Do your knees hurt sometimes? Join the club. Millions of Americans have been diagnosed with degenerative osteoarthritis in their knees and millions more experience occasional pain, stiffness or that low throbbing ache that forecasts chilly, wet weather ahead.
In response, plenty of us turn to over-the-counter painkillers, steroid injections or knee surgery. Even more of us take to our couches and baby our trick knees, thinking that sitting will fix the soreness.
Each of these options may make knees feel or function better for a while. But there’s increasing evidence that some of the most common approaches to combating knee problems can have downsides.
Here’s what you should know about the latest science on treatments for knee problems — including the one that almost every expert agrees upon. Talk to your doctor, of course, before changing how you treat your knees. Everyone’s knees are unique, and your response to treatments may not be the same as someone else’s.
Ibuprofen
A nonsteroidal anti-inflammatory drug (NSAID), ibuprofen is frequently recommended by doctors as an initial treatment for sore knees.
Which makes sense. Ibuprofen can combat both the pain and inflammation that are often present in aching knees, and it’s readily available over-the-counter in any drugstore.
But a 2024 study of 4,197 men and women with or at risk of developing arthritis raised worries about prolonged use. In the study, those who regularly used NSAIDs (mostly ibuprofen but also a separate class of NSAIDs called Cox-2 inhibitors, such as Celebrex) at prescribed doses for at least four years were much more likely than nonusers to develop “worsening pain, disability and stiffness,” said Zubeyir Salis, a professor of epidemiology at the University of Montpellier in France, who led the study.
Their knee scans also showed more changes suggesting their arthritis was progressing, and they opted for knee replacements at higher rates than those not taking the drug.
Another 2024 study used sophisticated statistical modeling to establish that taking ibuprofen “may provide symptom relief,” but, over time, “could also contribute to the progression” of arthritis, the authors wrote, even if people didn’t have sore joints when they began using the drug.
Neither study looked into how ibuprofen might contribute to knee problems. But other, earlier research found that NSAIDs may inhibit the production of specialized biochemicals in the knee that are needed for cartilage health. This may accelerate arthritis.
“My takeaway is that long-term NSAID treatment deserves regular review with a clinician,” Salis said. “NSAIDs can help relieve pain, but patients should check whether continued use is providing enough benefit to justify the risks.”
Cortisone shots
Administered by a physician, cortisone shots contain a steroid that provides rapid, if temporary pain relief, often lasting for several months. But repeated injections typically provide dwindling periods of relief.
They might also increase the odds of knee replacement. In a 2020 study from the Netherlands, researchers studied the knees of almost 4,000 men and women with or at risk for arthritis. Nearly 800 of them had gotten cortisone shots, often repeatedly, and a third of them had a knee replacement within two years, versus 5 percent of those who weren’t receiving the medication. Every additional shot after the first increased the risk of replacement surgery by more than 9 percent.
Other studies, including a 2021 review of the available research, suggest cortisone, especially in repeated doses, may be toxic for cartilage and, if it migrates outside the joint, can raise blood sugar levels and have other metabolic effects.
Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago, who has studied the effects of cortisone, cautions that it’s “difficult to tease out” the role of cortisone shots in knee replacement risk from those of excessively damaged knees. In other words, people with the worst arthritis may be the ones who seek out the most cortisone shots, explaining their higher risk for eventual knee replacement.
Still, anyone considering a cortisone shot for the first — or fifth — time should discuss the risks and benefits with their physician, Della Valle said, especially if the shots’ pain-relieving benefits have begun to diminish.
Meniscus surgery
If you’re over 50, you probably have a torn meniscus. Crescent-shaped discs of cushioning cartilage between the femur and tibia in the knee, they often thin and fray with age, making a torn meniscus during middle age almost universal.
Sometimes, the tear is painful or leads to catching of the knee. More often, there aren’t symptoms.
It’s often treated with arthroscopic partial meniscectomy, a minimally invasive surgery where the surgeon removes the tissue’s torn portion. The surgery is among the most common procedures in the world.
But about 15 years ago, physician-scientists in Finland began to wonder how well — and even whether — it really worked.
