Each year, millions of Americans limp into
doctors' offices and emergency rooms with knee pain. Often, the pain is the
result of an injury such as a ruptured ligament or torn cartilage. But certain
medical conditions can also bring you to your knees, including arthritis, gout
Depending on the type and severity of
damage, knee pain can be a minor annoyance, causing an occasional twinge when
you kneel down or exercise strenuously. Or it can lead to severe discomfort and
Many minor knee problems respond well to
self-care measures. More serious injuries, such as a ruptured ligament or
tendon, may require surgical repair. But knee surgery can often be performed
with a procedure that uses a few small incisions rather than a single large one.
Because there's less tissue disruption than with traditional surgery, you're
likely to heal more quickly and comfortably.
Still, it's better not to have knee pain at
all. Although every knee problem can't be prevented — especially if you're
active — you can take certain steps to reduce the risk of injury or disease.
Signs and symptoms
A knee injury can affect any of the
ligaments, tendons or fluid-filled sacs (bursa) that surround your knee joint as
well as the bones, cartilage and ligaments that form the joint itself. Because
of the knee's complexity, the number of structures involved, the amount of use
it gets over a lifetime and the range of injuries and diseases that can cause
knee pain, the signs and symptoms of knee problems can vary widely.
Acute knee pain
Severe knee pain that comes on suddenly but that's of limited duration (acute
pain) is often the result of injury. Some of the more common knee injuries and
their signs and symptoms include the following:
injuries. Your knee contains four ligaments — tough bands of
tissue that connect your thighbone (femur) to your lower leg bones (tibia
and fibula). You have two collateral ligaments — one on the inside (medial
collateral ligament) and one on the outside (lateral collateral ligament) of
each knee. A tear in one of these ligaments is usually the result of a fall
or contact trauma, especially in sports like football, and is likely to
cause immediate pain in the injured area. The discomfort, which can range
from mild to severe, is usually worse when you walk or bend your knee. If
the collateral ligament on the inside of your knee sprains or tears, you may
feel a ripping sensation. In some cases, this ligament may become calcified
after repeated injuries (Pellegrini-Stieda syndrome).
The other two ligaments are inside your
knee and cross each other as they stretch diagonally from the bottom of your
thighbone to the top of your shinbone (tibia). The posterior cruciate
ligament (PCL) connects to the back of your shinbone, and the anterior
cruciate ligament (ACL) connects near the front of your shinbone. If you
tear the ACL, either partially or completely, you're likely to know it right
away. You may feel or hear a pop in your knee and have intense pain and
immediate swelling. When you try to stand and put weight on your injured
leg, your knee may "buckle" or at least feel as if it might give
way. In most cases, you'll have to stop all activity, either because the
pain is too severe or because your knee isn't stable enough to support your
PCL tears aren't usually as dramatic or
painful. Most often, you'll experience pain and swelling in the space behind
your knee (popliteal fossa) and a feeling of instability, as if your knee
might give way.
injuries (tendonitis). Tendonitis is irritation and inflammation of
one or more tendons — the thick, fibrous cords that attach muscles to
bone. Athletes — especially runners, skiers and cyclists — are prone to
develop inflammation in the patellar tendon, which connects the quadriceps
muscle on the front of the thigh to the larger lower leg bone (tibia). Tendonitis
can occur in one or both knees and often causes pain and swelling at the
front of your knee and just below your kneecap. The discomfort usually isn't
constant but tends to occur when you jump, run, squat or climb stairs. The
quadriceps or patellar tendons may also rupture, either partially or
completely. In that case, the pain is likely to be most intense when you try
to extend your knee. If the tendon is completely ruptured, you won't be able
to extend or straighten your knee at all.
