Extreme knee pain. Or something?

The X-ray uploaded doesn’t show features of osteoarthritis, but this can sometimes be influenced by the position in which the X-ray was performed. A standing X-ray is always better. The MRI report is essentially normal, but reviewing the MRI films with a Orthopaedic surgeon would be advisable since sometimes subtle signs in correlation with clinical findings are better picked up by doctors. If you have never had any knee pain in the past, or never suffered any injury to the knee in the past or recently, then it’s likely that this pain is activity related or in other words due to unaccustomed activity. Presently, regular icing of the knee along with activity modification so as to avoid floor level activity (squatting/cross legged sitting) and avoid stair activity is advisable. Oral analgesic medications can be taken on an SOS basis. Such symptoms usually resolve in about a week’s time.

Watch for any instability which is perceived as sudden buckling or fear of the knee giving away. This might be worse while walking on an uneven surface. Also check if there’s any swelling, any locking or catching sensation, and any perceptible clicking associated with pain. These might suggest internal knee derangement and it would be advisable to consult an Orthopaedic surgeon to review the MRI films.

Once the pain has reduced consider starting physiotherapy to improve muscle strength. Also consider regular activities that help avoid muscle deconditioning such as swimming or cycling. Avoid walking long distances on concrete surfaces as the joint reaction force can aggravate knee pain.