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Knee Health: Tips to Reduce Pain

Contributor Kelly McInnis, DO
11 minute read
A young woman kneels on a running track, holding her knee.

Knee pain can rob a day of its best moments. It can end a morning walk, cancel soccer practice, and cut playtime short.

Sometimes, when knee pain lingers or worsens, those lost moments snowball into upended weeks or months. Vacation plans change, work setups look different, and exercise feels impossible.

“We often forget how much we rely on our knees until they become too painful for us to use,” says Kelly McInnis, DO, a Mass General Brigham sports medicine specialist. “How our knees feel tomorrow depends a lot on how we treat our knees today.”

Dr. McInnis is a team physician for the Boston Red Sox, New England Patriots, and Harvard University. She explains how knee pain develops and what people can do to reduce or manage their pain.

Signs and symptoms of knee problems

According to Dr. McInnis, a healthy knee does not limit daily or recreational activities. Signs of an unhealthy knee include:

  • Pain

  • Swelling

  • Limited motion

  • Locking, clicking, or catching sensations

Clicking sounds do not always signal an unhealthy knee. Those sounds usually come from soft tissue — such as a tendon — gliding over a protruding bone.

“We don’t worry about ‘clicks’ unless they’re associated with pain or loss of motion,” Dr. McInnis adds.

What causes knee pain?

The knee pays a high price for its position in the middle of the leg. It acts as a hinge between the thigh and shin bones, and its positioning should remain as well aligned as possible. A straight knee provides ample support for the body weight above it. Knees positioned too far inward (knocked knee) or outward (bow-legged) jeopardize this support. Either position can shift body weight onto structures not suited for handling an added load.

Dr. McInnis describes the knee as a “victim” to weaknesses in joints above (hip and spine) and below (foot and ankle). Weak muscles near the ankle or hip alter the position of the shin or thigh bone. When these bones change position, the knees are not aligned optimally, allowing long-term, or immediate, wear and tear to ensue.

Wear and tear also differs by age group.

Knee pain in children

Youth athletes often experience growing pains around the knee from stress injuries to growth plates. Osgood-Schlatter’s disease, or persistent pain at the top of the shin bone, occurs from overusing a growing knee.

Dr. McInnis noticed a spike in overuse injuries in youth sports during the COVID-19 pandemic. She says many youth athletes — understandably excited to return to their teams — rushed back to intense sports without properly conditioning their bodies.

Knee pain after walking? It might be a sign of arthritis in older adults.

Adults older than 40 often experience degenerative conditions in their joints, such as arthritisOsteoarthritis in the knee, which occurs when the cartilage padding between the thigh and knee bones thins or wears, can limit knee movement and trigger inflammation.

Less active adults with osteoarthritis experience a lot of knee pain when starting new activities. Dr. McInnis uses pickleball as an example. The constant stop-and-go movements from pickleball easily irritate a knee not accustomed to sudden movements.

Knee pain after a workout

Two types of knee pain exist:

  1. Traumatic knee pain: Immediate pain from a sudden awkward movement, impact, or collision to the leg. It doesn’t always occur from a violent or severe injury.

  2. Atraumatic knee pain: Pain from overuse. Knee pain from overuse tends to occur from more frequent, or more intense, exercise. It can also occur after ordinary activities, such as a walk.

Traumatic knee pain

Traumatic knee pain is not exclusive to athletes. Plenty of people experience traumatic injuries from ordinary, everyday activities.

After all, accidents happen. Suddenly slipping on ice or falling downstairs can bend the leg at an awkward angle. The knee absorbs the brunt of this impact, as do the ligaments, cartilage, and tendons holding it together.

These structures can handle only so much force before they strain or tear. A few of the most common traumatic knee injuries are:

Atraumatic knee pain

Overuse affects the knee in different ways. Active individuals may experience pain in one part of the knee, while others may feel it in a different location.

Kneecap pain

Patellofemoral pain, or pain in or around the kneecap, is common among athletes. The condition affects women more than men. Women typically possess weaker core and glute muscles than men, which affects kneecap tracking when pivoting and cutting.

Men use stronger muscles to lock their knees in place. For women who lack such support, the knee shifts inward upon impact with the ground. The inward force stresses the kneecap and surrounding ligaments.

Patellar tendonitis

Men experience patellar tendonitis, or pain directly below the kneecap, more frequently than women. The pain occurs in the patellar tendon, the tendon connecting the kneecap to the shinbone.

Dr. McInnis attributes the pain, in part, to a lack of flexibility. Men, who generally lack the same flexibility at women, will experience slightly more stiffness and tension at the tendon site.