injuries. The meniscus is a C-shaped cartilage that curves within
your knee joint. Meniscus injuries involve tears in the cartilage, which can
occur in various places and configurations. For example, the cartilage may
tear lengthwise or from the inside to the outside rim of the meniscus
(radial tear). Although you may not notice small tears, in most cases,
you'll have pain and mild to moderate swelling that develops over 24 to 48
hours. Occasionally, a lengthwise tear flips into the knee joint instead of
staying around the joint's edge, an injury called a bucket-handle tear. A
flap of the torn cartilage can interfere with knee movement and cause your
knee joint to lock so that you can't straighten it completely. The pain and
swelling often disappear on their own, but they're likely to return when
you're active again. In addition, repeated injuries can increase the size
and severity of existing tears.|
Some knee injuries cause inflammation in the bursae, the small sacs of fluid
that cushion the outside of your knee joint so that tendons and ligaments
glide smoothly over the joint. Bursitis can lead to warmth, swelling and
redness over the inflamed area, aching or stiffness when you walk, and
considerable pain when you kneel. Sometimes the bursa located over your
kneecap bone (prepatellar bursa) can become infected, leading to fever, pain
and swelling. When the pes anserine bursa on the lower inner side of your
knee is affected, you're likely to have pain when you go up or down stairs.
Sometimes injury or degeneration of bone or cartilage can cause a piece of
bone or cartilage to break off and float in the joint space. This may not
create any problems unless the loose body interferes with knee joint
movement — the effect is something like a pencil caught in a door hinge
— leading to pain and a locked joint.
kneecap. This occurs when the triangular bone that covers the front
of your knee (patella) slips out of place, usually to the outside of your
knee. You'll be able to see the dislocation, and your kneecap is likely to
move excessively from side to side. You're also likely to have intense pain
and swelling in the affected area and difficulty walking or straightening
your knee. Unfortunately, once you've had a dislocated kneecap, you're at
increased risk of having it happen again. Although you may not experience as
much swelling or discomfort with subsequent episodes, repeated dislocations
can lead to chronic knee pain. But good rehabilitation, with a focus on
strength training of the muscles that control your kneecap, can help prevent
disease. Primarily affecting athletic teens and preteens, this
overuse syndrome causes pain, swelling and tenderness at the bony prominence
(tibial tuberosity) just below the kneecap. The pain, which can range from
mild to debilitating, is usually worse with activity, especially running and
jumping, and improves with rest. Osgood-Schlatter disease frequently affects
just one knee but sometimes develops in both knees. The discomfort can last
from weeks to months and may continue to recur until your child stops
band syndrome. This occurs when the ligament that extends from the
outside of your pelvic bone to the outside of your tibia (iliotibial band)
becomes so tight that it rubs against the outer portion of your femur.
Distance runners are especially susceptible to iliotibial band syndrome,
which generally causes a sharp, burning pain in the knee that often begins
10 to 15 minutes into a run. Initially, the pain goes away with rest, but in
time it may persist when you walk or go up and down stairs.
knee. In this injury, your knee extends beyond its normally
straightened position so that it bends back on itself. Sometimes the damage
is relatively minor, with pain and swelling when you try to extend your
knee. But a hyper-extended knee may also lead to a partial or complete
ligament tear, especially in your ACL.
arthritis. Sometimes your knee joint can become infected, leading
to swelling, pain and redness. Septic arthritis often occurs with a fever.|
Chronic knee pain
Sometimes an injury can lead to ongoing (chronic) knee pain. Often, however,
chronic pain results from a medical condition such as:
arthritis. The most debilitating of the more than 100 types of
arthritis, rheumatoid arthritis can affect almost any joint in your body,
including your knees. In addition to pain and swelling, you're likely to
have aching and stiffness, especially when you get up in the morning or
after periods of inactivity; loss of motion in your knees and eventually
deformity of the knee joints; and sometimes a low-grade fever and a general
sense of not feeling well (malaise). Rheumatoid arthritis usually affects
both knees at the same time. And although it's a chronic disease, it tends
to vary in severity and may even come and go. Periods of increased disease
activity — called flare-ups or flares — often alternate with periods of
Sometimes called degenerative arthritis, this is the most common type of
arthritis. It's a wear-and-tear condition that occurs when the cartilage in
your knee deteriorates with use and age. Osteo-arthritis usually develops
gradually and tends to cause varying degrees of pain and swelling when you
stand or walk and before a change in the weather. It also can lead to
stiffness, especially in the morning and after you've been active, and to a
loss of flexibility in your knee joints.
With this type of arthritis, you're likely to experience redness, swelling
and intense pain in your knees that comes on suddenly — often at night —
and without warning. The pain typically lasts five to 10 days and then
stops. The discomfort subsides gradually over one to two weeks, leaving your
knee joints apparently normal and pain-free. Another condition, pseudogout
(chondrocalcinosis), which mainly occurs in older adults, can cause severe
inflammation and intermittent attacks of pain and swelling in large joints,
especially the knees.
of the patella" or patellofemoral pain. This is a general term
that refers to pain arising between your patella and the underlying
thighbone (femur). It's common in young women, especially those who have a
slight misalignment of the kneecap, in athletes, and in older adults, who
usually develop the condition as a result of arthritis of the kneecap.