The gold standard for testing treatments is a placebo-controlled trial, which is tricky with surgeries, since you’d have to perform a fake procedure.
But that’s what the Finnish researchers did, randomizing 145 patients with a meniscus tear to either a meniscectomy or a sham operation, during which people received anesthesia and surgeons used an arthroscope, but didn’t remove any portion of the meniscus.
A year after the procedure, there were “no significant between-group differences,” the scientists reported in a groundbreaking 2013 study in the New England Journal of Medicine. Knee pain and function were no better in the group undergoing the actual meniscectomy versus those getting the sham operation.
This year, the scientists reported results from a 10-year follow-up. By then, those who’d had the actual meniscectomy showed higher rates of new or worsening arthritis and more knee replacements than among the sham surgery group.
For Teppo Jarvinen, a professor of orthopedic surgery at the Finnish Centre for Evidence-based Orthopaedics in Helsinki and senior author of both studies, the takeaway is clear. “For the typical middle-aged or older patient with knee pain and a degenerative meniscal tear, I would advise against arthroscopic partial meniscectomy.”
But other surgeons see a continuing role for the procedure. “Several trials done in the last 15 years point strongly to a recommendation, endorsed by many professional societies, that individuals older than 45, with knee pain and a meniscal tear are best advised to try exercise, physical therapy, medications and other nonoperative approaches as the first option,” said Jeffrey Katz, a professor of medicine and orthopedic surgery at Harvard Medical School, who’s studied the results of meniscal surgery.
“For those who don’t benefit from these therapies,” he continued, “arthroscopic partial meniscectomy remains a reasonable choice.”
Talk in depth with your doctor about options if you’re diagnosed with a degenerative meniscus tear, he said.
Jarvinen said he wouldn’t have the surgery in that situation, but Katz demurred.
“I would consider it,” he said, “if nonoperative therapy was not working after a number of months.”
Sitting
You may want to rest if your knee hurts. But of all the options for knee pain, there’s one that experts consider to be the least effective and among the most detrimental: sitting.
In study after study, inactivity is linked to heightened risks for new or worsening knee arthritis. In a large-scale 2023 study, the more time people spent sitting and watching TV, the more likely they were to wind up with arthritic knees.
In another 2023 study, researchers grouped people with or at high risk for knee arthritis into those who sat for at least four hours on their own time, outside of work, and those who sat less.
The frequent sitters were about 25 percent more likely to develop arthritis or have their disease progress rapidly within two years than those who sat less. And if the frequent sitters also stayed chair-bound most of the day at work, their risk of new or rapidly worsening arthritis rose to 60 percent.
“You need to move when you have knee osteoarthritis,” said Daniel White, a professor of physical therapy at the University of Delaware, and the study’s senior author.
The best treatment: Walking
Helpfully, there’s a cheap, easy and scientifically backed way to do just that.
“I recommend all my patients with osteoarthritis to walk,” said Grace Hsiao-Wei Lo, a professor at the Baylor College of Medicine.
Lo led a 2022 study of 1,212 men and women with knee arthritis. Those who walked for exercise, whether often or occasionally, were far less likely during the subsequent two years to develop new pain or worsening joint degeneration than non-walkers.
It’s “a simple, non-pharmacological intervention with a low price tag and few barriers,” Lo said. But “it positively impacted structure and symptoms related to knee osteoarthritis.”
With that study and others as support, she and other knee experts are united in their advice that almost everyone, if they possibly can, should walk for the sake of their knees — including themselves. “I’m motivated by this study,” she said. “I’m out there walking for exercise two to three times a week.”
The Arthritis Foundation’s Walk with Ease program offers free, online advice about creating the right walking program for anyone with arthritis.
This is the final article in our week-long series about knee health. You can find the other stories in the series at the links below.
Do you have a fitness question? Email [email protected] and we may answer your question in a future column.
More about knees
How to take care of your knees in your 20s, 30s, 40s and beyond
The biggest mistake that people with knee pain make
At 63, he’s a top knee expert. Here’s his exercise routine for strong knees.
Scientists may have the key to treating arthritis: Regrowing the knee
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