Statesman Examiner

“My Knee Won’t Stop Swelling” and Five Strategies to Help Today!

- Rob Sumner Doctor of Physical Therapy

Hey Team! I have played a lot of basketball over the years, and one of the weirdest experience­s I have ever had was the time I collided with another player. I was driving to the lane, and another player slid over to stop me… and we hit knees! Boy, did that hurt. What transpired after this was the amount of swelling occurring to my knee. It immediatel­y ballooned up and became painful. But the weird part was it continued to stay swollen for weeks? Why? It did not even hurt anymore. I could move it, lightly bend and walk without pain? The blessing in this injury… I can easily relate to my many patients who ask me about persistent knee swelling- better known as effusion. So, let’s dig in and find out more.

Why Won’t My Knee Swelling Stop?

Knee effusion, or effusion in general, is swelling occurring inside a joint capsule. A deciding factor between effusion and swelling is where the swelling occurs. When woven together, each joint is encapsulat­ed by multiple tight ligaments, creating the “capsule” of the joint. Fluid usually circulates inside the capsule to provide nutrients to the joint, aid in lubricatio­n, and assist in joint health. The fluid inside the joint has a constant inflow- to- outflow regulation process keeping the same amount of fluid in the knee at all times. As the body uses the fluid for nutrients… the capsule circulates in new nutrient- dense fluid, thus keeping the joint healthy. Knee effusion occurs when the knee is traumatize­d, and capsule fluid becomes excessive. The fluid is trapped and cannot travel to other body parts.

Painful Joint With Swelling?

Knee effusion is painful due to the enlargemen­t occurring in the joint capsule. Picture your joint capsule as a balloon filling up with fluid. The capsule is very thick and does not stretch much; therefore, adding more fluid will push against the joint capsule and attempt to extend the capsule. This pressure in the joint creates pain! A lot of pain! The distention of the capsule is the root of your pain overall. Joint effusion occurs due to any irritation to the joint capsule or within the knee. This swelling is a protective mechanism but is NOT an indicator of the severity of the damage. Effusion can occur from slight irritation to significan­t ligament damage. Therefore, inferring the severity would be improper.

Can A Doctor Suck the Fluid Out?

Knee effusion is genuinely a fluid regulation issue. The inflow to outflow process within the joint capsule disrupts; therefore, more influx occurs than outflow. Naturally, the joint will slowly distend as a consequenc­e. Many of my patients are confused about why their doctor will not drain the fluid. Some doctors will drain this fluid if the distention becomes too great. The challenge is the fluid will return, and each poke of the needle increases the chance of infection in the patient. Therefore, aspiration (draining) of the joint is not usually favored unless the pain becomes too great. However, please note that this is a bandaid and not a long- term strategy. Knee inflammati­on and irritation will continue to disrupt the inflow/ outflow of fluid to the joint capsule.


# 1. Rest: Knee effusion stays in the joint for as long as the body continues to have inflammati­on or irritation. The more the joint remains inflamed…, the longer effusion will be present. Resting the joint is essential to reduce inflammati­on and return to a prior activity level.

# 2. Avoidance: The complement­ary factor to rest in reducing irritation is avoiding the exacerbati­ng factors. Part of the process of lowering knee effusion is to avoid painful activities. Typical activities to avoid: ascending/ descending stairs, deep squatting, long- standing with non- supportive shoes, and more than usual walking. These activities will increase pressure on the joints, thus reducing healing timeframes.

# 3. Knee sleeve: A knee sleeve will not remove the effusion from the joint, as the swelling is encapsulat­ed and has nowhere to go, but it can help with the pain. A knee sleeve will assist in creating compressio­n to the knee and allow you to feel more stable and secure with regular daily activities.

# 4. Light reciprocal exercise: Light non- weight bearing reciprocal activity has demonstrat­ed effectiven­ess in assisting a return to routine tissue healing, thus reducing effusion. Reciprocal exercises would consist of a stationary bicycle. A recumbent bike is preferred and helps create a non- painful, non- exacerbati­ng mode of activity with constant knee flexion/ extension. Movements in a non- weight bearing position will create a “flushing” effect in the knee and assist in an overall reduction in effusion.

# 5. Light quad activation exercises: Once the effusion is starting to reduce and pain continues to decrease, a great beginning to a return to full function is to start light quadriceps activation exercises. These exercises are beneficial in allowing the quad muscle to regain proper activation. More than a few small amounts of fluid will begin to reflexivel­y limit quad activation as a protective mechanism after the knee swells. The first muscle to atrophy (shrink) is the quadriceps; therefore, we will need to begin engaging the quads with activity safely, non- painful manner.

Ok Team, I sure hope this helps you today. I know from experience… knee swelling can be annoying. It is essential to follow the steps above to give your knee the best chance of healing. Swelling is a byproduct of irritation. What can you do today to minimize or eliminate irritation to your knee? Thank you to the people from last week who reached out to discuss mobility. These were some of the best conversati­ons on improving overall function for people with limited mobility. If you have a question or a comment from one of these articles… fire away. I love the input and questions. Please email me or call today. Keep Moving!

• The author, Rob Sumner, is a Doctor of Physical Therapy and owner of Sumner Specialize­d Physical Therapy. He’s happy to answer any questions about this article, wellness, fitness, or physical therapy overall by phone at (509) 684-5621 or by email at

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