'Referred' Knee Pain: What to Know

Medically speaking, "referred pain" means that the pain you're experiencing on one part of your body isn't the actual source of the problem. An extreme but straightforward example of the referred pain concept is in the case of heart attacks. You may recall that one sign of a heart attack is a sensation of pain in the jaw. That doesn't mean there's a problem with your jaw. It's a problem with your heart that is "referring" pain to the jawline. With knee pain, there are some considerations to make in deciding whether the pain is caused by a knee problem or an issue in another part of the body that is referring pain to the knee.

[Read: Got Knee Pain? 4 Knee-Friendly Exercise Modifications.]

Though it may seem strange on the surface, it's relatively common that the first and only sign of a problem with the hip joint is the onset of knee pain. In people who have arthritis, referred knee pain can often delay the diagnosis of a hip problem. It can be especially problematic if a provider who doesn't specialize in orthopedics is treating the pain. Referred pain is different than radiating pain. Whereas radiating pain tends to travel along an identifiable path, "from point A to point B," referred pain seems to come from the place it's being felt -- in this case, the knee, even though the problem is in the hip. One classic signal of osteoarthritis in the hip is referred pain to the groin, lower thigh and knee.

[See: 7 Exercises You Can Do Now to Save Your Knees Later.]

In addition to hip problems being one possible root cause of referred knee pain, so too are the feet. The way we walk has a significant effect on our knee joints, especially over time. For example, if the feet roll too deeply inward or outward while walking, the lower part of the leg is forced to move in a way that puts additional strain and pressure on the knee with every step. People who have a limited range of motion in their ankles also tend to have referred pain in the knees. A significant leg-length discrepancy can also create a referred pain situation in the knees. One completely modifiable risk factor for referred knee pain from foot problems is ill-fitting footwear. Those "well-loved" sandals, no matter how comfortable they are, could be putting your knees at unnecessary risk. Remember, your knees are shock absorbers. So give them the best cushion you can by choosing supportive shoes that are in good condition.

Your iliotibial band, or IT band for short, is a thick band of tissue that extends along the outer thigh, from the hip to the knee. It's responsible for the efficiency with which we can walk and run. Especially in athletes who repeatedly flex and extend the knee, the IT band can become irritated over time, leading to referred outer knee pain. Physiologists, physical therapists and orthopedic specialists are usually able to spot a problem with the IT band quickly. IT band issue can be tough to treat. They require quite strong commitment from the patient to do proper stretching exercises and to modify training regimens to alleviate irritation of the area so that inflammation can decrease. However, IT band problems do respond well to a diligent commitment to conservative treatment. Conservative treatment can often be all that's necessary to make the referred knee pain go away.

[Read: Choosing Between Partial and Total Knee Replacements.]

Of course, not all sources of knee pain are due to a problem with another part of the body. Some are, in fact, the result of a problem with the knee itself. Either way, getting to the bottom of the pain is crucial. Journaling or otherwise keeping track of the characteristics of your knee pain can help before you see a doctor about it. Where on the knee do you feel the pain? Which activities worsen or lessen the pain? What times of day does the pain appear? Your ability to precisely describe these things is a valuable way to assist your doctor in accurately diagnosing and treating the problem that is causing the knee pain.

Dr. Bert Mandelbaum is an orthopedic surgeon, a member of the Board of Directors and co-chair of medical affairs at the renowned Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, as well as the published author of "The Win Within: Capturing Your Victorious Spirit." He received his medical degree in 1980 from Washington University School of Medicine in St. Louis, Missouri, and completed his residency in orthopedic surgery at the Johns Hopkins Hospital in Baltimore, Maryland. Dr. Mandelbaum earned a fellowship in sports medicine at the University of California Los Angeles, where he also served as a faculty member from 1986 to 1989 before establishing a private medical practice in the Los Angeles area.

Dr. Mandelbaum became a contributor to U.S. News in 2017, covering a range of orthopaedic, adult and pediatric sports medicine and overall wellness topics. Dr. Mandelbaum has served as director of research for Major League Baseball and team physician for numerous collegiate and Major League Soccer teams, as well as for the U.S. Soccer Men's National Team. He currently serves as medical director of the FIFA Medical Center of Excellence in Santa Monica, and on the U.S. Olympic Committee National Medical Network Advisory Group. Dr. Mandelbaum also served as Chief Medical Officer for the 2015 World Special Olympic Games in Los Angeles; Chief Medical Director for the 2016 Copa America Centenario and CONCACAF; FIFA IOC Medical Officer for the 2016 Summer Olympic Games in Rio de Janeiro, Brazil; and Chief Medical Officer for the 2017 CONCACAF Gold Cup. He is a member of multiple professional medical societies including the American Academy of Orthopaedic Surgery, the American College of Sports Medicine and the American Orthopaedic Society for Sports Medicine.

In addition to authoring and co-authoring a bevy of clinical research on a variety of orthopaedic topics, Dr. Mandelbaum has received numerous public accolades including designation as a Super Doctor in Sports Medicine and Orthopaedic Surgery for a consecutive 12-year period since 2007. Dr. Mandelbaum is also a frequent medical expert contributor to mainstream media publications and websites including Medscape, Sports Illustrated, NBC Sports, MSN and Men's Health, as well as local and television news outlets, including NBC, ABC and Fox television affiliates. Visit his website or connect with Dr. Mandelbaum on Facebook or Twitter.