintain mobility, and reduce the risk of permanent nerve damage. With proper care and preventive measures, most people can overcome knee-related nerve pain and return to their normal activities.

Causes, Treatment, Recovery, and More

When surrounding structures put pressure on a nerve, it’s referred to as a pinched nerve. It causes symptoms in the part of the body that’s supplied by that nerve.

This article describes the causes and treatment of a pinched nerve in your knee.

A nerve becomes pinched when too much pressure is placed on it by the bone, tissue, or other structures around it.

This injures the nerve so it can’t function properly.

Although it’s most commonly associated with the nerves in your back, almost any nerve in your body can become pinched. Doctors call it nerve compression or entrapment.

There’s only one nerve going through your knee that’s at risk of being compressed. It’s a branch of your sciatic nerve called the peroneal nerve.

This nerve goes around the outside of your knee before traveling down the outside of your lower leg.

At the bottom of your knee, it lies between the bone and skin, which makes it vulnerable to compression by anything that puts pressure on the outside of your knee.

Traumatic injuries can lead to pressure on the nerve from inside your knee.

Common causes of a pinched nerve in your knee include:

• Crossing your legs. Compression by the opposite knee while you cross your legs is the most common cause.
• Squatting for long periods of time. This position put pressure on the side of your knee.
• Bone fracture. A fracture of the larger lower leg bone (tibia) or occasionally the smaller bone (fibula) near your knee can entrap the nerve.
• Knee ligament injury. The nerve can be pinched due to bleeding or inflammation when your ligament is injured.
• Lower leg cast. The top of the cast can press on the nerve.
• Knee brace. A tight or rigid brace can compress the nerve.
• Knee-high boots. When the top of a boot lands right below the knee, a pinched nerve can develop.
• Gynecologic or abdominal surgery. The equipment used to keep your legs rotated outward and knees flexed for most gynecologic and some abdominal surgeries can compress the nerve.
• Prolonged bed rest. Your legs tend to rotate outward and your knees flex while lying down, and the bed can put pressure on the nerve in this position.
• Thigh-high compression stockings. Designed to maintain pressure on your legs, these stockings can compress the nerve.
• Tumors or cysts. These can cause pressure when they’re located in or around the nerve.
• Complication of knee surgery. Rarely, the nerve is inadvertently pinched during knee replacement surgery or an arthroscopic procedure.

The peroneal nerve supplies both sensation and movement to the outside of your lower leg and the top of your foot. When it’s compressed, it becomes inflamed, which causes the symptoms of a pinched nerve.

Usually only the lining, or myelin, around the nerve is injured. When the nerve itself is also damaged, the symptoms are the same but more severe.

Weakness that limits your ability to lift your foot toward your leg, known as dorsiflexion, is often considered the most bothersome symptom. This causes your foot to drag when you walk.

Your ability to turn your foot outward and extend your big toe are also affected.

Other symptoms of a pinched peroneal nerve are felt on the outside of your lower leg and on the top of your foot. These include:

• numbness
• tingling or pins and needles feeling
• burning
• pain
• loss of sensation

If you’ve had a pinched nerve for two or more weeks, the muscles supplied by the nerve can begin to waste away.

Your symptoms may be intermittent or continuous depending on what’s pushing on the nerve.

The other common cause of these symptoms is a pinched nerve in your lumbar spine. When this is the cause, you’ll also have pain in your lower back or the back and outside of your thigh.

Your doctor will take your medical history and perform an exam to try to make a diagnosis and determine the cause.

The nerve in your knee can be felt as it travels around the top of your tibia, so your doctor may tap on it. If you feel a shooting pain down your leg, you probably have a pinched peroneal nerve.

Tests your doctor may order include:

• Knee X-ray: shows any bone fractures or masses
• Knee MRI: can confirm the diagnosis and show masses within the nerve and details of fractures of other problems in your bones
• Electromyogram (EMG): tests electrical activity in your muscles
• Nerve conduction test: tests the speed of signals in the nerve

The problem or activity that’s causing the pinched nerve should be treated or corrected first.