Chondromalacia of the patella causes pain and tenderness in the front of
your knee that's worse when you sit for long periods, when you get up from a
chair and when you climb stairs. You may also notice a grating or grinding
sensation when you extend your knee.|
In the simplest terms, a joint occurs
wherever two bones come together. But that definition doesn't begin to convey
the complexity of joints, which provide your body with flexibility, support and
a wide range of motion.
You have four types of joints: fixed,
pivot, ball-and-socket and hinge. Your knees are hinge joints, which, as the
name suggests, work much like the hinge of a door, allowing the joint to move
backward and forward. Your knees are the largest and heaviest hinge joints in
your body. They're also the most complex. In addition to bending and
straightening, they twist and rotate. This makes them especially vulnerable to
damage, which is why they sustain more injuries on average than other joints.
A closer look at your knees
Your knee joint is essentially four bones held together by ligaments. Your
thighbone (femur) makes up the top part of the joint, and two lower leg bones,
the tibia and the fibula, comprise the lower part. The fourth bone, the patella,
slides in a groove on the end of the femur.
Ligaments are large bands of tissue that
connect bones to one another. In the knee joint, four main ligaments link the
femur to the tibia and help stabilize your knee as it moves through its arc of
motion. These include the collateral ligaments along the inner (medial) and
outer (lateral) sides of your knee and the anterior cruciate ligament (ACL) and
posterior cruciate ligament (PCL), which cross each other as they stretch
diagonally from the bottom of your thighbone to the top of your shinbone.
Other structures in your knee include:
These fibrous bands of tissue connect muscles to bones. Your knee has two
important tendons, which make it possible for you to straighten or extend
your leg: the quadriceps tendon, which connects the long quadriceps muscle
on the front of your thigh to the patella, and the patellar tendon, which
connects the patella to the tibia.
This C-shaped cartilage, which curves around the inside and outside of your
knee, cushions your knee joint.
A number of these fluid-filled sacs surround your knee. They help cushion
your knee joint so that ligaments and tendons slide across it smoothly.|
Normally, all of these structures work
together smoothly. But injury and disease can disrupt this balance, resulting in
pain, muscle weakness and decreased function.
Knee injuries: The hows and whys
Many knee injuries are due to overuse, problems with alignment, sports or
physical activities, and failure to warm up and stretch before exercise. But
they can also result from trauma, such as a car accident, a fall or a direct
blow to your knee.
Common knee injuries and their causes
injuries. You're most likely to tear your collateral ligaments in
sports that require quick stops and turns, such as soccer, basketball and
skiing, or in contact sports when repeated blows to the inside or outside of
your knee can cause the opposing ligament to stretch or tear. Collateral
ligaments can also be damaged by repeated stress, which causes them to lose
their elasticity, much like an overstretched rubber band.
Most ACL injuries are sports-related.
They frequently occur during activities such as football, basketball, soccer
and skiing when you slow down suddenly or cut or pivot with your foot firmly
planted — movements that twist or overextend your knee. ACL tears rarely
result from contact with other players, but they can develop when you land
awkwardly from a jump or fall. PCL tears, on the other hand, aren't usually
associated with sports. Because the PCL is a strong ligament located deep
inside your knee, tears most often result from traumatic injuries, such as
those you might receive in a car accident. And because a violent impact is
needed to damage the PCL, you're almost certain to injure other ligaments at
the same time.
injuries. Inflammation of the quadriceps tendon (tendonitis) can
occur in people who run, bicycle or ski. It can also result from
inflammatory diseases that occur throughout your body, most notably
rheumatoid arthritis. Middle-age weekend warriors are more likely to rupture
their quadriceps tendon than seasoned athletes are. And patellar tendon
ruptures frequently occur in active younger people who have a history of tendonitis
or who have had steroid injections in their knees.
injuries. A meniscus tear can result from aggressive pivoting or
sudden turns — any activity that twists or rotates your knee.
Occasionally, you can tear your meniscus while lifting something heavy.
