OpenHealth Q&A

Seeking Assistance for Year-Long Bilateral Knee Pain

I am a 23-year-old male, standing at 5 feet 8 inches and weighing 182 pounds. For a little over a year, I have been grappling with bilateral knee pain. Despite consulting numerous doctors and undergoing various tests, I have yet to find definitive answers or relief from this condition. The issue first arose in August 2024, shortly after I began a new position as a veterinary assistant and moved into a third-floor apartment. My daily activity levels increased significantly; at work, I averaged about 4 miles of walking, and I supplemented this with additional recreation—running or walking—at home. This level of physical exertion was not unfamiliar to me, as I had been an active runner for years without any problems. However, one day during my lunch break, I experienced a sudden, intense pain in my left knee. I took a moment to sit down, and the pain subsided, leading me to disregard it. The next day, I continued with my routine without issue until after a workout at the gym. While using the elliptical, the same sharp pain returned, but this time it affected both knees, and it persisted. What followed was a period of excruciating discomfort lasting around three weeks, during which I would rate the pain between 8 and 9 out of 10. Neither over-the-counter medication like ibuprofen or Tylenol nor ice or heat relief provided any comfort. Determined to get to the bottom of this, I sought immediate care where I underwent bilateral x-rays and inflammatory marker tests that revealed nothing atypical. I then found a new primary care physician who suggested physical therapy, diagnosing my condition as likely patellar tendinitis. I committed to six weeks of therapy focused on stretching and various exercises, both at the clinic and at home. This regimen yielded some improvement, reducing my pain to a 5 or 6 out of 10. My physical therapist eventually recommended that I continue my exercises independently, so I persisted with them. However, despite my efforts, my discomfort persisted due to the demanding physical nature of my job, which involved significant walking and squatting. Over time, I had to take multiple leaves from work, and by December 2024, the ongoing pain compelled me to quit my job altogether. Following my departure from work, I observed a gradual decrease in discomfort, bringing my pain down to a 3 or 4 out of 10 by February 2025, likely due to a marked reduction in my daily activity. Fast forward to September 2025: I have undergone an MRI which showed no issues, in addition to numerous blood tests including screenings for autoimmune disorders and rheumatic arthritis, all of which returned normal results. Based on my concerns, I was referred to an orthopedic surgeon who has prescribed exercises to be performed three times a day for the past two months; however, these have not led to any substantial improvement. I remain convinced that my situation is physiological in nature since neither physical therapy nor extensive rest over the past year has yielded any results, and my various imaging and blood tests continue to show normal findings. One particularly troubling symptom has been the sudden redness in my knees during the night, often accompanied by increasing pain. More recently, I have noticed red dots appearing sporadically on one or both of my legs, which move around and fade away, only to be replaced by red streaks that cause significant discomfort. I am desperately seeking someone who may recognize these symptoms as I yearn for clarity on my condition and a resolution, which remains elusive after a full year of distress.

Answers (1)

9/10/2025, 3:11:07 AM

OpenHealth AI

I'm sorry to hear about the significant pain and challenges you've been facing with your knees. Chronic pain can be frustrating, especially when tests do not provide clear answers. It sounds like you've been proactive in seeking help and considering various treatment options, which is commendable.

Key Points:

1. Your knee pain and symptoms have persisted for over a year, yet imaging studies haven't revealed significant structural issues.
2. There’s a complex interplay between activity levels, your physical job, and symptoms that have not responded to conventional treatments.
3. New symptoms, such as redness in the knees and the appearance of red dots and streaks on the legs, suggest the need for further evaluation.

Explanation: The persistence of your knee pain, especially after being active and undergoing multiple treatments, raises several possibilities:

• Patellar Tendinitis (which seems to have been initially considered) is common but usually improves with rest and targeted rehabilitation.
• Inflammatory Conditions: The sudden redness and discomfort you mentioned, particularly at night, could indicate an inflammatory condition, possibly involving the joints or even skin reactions.
• Since your MRI and blood tests have returned normal results, conditions like autoimmunity or chronic injuries are less likely, but more complex disorders (such as certain types of inflammatory arthritis) might still be possibilities.

Next Steps:

1. Symptom Diary: Keep a daily record of your symptoms, pain levels, activities, and any changes, including when redness appears and if it correlates with exercise or rest. This could help identify patterns.

2. Second Opinion: Consider seeking a second opinion from a rheumatologist who specializes in inflammatory joint diseases. They may suggest further testing, such as ultrasound or specific inflammatory markers that are not routinely checked, to look for signs of inflammation.

3. Activity Modification: While you continue with exercises prescribed by your orthopedist, consider reducing high-impact activities or those that involve significant squatting or prolonged walking. This may help alleviate symptoms while you seek further evaluation.

4. Consultation on Skin Symptoms: Because of your new skin symptoms, it may also be beneficial to see a dermatologist. They can evaluate the red dots and streaks to rule out any dermatological conditions or reactions that could relate to your knees.

5. Explore Other Treatments: If inflammation is confirmed, treatments like corticosteroid injections into the knee joint, dietary changes (like anti-inflammatory foods), or corticosteroid medications could be options to discuss with your healthcare team.

6. Mental Health Support: Chronic pain can take a toll on mental well-being. Consider speaking with a counselor or therapist to manage stress or anxiety resulting from this prolonged experience.

Please know that you are not alone in this journey, and it’s important to continue to advocate for your health. Keep me posted on your progress, and I'm here to help with more advice or questions you may have along the way.