Treatment is aimed at reducing pain and improving mobility.

Over-the-counter pain medication

Any medication that reduces inflammation can improve your symptoms, such as anti-inflammatories like ibuprofen and naproxen.

Heat or ice

Applying either heat or ice for 15 to 20 minutes at a time can give some relief from the symptoms.

If you’ve lost sensation, you have to be careful you don’t get frostbite or a burn on your skin. An ice pack can make your symptoms worse if it puts too much pressure on the nerve.

Corticosteroid injection

A corticosteroid injection can reduce the inflammation, which reduces the pressure on your nerve.

Orthotic boot

If your gait is affected because you can’t bend your foot, an orthotic boot can help. This is a support that keeps your foot in a neutral position so you can walk normally.

Surgery

Your doctor can perform surgery to correct a fracture, tumor, or other invasive problem causing a pinched nerve.

If conservative treatment doesn’t work, a procedure called peroneal nerve decompression can done to remove the pressure on your nerve.

Physical therapy

Your nerve can be permanently damaged if it’s pinched for a long time. If that happens, it can’t be fixed with surgery. Physical therapy can be helpful for strengthening and gait training

Usually a pinched peroneal nerve will get better on its own within days to weeks once you stop the behavior or fix the condition that’s causing it.

If surgery is needed, your symptoms should disappear immediately, but it takes about four months to recover from surgery.

Things you can do to prevent a pinched peroneal nerve include:

• Avoid behaviors and activities that cause it such as crossing your legs, frequent squatting, and wearing knee-high boots.
• Tell your doctor if a cast or brace feels tight or is causing numbness or pain in your leg.
• Use devices that softly hold your ankles to prevent leg rotation during prolonged bed rest.
• Reposition yourself frequently during prolonged bed rest to avoid continuous pressure on the side of your knee.

The peroneal nerve that runs along the outside of your knee can become pinched when it’s compressed. Crossing your legs is the most common cause but anything outside or inside your knee that puts pressure on the nerve can do it.

A pinched nerve in the knee usually heals itself when the cause is removed, but surgery is sometimes needed to relieve the pressure.

What We Know About Sciatica Knee Pain

It’s no secret that your knees can take a beating. They are two of the most essential, load-bearing joints in the body. However, as a result, this also means they can be susceptible to a number of different issues that can result in pain, discomfort, or other symptoms. This can include—but is not limited to—sciatica.

What Is Sciatica?

“Sciatica is pain in the back and buttock due to spine disease,” states Joshua M. Ammerman, M.D., a board-certified neurosurgeon who serves as chief of the neurosurgery section and chair of the Department of Surgery at Sibley Memorial Hospital in Washington, D.C. The pain is the result of compression, irritation, or inflammation of the sciatic nerve or nerve roots in the low back.

Spine diseases that can result in sciatica include:

• Degenerative disc disease (DDD): When the discs between the vertebrae wear down with time and stress

• Disc herniation: Where the inside of the discs between the vertebrae leak out and compress/irritate surrounding nerves

• Spinal stenosis: A narrowing of the spinal canal that can pinch nerves

• Spondylolisthesis: A condition that occurs when one vertebra in the back slips forward onto the one directly below it

How Can Sciatica Cause Knee Pain?

The problem with sciatica is that the issues it can cause don’t stop with the back. In fact, sciatic nerve pain and other related symptoms can take a trip all the way down to the end of your leg and make a pit stop in your knee via a branch of the sciatic nerve known as the peroneal nerve. This can cause symptoms in your knee such as:

• A dull ache, warm sensation, or sharp pain anywhere around the knee

• An inability to straighten your knee

• Buckling of the knee

• Problems with bearing weight on the knee

In short: Because sciatica is most commonly caused by an issue in the low back, it can travel to other parts of the body and cause problems. For example, “If arthritis in the spine is pressing on the L3-L4 level nerves it can cause pain, numbness, tingling, or weakness in that nerve’s distribution,” says Dr. Ammerman. [Arthritis is a broad term used to cover conditions that cause pain and swelling in the joints.] “Those nerves travel out of the back, through the buttock, along the front of the thigh, and terminate at the knee.