Older adults sometimes tear their meniscus during repetitive movements such
as kneeling or squatting, but more often it tears because it has degenerated
Sometimes called housemaid's knee or carpet layer's knee, prepatellar
bursitis often occurs after an activity that requires you to kneel for long
periods — scrubbing floors, gardening or installing tile or carpet, for
example. It can also result from an infection or as one of the symptoms of
arthritis or gout.
kneecap. Kneecap (patellar) dislocations can occur in contact
sports and in activities that require you to change direction while running,
such as tennis, racquetball and volleyball. If your knees tend to turn
inward or your kneecaps are higher than normal, you may be more prone to
disease. This condition can develop in athletic young people during
the years when their bones are growing rapidly — usually ages 10 to 15 for
boys and 8 to 13 for girls. Osgood-Schlatter disease results from repeated
tugging of the patellar tendon on a growth plate at the top of the tibia.
This is most likely to occur during activities that involve running, jumping
and bending, when the pull of the quadriceps muscle puts tension on the
patellar tendon. In time, the tendon may begin to pull away from the tibia,
resulting in a small bump you can see. In severe cases, the tendon may come
away from the tibia completely.
knee. This usually results from an awkward landing after a jump or
from a contact injury.
band syndrome. This is a common cause of lateral knee pain in
runners. Competitive runners are especially susceptible, but amateurs aren't
exempt. You're more likely to develop iliotibial band syndrome if you have
biomechanical problems such as unequal leg length or weak hip abductors, the
muscles responsible for sideways leg motion. Exercising on concrete surfaces
or uneven ground, increasing the intensity or duration of your exercise too
quickly, wearing worn or ill-fitting shoes, and excessive uphill or downhill
running also can contribute to iliotibial band syndrome.|
Weighing more than your ideal weight is one
of the leading risk factors for knee pain. Excess weight increases stress on
your knee joints, even during ordinary activities such as walking or going up
and down stairs. It also puts you at increased risk of osteo-arthritis by
accelerating the breakdown of joint cartilage.
Other factors that make you more
susceptible to knee pain include:
Any repetitive activity, from cycling a few miles every morning to gardening
all weekend, can fatigue the muscles around your joints and lead to
excessive loading stress. This causes an inflammatory response that damages
tissue. If you don't allow your body time to recover, the cycle of
inflammation and microdamage continues, putting you at increased risk of
injury. It's not repeated motion itself that's to blame, but rather the lack
of adequate recovery time. That's why current strength training guidelines
advise against working the same muscle group on consecutive days, for
muscle flexibility or strength. According to experts, lack of
strength and flexibility are among the leading causes of knee injuries.
Tight or weak muscles offer less support for your knee because they don't
absorb enough of the stress exerted on your knee joints.
problems. Certain structural abnormalities, such as having one leg
shorter than the other, misaligned knees, and even flat feet can make you
more prone to knee problems.
sports and activities. Some sports and activities put greater
stress on your knees than others. Alpine skiing with its sharp twists and
turns and potential for falls; basketball's jumps and pivots; and the
repeated pounding your knees take when you run or jog all increase your risk
injury. Having a previous knee injury makes it more likely that
you'll injure your knee again.
Certain types of knee problems are more common in young people —
Osgood-Schlatter disease and patellar tendonitis, for example. Others, such
as osteo-arthritis, gout and pseudogout, tend to affect older adults.
For reasons that aren't entirely clear, your sex may increase your risk of
some types of knee injuries. Women are more prone to ACL tears than men are,
and teenage girls are more likely than boys to experience a dislocated
kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter
disease and patellar tendonitis than girls are.|
When to seek
If you have new knee pain that isn't severe
or disabling, a good rule of thumb is to try treating it yourself first. This
includes resting, icing and elevating the affected knee, and sometimes using non-steroidal
anti-inflammatory drugs to reduce pain and inflammation. If you don't notice any
improvement in three to seven days, see your doctor or a specialist in sports
medicine or orthopedics.
Some types of knee pain require more
immediate medical care. Call your doctor if you:
|Can't bear weight on your knee
|Have significant knee swelling
|See an obvious deformity in your leg or
|Have significant pain
|Have a fever, in addition to redness,
pain and swelling in your knee, which may indicate an infection|
Pinpointing the reason for knee pain can be
challenging because of the wide range of possible causes. Often, a comprehensive
medical history and thorough physical exam play a larger role in diagnosis than
any single test.
