What should I do for pain and muscle tightness in the knee and upper leg after a fall?

Management of Knee and Upper Leg Pain After a Fall

For pain and muscle tightness in the knee and upper leg after a fall, immediately apply ice (ice-water mixture in a bag with a damp cloth barrier) for 20-30 minutes, avoid activities that cause pain, and seek medical evaluation to rule out fracture—especially if you cannot bear weight, cannot flex the knee to 90 degrees, are over 55 years old, or have isolated patellar tenderness. 1

Immediate First Aid (First 72 Hours)

Ice Application

• Apply cold therapy using an ice-water mixture in a plastic bag surrounded by a damp cloth—this is more effective than ice alone or gel packs 1
• Limit application to 20-30 minutes per session, 3-4 times daily 1
• Always place a barrier (thin towel) between ice and skin to prevent cold injury 1
• Cold application decreases pain and swelling acutely but does not improve long-term recovery time 1

Activity Modification

• Avoid all activities that cause pain and limit use of the injured leg 1
• Do not bear weight on the injured leg until evaluated by a medical professional 1
• Assume any painful extremity injury could include a bone fracture until proven otherwise 1

When to Seek Emergency Care

Activate emergency services immediately if: 1

• The leg appears blue or extremely pale (suggests vascular compromise)
• You experience tingling in the extremities
• You have severe or worsening pain
• You fell from greater than standing height

Medical Evaluation Criteria

You need knee radiographs (X-rays) if you meet ANY of the following Ottawa Knee Rule criteria: 1

• Age 55 years or older
• Isolated tenderness of the patella (kneecap)
• Tenderness at the head of the fibula
• Cannot flex knee to 90 degrees
• Cannot bear weight immediately after injury (unable to take 4 steps)

Pain Management

• Use NSAIDs (ibuprofen) or acetaminophen for pain control—both are equally effective 2, 3
• Be aware that NSAIDs can cause GI side effects including ulcers and bleeding, though serious complications are rare 3
• NSAIDs inhibit platelet function and prolong bleeding time, so use caution if you have bleeding disorders 3

Compression (Controversial Benefit)

• Compression wraps may provide comfort in the acute phase but do not reduce swelling, improve function, or speed recovery 1
• If applying compression, ensure it does not compromise circulation 1
• Compression bandages alone (without proper functional support) are less effective than braces for ligament injuries 1, 2

What NOT to Do

• Do not apply heat—cold application is superior for acute injuries 1
• Do not attempt to move or straighten the injured leg if deformity is present 1
• Do not use rigid immobilization for more than 10 days if a sprain/strain is diagnosed, as this leads to worse outcomes 1, 2

Follow-Up Treatment (If Fracture Ruled Out)

Functional Support

• If diagnosed with a ligament injury (sprain/strain), use a functional knee brace for 4-6 weeks rather than immobilization 1, 2, 4
• Braces are superior to elastic bandages or compression wraps alone 1, 2

Early Mobilization

• Begin gentle range-of-motion exercises within the first week to prevent stiffness 1, 4
• Early weight-bearing as tolerated with appropriate support improves outcomes 1, 2
• Start therapeutic exercises immediately rather than waiting—this optimizes recovery and prevents chronic instability 1, 2, 4

Exercise Therapy

• Progressive strengthening exercises are essential, as improved upper leg muscle strength underlies the beneficial effects of rehabilitation 2, 5
• Include resistance exercises in all directions (3 sets of 10 repetitions) 2
• Add proprioceptive training (balance exercises) to reduce risk of recurrent injury 2

Common Pitfalls to Avoid

• Delaying medical evaluation when Ottawa Knee Rule criteria are met—this risks missing fractures 1
• Prolonged immobilization beyond 10 days leads to muscle deconditioning, stiffness, and worse outcomes 1, 2
• Discontinuing exercises once pain subsides increases risk of recurrent injury and chronic instability 1, 2
• Using compression bandages as sole treatment without proper functional support 1, 2
• Returning to full activity before completing 4-6 weeks of rehabilitation 2, 4

Return to Activity Timeline

• Sedentary activities: 2 weeks with functional brace support 4
• Moderate physical activities: 3-6 weeks with activity restrictions 4
• Full return to demanding activities: 6-8 weeks depending on rehabilitation progress 4
• Continue prophylactic bracing during high-risk activities in the initial return phase 4