Inner Knee Pain When Walking: Causes, Symptoms, and Management

Why does the inner side of my knee hurt when I walk?

Inner knee pain during walking often stems from issues affecting the medial meniscus, medial collateral ligament (MCL), or the pes anserine bursa, frequently exacerbated by overuse, improper biomechanics, or underlying degenerative changes within the joint.

Understanding Inner Knee Anatomy

To comprehend why the inner side of your knee might hurt, it's crucial to understand the key anatomical structures in this region. The knee joint, a complex hinge joint, relies on a delicate balance of bones, ligaments, tendons, and cartilage for stable, pain-free movement. On the inner (medial) side of the knee, several structures are particularly relevant:

• Medial Meniscus: This C-shaped piece of cartilage acts as a shock absorber and helps distribute weight evenly across the joint. It sits between the femur (thigh bone) and tibia (shin bone).
• Medial Collateral Ligament (MCL): A strong band of fibrous tissue running along the inner side of the knee, connecting the femur to the tibia. Its primary role is to resist valgus (inward) stress and prevent the knee from buckling inwards.
• Pes Anserine Bursa: A small, fluid-filled sac located on the inner side of the shin bone, about 2-3 inches below the joint line. It provides cushioning and reduces friction between the tendons of the sartorius, gracilis, and semitendinosus muscles (collectively known as the "pes anserine" or "goose's foot" tendons) and the tibia.
• Adductor Muscles: Several muscles on the inner thigh (e.g., adductor magnus, longus, brevis, gracilis) can refer pain to the inner knee if strained or tight.
• Medial Condyles of Femur and Tibia: The bony surfaces of the thigh and shin bones that form the medial compartment of the knee joint.

Common Causes of Inner Knee Pain During Walking

Pain on the inner side of the knee during walking is a common complaint, often indicative of specific injuries or conditions affecting the structures mentioned above.

• Medial Meniscus Injury:
  • Description: Tears or degeneration of the medial meniscus are frequent culprits. Tears can be acute (from a sudden twisting motion) or degenerative (due to age-related wear and tear).
  • Symptoms: Pain, especially with twisting, squatting, or walking on uneven surfaces. You might experience clicking, popping, or a sensation of the knee "giving way" or "locking." Walking often exacerbates the pain as it loads the damaged cartilage.
• Medial Collateral Ligament (MCL) Sprain:
  • Description: An injury to the MCL typically occurs from a direct blow to the outside of the knee or a valgus (inward) stress, such as during sports or a fall. Sprains range from mild (Grade I, stretched) to severe (Grade III, completely torn).
  • Symptoms: Pain and tenderness along the inner side of the knee, often worse with walking, bending the knee, or applying pressure to the inner side. Swelling and instability (feeling loose) may also be present, especially with higher-grade sprains.
• Pes Anserine Bursitis:
  • Description: Inflammation of the pes anserine bursa, often caused by overuse, repetitive friction, tight hamstrings, obesity, or incorrect biomechanics.
  • Symptoms: Pain and tenderness on the inner side of the knee, a few inches below the joint line. The pain is typically worse with activity, especially ascending or descending stairs, or prolonged walking. It can be particularly noticeable when initiating movement after rest.
• Osteoarthritis (Medial Compartment):
  • Description: A degenerative joint disease where the cartilage that cushions the ends of the bones wears away. When this occurs in the medial compartment, it leads to bone-on-bone friction on the inner side of the knee.
  • Symptoms: Gradual onset of pain, stiffness (especially after rest), tenderness, and sometimes swelling. Pain often worsens with activity, including walking, and can be accompanied by a grinding or crunching sensation (crepitus).
• Adductor Tendinopathy/Strain:
  • Description: Inflammation or tearing of the tendons of the adductor muscles where they attach near the inner knee. This is less common than other causes but can contribute to inner knee pain.
  • Symptoms: Pain along the inner thigh that can radiate to the inner knee, often worse with activities that engage the adductor muscles, such as walking, running, or crossing the legs.
• Referred Pain:
  • Description: Less common, but pain originating from the hip or lower back (e.g., lumbar radiculopathy) can sometimes be referred to the inner knee.
  • Symptoms: Pain patterns that don't directly correlate with knee movement, often accompanied by symptoms in the hip, buttock, or lower back.