In addition to asking about your pain —
its location, what it feels like, when it started, what makes it seem better or
worse — your doctor may inquire about your exercise program, sports you play
or used to play, and any previous injuries to your knee joint. During the
physical exam, your doctor is likely to inspect your knee for swelling, pain,
tenderness, warmth and visible bruising; check your range of motion; and perform
a number of maneuvers to evaluate the integrity of the structures in your knee.
One of these maneuvers, the Lachman's test,
helps detect injuries to the ACL. In the Lachman's test, your knee is bent at a
30-degree angle, and your doctor gently moves your lower leg forward at the
knee. If your lower leg moves freely without reaching a firm endpoint, you're
likely to have a torn ACL. Other maneuvers assess the PCL, tendons and meniscus.
These tests may not be accurate in some
instances — when movement in your knee is restricted by swelling or by
contracted muscles in the back of your leg, for example. In that case, your
doctor may order a magnetic resonance imaging (MRI) test to aid in the
Unlike an X-ray, which isn't useful for
viewing ligaments, tendons and muscles, an MRI can help identify injuries and
damage to soft tissue. Still, if your injury allows your doctor to perform a
complete physical exam, the exam is likely to be as accurate in diagnosing knee
injuries as an MRI is.
Depending on the type of injury, your
doctor may order other imaging tests, including:
Your doctor may first recommend having an X-ray, which can help detect bone
fractures and degenerative joint disease.
tomography (CT) scan. This specialized X-ray, which creates
cross-sectional images of the inside of your body, may help diagnose bone
problems and detect loose bodies.|
If your doctor suspects an infection, gout
or pseudogout, you're likely to have blood tests and sometimes arthrocentesis, a
procedure in which a small amount of fluid is removed from your injured joint
with a needle and sent to a laboratory for analysis.
Not all knee pain is serious. But some knee
injuries and medical conditions, such as osteo-arthritis, can lead to increasing
pain, joint damage and even disability if left untreated. And having a knee
injury — even a minor one — makes it more likely that you'll have similar
injuries in the future. Repeated injuries increase your risk of arthritis in the
The key to treating many types of knee pain
is to break the cycle of inflammation that begins right after an injury. Even
minor trauma causes your body to release substances that lead to inflammation.
The inflammation itself causes further damage, which in turn triggers more
inflammation and so on. But a few simple self-care measures can be remarkably
effective in ending this cycle. For best results, start treating your injury
right away and continue for at least 48 hours.
Commonly referred to by the acronym
P.R.I.C.E., self-care measures for an injured knee include:
The best way to protect your knee from further damage depends on the type
and severity of your injury. For most minor injuries, a compression wrap is
usually sufficient. More serious injuries, such as a torn ACL or high-grade
collateral ligament sprain usually require crutches and sometimes also a
brace to help stabilize the joint with weight bearing.
Taking a break from your normal activities reduces repetitive strain on your
knee, gives the injury time to heal and helps prevent further damage. Minor
injuries may require only a day or two of rest, but severe damage is likely
to need a longer recovery time.
A staple for most acute injuries, ice reduces both pain and inflammation.
Some doctors recommend applying ice to your injured knee for 15 to 20
minutes three times a day. A bag of frozen peas works well because it covers
your whole knee. You can also use an icepack wrapped in thin fabric to
protect your skin. Although ice therapy is generally safe and effective,
don't leave ice on longer than recommended because of the risk of damage to
your nerves and skin. After two days, you might try switching to heat to
relax your muscles and increase blood flow.
This helps prevent fluid buildup (edema) in damaged tissues and maintains
knee alignment and stability. Look for a compression bandage that's
lightweight, breathable and self-adhesive. It should be tight enough to
support your knee without interfering with circulation.