“Additionally, though knee pain due to sciatica is somewhat uncommon, many patients with spine disease have an abnormal gait pattern, which can also stress the knee and lead to local pain.”

What Are Some More Common Causes of Knee Pain?

“The most common cause would be degenerative arthritis of the knee joint,” Dr. Ammerman says. “In addition, gout can cause knee pain and—though less common—infections of the knee joint.”

It’s also worth noting that knee pain and discomfort can be caused by things other than an underlying disease or condition. These can include:

• Heavy physical activity that puts additional and/or repeated strain on the knee

• Lack of physical activity

• Strains and sprains of the tendons/ligaments/muscles within the structure of the knee

How Long Does Sciatica-Related Knee Pain Last?

If sciatica is truly the cause of your knee pain, then it will only last if your sciatica does. That said, how long your sciatica will drag out depends on the type of sciatica: acute or chronic.

An acute sciatic episode will typically resolve within a few weeks, and you may have a few episodes a year. However, chronic sciatica is a lifelong condition that will not really resolve on its own without intervention by a specialist.

How Is Sciatica Treated?

In most cases, sciatica can be treated conservatively. Most patients with sciatica symptoms improve over time and respond well to non-surgical treatments, such as medication, exercise and special sciatica stretches, and physical therapy (PT). Spinal manipulation, such as chiropractic care, also can help reduce sciatica symptoms.

“I always recommend beginning with rest, ice, and elevation,” Dr. Ammerman says. “If those do not solve the issue, then the judicious use of NSAIDs [non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen] can be very helpful. For symptoms that do not respond to the above measure or persist beyond a few weeks, a consultation with a physician is appropriate. ”

What At-Home Stretches Can Provide Relief?

As mentioned, the only way to get rid of pesky knee pain caused by sciatica is to alleviate sciatica itself. There are several stretches you can do to help take some of the pressure off your sciatic nerve. They include:

• Knee to chest to reduce nerve compression: Lying down, gently hug one of your knees to your chest while extending the other leg flat on the floor. Hold for about 30 seconds, and alternate to hug the other knee to your chest.

• Lower trunk rotations to increase the mobility and flexibility of your spine: Lying flat on the floor, bend both of your knees in and rotate at the hips so both knees are pointing to the right and resting on the floor. Hold for three to five seconds, and rotate at the hips so your knees rest on the floor and point to the left. Keep alternating or hold the stretch on each side for about 30 seconds.

• Pelvic tilt or all fours opposite arm and leg extensions to strengthen your abdominal muscles and stretch the low back

GettyImages/DjordjeDjurdjevic

No matter the cause, knee pain can be a real pain [in the back]. But remember: At the end of the day, it’s important to speak to a physician first to get a proper diagnosis when your knee—or any other part of your body—is hurting for an extended period of time. Until then, take time to rest.

Notes: This article was originally published August 18, 2022 and most recently updated September 26, 2022.

Our Review ProcessMary Kate Phan:  

Mary Kate Phan is a writer with a wealth of experience in discussing health care-related topics. From neurology to podiatry, she has helped patients understand complex conditions and procedures that may help improve their lives for the better.

Shaheen Lakhan, M.D., Neurologist:  

Shaheen Lakhan, M.D., Ph.D., FAAN, is a physician-scientist and clinical development specialist. He is board-certified in both neurology and pain medicine with clinical training from the Cleveland Clinic and Massachusetts General Hospital.

causes, treatment – how to get rid of pain in the knee area

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Legs hurt below the knees

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If the legs are aching below the knees, then the doctor conducts a differential diagnosis, during which he specifies what exactly caused the discomfort: changes in the vessels, nerves, ligaments, joints or bones. The treatment program depends on the results of the diagnosis.

