Knee Pain: Burning Sensation on the Side When Kneeling

Why does the side of my knee burn when I kneel on it?

A burning sensation on the side of your knee when kneeling often indicates irritation or compression of lateral knee structures, most commonly the iliotibial band (IT band), associated bursae, or peripheral nerves, exacerbated by direct pressure or pre-existing biomechanical factors.

Understanding Knee Anatomy & Relevant Structures

To grasp why your knee might burn on the side when kneeling, it's crucial to understand the key anatomical components in this region. The knee joint is a complex hinge joint, but its lateral (outer) aspect is home to several structures sensitive to pressure and friction.

• Iliotibial Band (IT Band): This is a thick, fibrous band of fascia that runs along the outside of the thigh, extending from the hip (iliac crest) down to just below the knee, attaching to the lateral condyle of the tibia (Gerdy's tubercle). Its primary role is to stabilize the knee and assist with hip abduction.
• Bursae: These are small, fluid-filled sacs that reduce friction between bones, tendons, and muscles. While many bursae are around the knee, specific ones like the lateral femoral epicondyle bursa (under the IT band) or the prepatellar bursa (at the front of the kneecap) can become inflamed and cause radiating pain.
• Nerves: Several nerves traverse the knee region. The common peroneal nerve is particularly relevant here, as it wraps around the head of the fibula (the smaller bone on the lateral side of the lower leg) before dividing into superficial and deep branches. Compression or irritation of this nerve can cause burning, tingling, or numbness.
• Lateral Meniscus: This is a C-shaped piece of cartilage that cushions the outer compartment of the knee, providing shock absorption and stability.
• Lateral Collateral Ligament (LCL): A strong ligament on the outside of the knee that helps stabilize the joint against varus (bow-legged) forces.

Common Causes of Lateral Knee Burning During Kneeling

The burning sensation you experience is typically a sign of inflammation, compression, or irritation. Here are the most common culprits:

• Iliotibial Band Friction Syndrome (ITBS): This is arguably the most common cause of lateral knee pain in active individuals and can be significantly aggravated by kneeling. As the knee bends and straightens, the IT band slides over the bony prominence of the lateral femoral epicondyle. Repetitive motion, combined with factors like tight IT bands, weak hip abductors, or poor biomechanics, can lead to excessive friction and inflammation, resulting in a burning sensation. Direct pressure from kneeling can further compress the inflamed band against the bone.
• Lateral Bursitis: While less common than ITBS, the bursa located beneath the IT band near the lateral femoral epicondyle can become inflamed (bursitis). Direct pressure from kneeling can compress this inflamed bursa, leading to a sharp, burning pain.
• Nerve Compression or Irritation: The common peroneal nerve, as it passes around the fibular head, is vulnerable to external compression. Sustained kneeling can directly press on this nerve, leading to a burning, tingling, or even numb sensation along the outside of the lower leg and top of the foot. This is a crucial consideration if the burning extends beyond the knee joint itself.
• Lateral Meniscus Injury: If the kneeling involves any twisting motion or if there's a pre-existing lateral meniscus tear, the pressure and position of kneeling can aggravate the injury, leading to pain that may be described as burning, sharp, or aching on the side of the knee.
• Osteoarthritis (Lateral Compartment): In older individuals or those with a history of knee injury, degenerative changes in the lateral compartment of the knee can cause chronic pain. Kneeling can place direct pressure on the worn cartilage and bone, leading to a burning or aching sensation.
• Fat Pad Impingement (Hoffa's Syndrome): Although typically anterior (front of the knee), severe inflammation of the infrapatellar fat pad (Hoffa's fat pad) can sometimes radiate pain to the sides of the knee, especially when compressed by kneeling.

Factors Aggravating Lateral Knee Pain During Kneeling

Several factors can contribute to or worsen the burning sensation:

• Prolonged or Repetitive Kneeling: Sustained pressure or repeated flexion and extension of the knee while kneeling increases friction and compression on lateral structures.
• Hard Surfaces: Kneeling directly on hard surfaces without adequate padding significantly increases direct pressure on the lateral knee.
• Muscle Imbalances:
  • Tight IT Band: Restricts normal movement and increases friction.
  • Weak Hip Abductors (e.g., gluteus medius): Leads to compensatory mechanics that place more stress on the IT band.
  • Weak Core Muscles: Can contribute to overall poor kinetic chain stability, affecting knee alignment.
• Improper Biomechanics: Issues like excessive pronation of the foot, genu valgum (knock-knees), or genu varum (bow-legs) can alter the loading patterns on the knee, predisposing it to lateral pain.
• Sudden Increase in Activity: Rapidly increasing activities that involve kneeling or deep knee flexion without adequate conditioning can overload the tissues.

When to Seek Professional Medical Advice

While occasional burning might resolve with rest, it's important to consult a healthcare professional, such as a physical therapist or orthopedic doctor, if you experience any of the following:

• Persistent or Worsening Pain: If the burning doesn't improve with rest and self-care within a few days.
• Significant Swelling or Redness: Signs of acute inflammation or infection.
• Numbness, Tingling, or Weakness: Especially if it extends down the leg, which could indicate nerve involvement.
• Audible Pop or Snap at the Time of Injury: Suggests a more acute structural injury like a meniscus tear or ligament damage.
• Inability to Bear Weight: Indicates a potentially more severe injury.
• Pain Accompanied by Fever or Chills: Could indicate an infection.

Strategies for Relief and Prevention

Managing and preventing lateral knee burning during kneeling involves a multi-faceted approach:

• Modify Activity and Rest: Avoid prolonged kneeling or activities that aggravate the pain. Allow the irritated tissues time to heal.
• Use Proper Padding: Always kneel on soft surfaces or use a knee pad or cushion to distribute pressure and reduce direct compression.
• Ice Application: Apply ice to the affected area for 15-20 minutes several times a day to reduce inflammation and pain.
• Stretching: Focus on flexibility for the muscles and tissues that influence the IT band and knee mechanics:
  • IT Band Stretches: Cross-leg stretch, foam rolling the IT band (use caution, as this can be intense).
  • Hip Flexor Stretches: Kneeling hip flexor stretch.
  • Quadriceps and Hamstring Stretches: Ensure good overall leg flexibility.
• Strengthening Exercises: Address muscle imbalances to improve knee stability and reduce stress:
  • Hip Abductors: Side-lying leg raises, clam shells, band walks.
  • Gluteal Muscles: Glute bridges, squats, lunges.
  • Core Strength: Planks, bird-dog.
  • Vastus Medialis Obliquus (VMO): Terminal knee extensions, step-ups.
• Footwear and Orthotics: Ensure your footwear provides adequate support. If you have significant foot pronation or supination, custom orthotics might help improve lower limb alignment.
• Gradual Return to Activity: When pain subsides, slowly reintroduce activities involving kneeling, ensuring proper technique and adequate warm-up.

By understanding the anatomical basis and implementing targeted strategies, you can effectively manage and prevent the burning sensation on the side of your knee when kneeling, allowing you to move more comfortably and confidently.