Because gravity drains away fluids that might otherwise accumulate after an
injury, elevating your knee can help reduce swelling. Try propping your
injured leg on pillows or sitting in a recliner.|
Non-steroidal anti-inflammatory drugs
(NSAIDs), including aspirin, ibuprofen (Motrin, Advil, others) and naproxen
sodium (Aleve, Naprosyn), can help relieve pain. But if taken immediately after
an injury, they may actually increase swelling. What's more, NSAIDs can have
side effects, especially if you take them for long periods or in amounts greater
than the recommended dosage. Even small doses may cause nausea, stomach pain,
stomach bleeding or ulcers, and large doses can lead to kidney problems and
fluid retention. NSAIDs also have a ceiling effect, which means there's a limit
to how much pain they can control. If you have moderate to severe pain,
exceeding the dosage limit probably won't relieve your symptoms. Taking two
different NSAIDs at the same time also won't provide more relief but may
increase your risk of side effects.
When self-care measures aren't enough to
control pain and swelling and promote healing in an injured knee, your doctor
may recommend other options, including:
Normally, the goal of physical therapy is to strengthen the muscles around your
knee and help you regain knee stability. Depending on your injury, training is
likely to focus on the muscles in the back of your thigh (hamstrings), the
muscles on the front of your thigh (quadriceps), and your calf, hip and ankle.
You can do some exercises at home. Others require the use of weight machines,
exercise bicycles or treadmills, which may mean visits to an athletic club,
fitness center or clinic.
In the early stages of rehabilitation, you
work on re-establishing full range of motion in your knee. You then progress to
knee-, hip- and ankle-strengthening exercises combined with training to improve
your stability and balance. Finally, you work on training specific to your sport
or work activities, including exercises to help you prevent further injury.
Depending on the type of injury, you can
expect to be back to your normal daily activities in as little as two to four
weeks. But to maintain maximum knee stability, you'll need to follow an exercise
program for your legs two to three days a week.
There's no single best way to treat most knee injuries. Whether surgical
treatment is right for you depends on many factors, including:
|The type of injury and amount of damage
to your knee
|The risk of future injury or damage if
you don't have surgery
|Your lifestyle, including what sports
|Your willingness to modify your
activities and sports
|Your motivation to work through
rehabilitation to strengthen your knee after surgery|
If you have an injury that may require
surgery, it's usually not necessary to have the operation immediately. In most
cases, you'll do better if you wait until the swelling goes down and you regain
strength and full range of motion in your knee.
Before making any decision, consider the
pros and cons of both non-surgical rehabilitation and surgical reconstruction in
relation to what's most important to you. Non-surgical treatment isn't an option
if you have cartilage damage that interferes with your range of motion (locked
knee) or if the blood supply to your knee is severely compromised.
If you choose to have surgery, your options
surgery. Depending on the nature of your injury, your doctor may be
able to examine and repair your joint damage using an arthroscopic technique
(arthroscopy) that requires just a few small incisions. Arthroscopy may be
used to remove loose bodies from your knee joint, to repair torn or damaged
cartilage or ligaments and even to correct damage from degenerative joint
diseases such as arthritis. The advantage of the procedure is that you're
likely to recover more quickly and with less discomfort than you would with
open surgery. Even so, recovery from ligament and meniscus surgery is often
slow and requires a strong commitment to physical therapy.
replacement surgery (unicompartmental arthroplasty). If you have
considerable knee damage from degenerative arthritis but still retain some
healthy cartilage, and conservative measures such as lifestyle changes,
medication and physical therapy fail to help your symptoms, you may be a
candidate for a partial knee replacement. In this procedure, your surgeon
replaces only the most damaged portion of your knee with a prosthesis made
of metal and plastic. The surgery can usually be performed with a small
incision, and your hospital stay is typically just one night. You're also
likely to heal more quickly than you are with surgery to replace your entire
knee. Unfortunately, many people who opt for knee replacement surgery have
damage too extensive for unicompartmental arthroplasty. In addition,
long-term results may not be as good as they are with a total knee
replacement (total knee arthroplasty). In this procedure, your
surgeon cuts away damaged bone and cartilage from your thighbone, shinbone
and kneecap, and replaces it with an artificial joint (prostheses) made of
metal alloys, high-grade plastics and polymers. Total knee arthroplasty can
improve knee problems associated with osteo-arthritis, rheumatoid arthritis
and other degenerative conditions such as osteo-necrosis — a condition in
which obstructed blood flow causes your bone tissue to die. You may be a
candidate for total knee replacement if you have a severely damaged,
arthritic knee that limits your mobility and function, you're older than 55
and in generally good health, and conservative measures fail to improve your
In recent years, a number of non-surgical treatments for knee pain that results
from arthritis have been investigated or become available. Some are in the
experimental stage, and others are used fairly routinely to control pain and
inflammation. They include:
and chondroitin. These substances, found naturally in cartilage,
are also available as over-the-counter dietary supplements. Although both
may help relieve the pain of osteo arthritis of the knee, some research has
focused on the use of glucosamine alone because chondroitin may be
associated with bleeding problems. Unlike traditional anti-inflammatory
drugs, which simply reduce inflammation, glucosamine appears to actually
decrease the rate of cartilage destruction and may even promote the
formation of new cartilage. The results aren't immediate, however — it may
take four to six weeks of taking up to 1,500 milligrams a day to see
improvement. A major, federally sponsored study of these substances is under
injections. Injections of a corticosteroid drug into your knee
joint may help reduce the symptoms of an arthritis flare and provide pain
relief that lasts a few months. You usually must wait at least four months
between injections. The injections aren't effective in all cases and cause
some of the same side effects that oral steroid medications do, including an
increased risk of infection, water retention and elevated blood sugar
acid. This thick fluid is normally found in healthy joints, and
injecting it into damaged ones may ease pain and provide lubrication.