Biomechanical Factors Contributing to Inner Knee Pain

Beyond specific injuries, certain biomechanical imbalances and movement patterns can predispose individuals to inner knee pain, especially during walking.

• Overpronation (Flat Feet): When the arches of the feet collapse excessively during walking, it can cause internal rotation of the lower leg (tibia). This rotation places increased stress on the medial structures of the knee, particularly the MCL and medial meniscus.
• Valgus Knee Alignment ("Knock-Knees"): A structural or functional alignment where the knees angle inwards towards each other. This alignment places chronic compressive loads on the lateral (outer) compartment of the knee and tensile stress on the medial (inner) structures, including the MCL and medial meniscus.
• Muscle Imbalances:
  • Weak Hip Abductors and External Rotators: Muscles like the gluteus medius and minimus help stabilize the pelvis and prevent the knee from collapsing inwards during walking. Weakness here can lead to increased valgus stress at the knee.
  • Tight Hamstrings, Quadriceps, or Adductors: Restricted flexibility in these muscle groups can alter knee mechanics, increasing strain on the medial compartment. Tight hamstrings, for instance, can increase posterior pull on the tibia, affecting meniscal loading.
• Improper Gait Mechanics:
  • Overstriding: Taking excessively long steps can increase the impact forces on the knee joint and place greater stress on ligaments and cartilage.
  • Excessive Trunk Lean: Leaning the trunk to one side during walking can shift the center of gravity, altering the load distribution across the knee joint.

When to Seek Professional Help

While some mild inner knee pain might resolve with rest and self-care, it's important to consult a healthcare professional, such as an orthopedic doctor, physical therapist, or sports medicine specialist, if you experience:

• Persistent pain that doesn't improve with rest or self-care within a few days.
• Sudden, severe pain after an injury.
• Significant swelling, bruising, or redness around the knee.
• A sensation of the knee locking, catching, or giving way.
• Inability to bear weight on the affected leg.
• Numbness or tingling in the lower leg or foot.
• Pain that worsens over time or interferes with daily activities.

A professional evaluation can accurately diagnose the underlying cause and guide appropriate treatment, which may include physical therapy, medication, injections, or in some cases, surgical intervention.

Initial Self-Care and Management Strategies

For mild, acute inner knee pain, initial self-care can often provide relief.

• RICE Protocol:
  • Rest: Avoid activities that exacerbate the pain.
  • Ice: Apply ice packs to the affected area for 15-20 minutes several times a day to reduce inflammation and pain.
  • Compression: Use a compression bandage to help reduce swelling.
  • Elevation: Elevate the leg above heart level when resting.
• Activity Modification: Temporarily reduce or modify activities that trigger pain. Opt for low-impact alternatives like cycling or swimming if walking is painful.
• Appropriate Footwear: Ensure your shoes provide adequate support and cushioning. Consider orthotics if overpronation is a contributing factor.
• Over-the-Counter Pain Relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

Preventing Inner Knee Pain

Preventing inner knee pain involves addressing underlying biomechanical issues, strengthening supportive musculature, and practicing safe movement.

• Strength Training:
  • Hip Abductors and External Rotators: Strengthen muscles like the gluteus medius and minimus to improve hip and knee stability. Exercises like side leg raises, clam shells, and resistance band walks are beneficial.
  • Quadriceps and Hamstrings: Maintain balanced strength in these major thigh muscles.
  • Core Stability: A strong core contributes to overall body stability and efficient movement patterns.
• Flexibility and Mobility: Regularly stretch tight muscles, particularly hamstrings, quadriceps, and adductors, to improve range of motion and reduce strain on the knee.
• Proper Footwear and Orthotics: Wear supportive shoes appropriate for your activity level and gait. Custom or over-the-counter orthotics can help correct excessive pronation.
• Gradual Progression: When starting new activities or increasing intensity, do so gradually to allow your body to adapt and prevent overuse injuries.
• Warm-up and Cool-down: Always perform a dynamic warm-up before exercise and a static cool-down afterwards.
• Maintain a Healthy Weight: Excess body weight places increased stress on the knee joints, accelerating wear and tear.

By understanding the anatomy, common causes, and contributing factors to inner knee pain, you can take proactive steps to manage existing discomfort and prevent future issues, enabling you to walk with greater comfort and confidence.