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Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 25 years of experience

Publication date: September 25, 2021

Verification date: February 02, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of pain in the legs below the knees

Types of pain

First aid for pain in the legs below the knees

Which doctor to contact

Diagnostic methods

How to treat pain in the legs below the knees

Rehabilitation

Rehabilitation treatment is a necessary stage of complex therapy. Without it, there is a risk of recurrence of the disease, its transition to a chronic form, and a decrease in the quality of life.

Rehabilitation treatment is carried out in the rehabilitation center “Laboratory of Movement”.

Consequences

Prevention

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knee pain – causes and treatment

Symptoms of knee pain

Symptoms of knee pain depend on its causes and severity. Knee pain is a common problem.

Sudden pain in the knee occurs when too much stress and injury.

Weakness in the knees can occur, to the point of feeling that the legs are about to give way.

Depending on the cause of the pain, other symptoms may occur: stiffness, clicking in the knee, knee stuck in one position, inability to straighten the leg.

How does knee pain affect us?

Knee pain is more common in the elderly, overweight (due to increased stress on the joints) and when playing sports. The knee joints provide freedom of movement, so knee pain greatly affects our lives. With knee pain, we cannot play sports, it is difficult for us to walk and climb stairs.

Ease the pain

DID YOU KNOW?

The knee joint is made up of three bones, tendons that attach muscles to bones, and ligaments that stabilize and connect bones. In the cavity of the knee joint there are two C-shaped cartilages – the menisci. Their main role is to cushion the joint. A fluid-filled bursa keeps the joint moving smoothly.*

69% of people have experienced knee pain.**

Get rid of pain

*Knee (human anatomy): images, functions, ligaments, muscles. 2016 Knee (Human Anatomy): Images, Functions, Ligaments, Muscles. [ONLINE] available at: http://www.webmd.com/pain-management/knee-pain/picture-of-the-knee. [checked 04/18/2016].
**Global Pain Index 2014: GSK-supported study, full report, p. 47

Why knee pain occurs

Knee pain occurs due to trauma (sprains and tendons, sprains, torn ligaments or menisci), osteoarthritis, tendonitis (inflammation of the tendons) and bursitis (fluid accumulation in joint capsules) .

Sports injuries

Knee injuries are common among athletes. They often have a ligament tear in the knee joint, accompanied by sudden pain in the knee. Running, walking, jumping, and cycling can cause runner’s knee syndrome when the knee joint is overstressed, for example. It usually manifests itself in the form of pain in the patella and occurs due to excessive exertion, injury, diseases of the leg bones or muscle weakness.

Inflammatory processes in the knee joints

Knee injuries in osteoarthritis develop gradually. If, as a result of problems with the hip or ankle joints, a person’s gait is disturbed, then osteoarthritis leads to deformity of the knee joints. This, in turn, is fraught with injury. Knee injuries, even minor ones, increase the likelihood of such injuries in the future.

Find the cause of the pain

Pain in the side of the knee can be caused by a torn ligament or a tear in the meniscus (the layer of cartilage that stabilizes the joint). Pain in the front of the knee is usually due to inflammation of the joint capsule and cartilage problems. Pain in the back of the knee can be caused by osteoarthritis.

Treatment

How to diagnose and treat knee pain depends on the cause of the pain. To determine it, you need to consult a doctor. The doctor will examine your knee, check its mobility, swelling, bruising and local temperature increase. Your doctor may recommend physical therapy and a knee brace to relieve pain, refer you for additional tests (x-rays, MRIs, ultrasounds, or CT scans), show you exercises to strengthen your knee, and prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and treat its causes. In addition, after consulting a doctor at home, you can provide protection and rest to the injured knee, apply ice, apply a compression bandage and keep the knee above the level of the heart. Over-the-counter topical and internal pain medications can be taken to relieve short-term mild pain and reduce inflammation.