Injected hyaluronic acid, which is derived from rooster combs, was first
used in the 1970s to treat arthritis in racehorses. The Food and Drug
Administration (FDA) approved it for human use in 1997. Experts aren't quite
sure how hyaluronic acid works, but it may reduce inflammation. Relief from
a series of shots may last as long as six months.
painkillers. Applying certain ointments to your skin may help
relieve the pain and stiffness of osteo arthritis. A study published in the
April 2004 issue of Rheumatology reported that a cream called
Celadrin, which contains cetylated fatty acids, greatly improved mobility
and function in people with osteo arthritis of the knee. The effects were
apparent within 30 minutes of applying the cream. In another study, a
lidocaine patch applied to arthritic knees provided significant pain relief.
Neither treatment has been approved for treating knee pain, however. But the
FDA has approved another over-the-counter product, capsaicin, for the
temporary relief of arthritis pain. It's sold under several names, and many
pharmacies also carry their own brands.
In countries other than the United
States, doctors often prescribe topical NSAIDs for relief of chronic
musculoskeletal conditions such as arthritis and tendonitis. A systematic
review of treatment with NSAID creams found that they were as effective as
oral medications but without the serious side effects.
Scientists are investigating whether ginger extract can reduce the pain of
osteo-arthritis and improve knee mobility and function. Initial studies
indicate ginger may reduce the body's production of inflammatory substances,
but some experts say more research is needed to confirm these findings. And
although it's generally free of side effects, large amounts of ginger may
cause stomach or intestinal irritation. Use fresh or powdered ginger with
caution if you have ulcers, inflammatory bowel disease or gallstones.|
Although it's not always possible to
prevent knee pain, the following suggestions may help forestall injuries and
pounds off. Maintaining a healthy weight is one of the best things
you can do for your knees — every extra pound puts additional strain on
your joints, increasing the risk of ligament and tendon injuries and even
stay limber. Because weak muscles are a leading cause of knee
injuries, you'll benefit from building up your quadriceps and hamstrings,
which support your knees. Try knee extensions, hamstring curls and leg
presses to strengthen these muscles. Balance and stability training helps
the muscles around your knees work together more effectively. And because
tight muscles also can lead to injury, stretching is also important. Try to
include flexibility exercises in your workouts.
about exercise. If you have osteo arthritis, chronic knee pain or
recurring injuries, you may need to change the way you exercise. That
doesn't mean you have to stop being active, but it does mean being smart
about when and how you work out. If your knees ache after jogging or playing
basketball or other sports that give your joints a real pounding, consider
switching to swimming, water aerobics or other low-impact activities — at
least a few days a week. Sometimes simply limiting high-impact activities
will provide relief.
your shoes fit well. If the shoe fits, you'll be a lot safer.
Choose footwear that's appropriate for your sport. Running shoes aren't
designed for pivots and turns, for instance, but tennis and racquetball
knees. Wearing proper gear for knee-sensitive activities can help
prevent injuries. Use kneepads when playing volleyball or laying carpet, and
buckle your seatbelt every time you drive. Most shattered kneecaps occur in
your body. If your knees hurt, or you feel fatigued, don't be a
hero — take a break. You're much more likely to injure yourself when