After the back, the knees are the second-most common site of chronic pain in the body. Many people will experience knee pain at some point in their lives, whether from injuries to cartilage and soft tissue as active younger adults, or from wear and tear as they age.
As your largest joint, your knees absorb force when you’re playing sports, taking the stairs and getting into bed. That stress can wear down your joints and, if you already have an injury, lead to pain that can range from uncomfortable to debilitating.
Chronic pain can be particularly draining — physically, financially and emotionally, said Dr. Matthew Abdel, an orthopedic surgeon at the Mayo Clinic. Someone might not say, “‘Hey, my knee’s really killing me,’” he said. “But as they’re talking to you about something that’s totally unrelated, they’re thinking about it.”
Fortunately, there are steps you can take to manage the discomfort, maintain your mobility and prevent future injury. “You don’t just necessarily go from ‘my knee hurts’ to having surgery,” said Robert Turner, a physical therapist at the Hospital for Special Surgery in New York. Here’s how to distinguish between common kinds of knee pain and what experts recommend for treating them.
Common causes of knee pain
The most common cause of chronic knee pain, particularly in adults 55 and older, is osteoarthritis. With this condition, the cartilage in your joints wears out and loses its ability to absorb shock. This leads to inflammation, occasional swelling and pain that generally becomes worse over time, though you may have good and bad days, said Dr. Nicholas Scarcella, an orthopedic surgeon at the Cleveland Clinic. That pain can be sharp or throbbing and can occur in different parts of the knee, along the sides or under the kneecap. People with osteoarthritis often feel stiffness in the morning, and it generally becomes easier to move later in the day.
Among people who are physically active, overuse injuries are also common causes of knee pain. These injuries are typically caused by suddenly increasing your exercise intensity, duration or volume. Distance runners can be prone to IT band syndrome, which stems from repetitive movement and causes pain on the outside of the knee. Overuse, weak quad muscles, poor knee alignment and previous injuries can lead to patellofemoral pain syndrome, also called runner’s knee, which causes pain underneath the kneecap.
Knee pain can also come on suddenly, after a fall or accident, while playing sports or even just while bending over in the garden. With these injuries, the pain can be sharp and intense.
One of the most common knee injuries is a tear in your meniscus, a crescent-shaped piece of cartilage that absorbs shock and helps keep your knee stable. Tears are often caused by a twisting motion and can result in sharp pain, swelling and trouble bending the joint afterward. “It tends to be an event that someone remembers,” Dr. Scarcella said.
Ligament sprains are another common injury that occur when one of your knee’s four major ligaments — ropelike bands of connective tissue that provide stability — stretches too far or tears. Two commonly injured ligaments are the M.C.L. and the A.C.L. With an A.C.L. tear in particular, you may feel a pop.
Treating pain from overuse and arthritis
Even if your pain has appeared gradually, you should consider seeing a physical therapist. They can help you identify ways you move that may be contributing to your knee pain, such as weakness in your hips or a tendency for your feet to collapse inward, Dr. Turner said. They will know if you should see a physician. (You can often see a physical therapist without a referral. But your coverage will vary based on your insurance and where you live, so it’s worth checking with your provider in advance.)
If your pain is chronic rather than the result of a new injury, strengthening the muscles around the knee, both above (your glutes, hip flexors, quads and hamstrings) and below (your calves and ankle muscles), can be effective at reducing pain from different causes and preventing future aches. For patellofemoral pain, strengthening your quads, hip abductors and core muscles and stretching your quads can help.
Exercise can also reduce pain from osteoarthritis, and it may be as effective as over-the-counter pain relievers. Lower-impact forms of aerobic exercise such as biking, swimming or using the elliptical can be good options if your usual routine is painful. Some studies have shown that taping and wearing stable, supportive shoes may also help reduce knee pain.
If lifestyle changes and oral medications aren’t helping, your doctor might recommend steroid injections. These may reduce your pain for a few weeks at a time but are not recommended for frequent use, Dr. Scarcella said.
There is mixed evidence in support of hyaluronic acid injections to reduce pain, but some doctors say they can help patients with less advanced osteoarthritis for whom other treatments have failed. Some doctors may recommend platelet-rich plasma injections to reduce pain in certain patients, but these treatments can be expensive and they haven’t been found to regenerate cartilage, said Dr. Joanne Borg Stein, the director of regenerative medicine for Mass General Brigham. If you’ve tried a range of treatments and your pain is still affecting your quality of life, your doctor may recommend knee replacement surgery.
Treating injuries
For sudden injuries, Dr. Turner recommends stopping the activity that caused the pain and applying ice around the circumference of the joint rather than just the front. Over-the-counter pain relievers like ibuprofen or topical alternatives can help. Certain injuries, like a torn A.C.L. or meniscus, may require surgery in some patients.
You should see a doctor if your knee feels unstable or if you have sudden sharp, shooting pain, can’t manage stairs or can’t walk more than four steps without pain, Dr. Turner said. You also shouldn’t ignore a fever — which can be a sign of an infection — or pain that is worsening, directly over the bone or keeping you up at night, said Dr. Borg Stein.
How to keep your knees healthy
Many risk factors for knee pain are out of our hands, Dr. Abdel said — you can’t change your age or genetics, for example. But maintaining a healthy body weight can help reduce the load on your knees. Every step puts a load of two to three times your body weight on your knee.
Staying active is also important. Though it’s a common misconception that some forms of exercise negatively affect your knees, muscles that are weakened from inactivity can increase your risk of developing osteoarthritis down the line.
Even if you have arthritis, as long as you are flexible and strong, eat well and get adequate rest, “you’re going to have much better function and reduced symptoms,” Dr. Borg Stein said. “So even if we can’t totally prevent it, we can certainly manage it proactively.”
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