Knees Archive

Improving range of motion, muscle strength, and weight control can help reduce pain and make your knees feel younger.

Image: © jacoblund/Thinkstock

Knee pain is common in older age, often caused by osteoarthritis (the wearing away of knee cartilage). Fortunately, there are ways to fool Father Time and postpone knee problems or even prevent them entirely. "In many cases, you can delay or avoid the need for surgical intervention, such as a knee replacement," says Dr. Lars Richardson, an orthopedic surgeon with Harvard-affiliated Massachusetts General Hospital.

The aging knee

Your knees absorb a huge amount of pressure with every step — typically one-and-a-half times your body weight. That pressure, plus regular wear and tear, takes a toll over time. Muscles and ligaments get weaker. The knee's two shock absorbers — pads of cartilage called menisci — start to deteriorate. So does the articular cartilage protecting the ends of the leg bones where they meet at the knee. If you have a family history of osteoarthritis, if you're overweight, or if you've had some knee injuries, you may be more prone to this deterioration.

Osteoarthritis pain can be debilitating. Strategies can help get you moving again.

Pain from osteoarthritis is more than just a nuisance. Knee pain, in particular, can not only keep people from exercising, but also have a chilling effect on their ability to participate in social activities, especially those that involve walking or traveling, says Elena Losina, the Robert W. Lovett Professor of Orthopedic Surgery at Harvard Medical School and co-director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital.

"In fact, the quality of life of a person with persistent pain due to knee osteoarthritis is similar to quality of life in women with metastatic breast cancer controlled by therapy," she says.

On call

Q. I have osteoarthritis. My right knee is especially painful and stiff. How do I know when the time is right for knee replacement surgery?

A. Timing is key. If you get the procedure too soon, you might not see enough improvement to make the surgery worth it. In addition, the younger you are when you have knee replacement surgery, the greater the chances it will not last and another surgery may be needed. But if you wait too long, you may subject yourself to unnecessary pain and disability.

You've tried nearly everything for your worn-out knee. But the remaining possibilities may include some risky options.

Knee osteoarthritis affects about half of us in older age. The cartilage that acts as a cushion between the bones wears away, and it hurts when the bones grind against each other. In many people, arthritis can become severe enough that they consider a knee replacement. Since surgery is an expensive and complicated option, you may wonder what else you can do to reduce knee pain. Beware: some treatments are bogus and even dangerous.

Stay away from these

The first sign that a knee pain treatment isn't the best choice: an ad promising that it's the surefire solution.

If you're having the occasional twinge of joint pain when you go for a walk or climb stairs, or you're worried about arthritis because a parent had it, one step toward prevention is to check your weight.

There are two ways that being overweight raises your risk for developing osteoarthritis (the most common joint disorder, which is due to wear and tear on a joint). First, excess weight puts additional stress on weight-bearing joints (the knee, for example). Second, inflammatory factors associated with weight gain might contribute to trouble in other joints (for example, the hands).

Research we're watching

If you have an arthritis-related condition called Heberden's nodes, you may be at higher risk for arthritis-related knee problems, according to a study published online January 9 by Arthritis & Rheumatology.

Heberden's nodes develop when cartilage in the fingers wears away, causing the bones to rub against one another. This prompts new bone to form, creating bony nodules in the knuckles closest to the fingertips.

Hip and knee pain can keep you from the activities you love, as well as make routine tasks difficult. But there are many ways to get you moving again pain-free, without surgery. Here are some of the treatments that can help relieve hip and knee pain.

Ultrasound, phonophoresis, and iontophoresis

Therapeutic ultrasound is a simple procedure that uses sound waves to increase blood flow, relax muscle spasms, and aid healing that leads to faster hip pain relief and knee pain relief. The therapist applies gel to your skin and moves an ultrasound wand over your skin around the painful area. In a special ultrasound technique called phonophoresis, medication (often hydrocortisone) is added to the gel. In a survey of orthopedic physical therapists, more than half said they would use ultrasound and phonophoresis to reduce soft-tissue inflammation (in tendinitis or bursitis, for example). These techniques are also used to manage pain, heal tissue, and help muscles stretch.

A desire to stay active and a natural aversion to pain send nearly 800,000 Americans to orthopedic surgeons each year for a hip or knee replacement. And we're seeking these operations much earlier in life. According to Dr. Scott Martin, associate professor of orthopedic surgery at Harvard Medical School, this isn't a healthy trend. "A lot of joint replacements are being done because they can be," says Dr. Martin.

Every surgical procedure carries the risk of complications — or even death. Because the average joint that's replaced only lasts 10 to 15 years, having the procedure done at age 50 instead of 70 means there's a good chance you'll need a second procedure when you're older and at higher risk for complications.

In the journals

Corticosteroid injections are used to ease short-term knee osteoarthritis pain, but a new study in the May 16, 2017, Journal of the American Medical Association suggests the treatment may not help in the long term.

Researchers recruited two groups of 70 people, average age 58, with knee osteoarthritis. One group received 40 milligrams of the steroid triamcinolone (Kenacort, Kenalog, Artistocort) every three months for two years, while the other group got placebo injections. By the end, pain scores — measured on a scale from zero for no pain to 20 for extreme pain — had dropped by only 1.2 points among the steroid group, while the placebo group's score dropped by 1.9 points, neither of which was clinically significant.