IT band pain

Athletes who run long distance tend to experience pain on the outside of their knees. This pain occurs from the iliotibial (IT) band, which extends just beneath the hip to the outside of the knee.

Women experience IT band pain more frequently than men for the same reason they might experience kneecap pain: weaker gluteal muscles. Instability from these muscles makes the IT band more likely to cross over a boney prominence on the knee’s edge. The crossover compresses the band, causing pain.

“When the knee bends and straightens, the band acts almost like a windshield wiper over that edge,” says Dr. McInnis. “Tension builds, friction ensues, and pain mounts.”

When should I see a doctor for knee pain?

The knee requires urgent medical attention if a patient experiences:

  • Swelling lasting longer than 2 days

  • Moderate to severe pain

  • Difficulty bearing weight

  • Instability or buckling

  • Decreased range of motion

Mass General Brigham Orthopedics Walk-In offers same-day care for knee injuries. Open 7 days a week, the center accommodates patients without appointments and stays open for extended hours.

Knee pain getting worse? Here’s what to do.

Dr. McInnis hears patients describe ways they’ve tried making knee pain go away on their own. However, their attempts may make pain worse.

Athletes might feel stiffness in their knee and attempt a common stretch: bending the knee and pulling one’s foot to their rear. Bending the knee only loads the joint with more force, which irritates existing pain and inflammation. Squatting at the gym without using proper form or technique irritates pain in a similar manner, as does climbing up or down long flights of stairs.

“If you develop knee pain and aren’t exactly sure what’s causing it, you’re going to want to avoid loading the knee with as few of these provocative activities as possible,” says Dr. McInnis.

How to address knee pain

A doctor evaluates a patient’s knee for structural damage. The patient may need surgery depending on the damage found.

Plenty of patients can manage traumatic or atraumatic knee pain without undergoing an operation. Several non-surgical treatments may provide relief instead.

Modify activities.

Switching from impact to non-impact exercises prevents the knee from absorbing too much force. Impact exercises involve picking the feet up and placing them down. These include:

  • Running

  • Hiking

  • Jumping

Non-impact exercises divert force away from the knee. They strengthen muscles, such as the glutes and core, that support the knee. A few common non-impact exercises are:

  • Cycling

  • Swimming

  • Elliptical workouts

  • Rowing

“If an athlete is experiencing knee pain and is running 20-plus miles a week, then I might ask them to shift their focus to biking for 2 to 4 weeks,” says Dr. McInnis. “We then wait and see if their pain improves before allowing them to resume impact activities.”

Use gels, medication, and braces.

These options may help with short-term pain relief:

  • Topical gels

  • Acetaminophen

  • Ibuprofen

Acetaminophen helps relieve pain, but not inflammation. Topical gels and ibuprofen help relieve both, as do ice packs.

Some patients treat their pain with alternative medications such as herbal agents, like turmeric or curcumin. Although easily found at local grocery stores, these agents are not controlled by the FDA and research has yet to prove their definitive effectiveness.

A simple knee sleeve can also offer comfort and compression. Doctors know best if a patient can benefit from a more sophisticated knee brace. A knee brace for osteoarthritis, for example, might not help reduce knee pain from working out.

“Patients sometimes assume a fancier, heavier knee brace prevents them from injuring their knee,” Dr. McInnis says. “But there’s no guarantee it will help heal or prevent an injury.”

Try physical therapy.

If knee pain persists after 4 to 6 weeks of modified activity and over-the-counter medication, Dr. McInnis often refers the patient for physical therapy after evaluation. A physical therapist teaches patients how to properly stretch their knees and strengthen supporting muscles.

Ask your doctor about injections.

Physical therapy might not work for everyone. Those struggling with pain 8 weeks into physical therapy may have the option of trying different types of injections to help with joint pain. Injections work in tandem with therapeutic exercises taught at physical therapy.

Anti-inflammatory cortisone injections may reduce pain enough for athletes to resume activity.

Exercise is medicine. The best way to keep your knee strong and healthy is to stay active with the right exercise.

Kelly McInnis, DO
Sports Medicine Specialist
Mass General Brigham

New treatments for knee pain

Platelet-rich plasma (PRP) injection is a new method that can be helpful for treating joint injuries and arthritis pain. Dr. McInnis says Mass General Brigham regenerative medicine specialists have already begun using the treatment on patients with osteoarthritis in the knee.

PRP injections require a blood draw from the arm. A doctor then separates the patient’s blood into 3 main components:

  1. Red blood cells

  2. White blood cells

  3. Platelets

Platelets are natural healing cells. They carry powerful proteins that can be helpful in reducing inflammation. Upon separating and concentrating platelets from the patient’s blood, doctors inject them directly into the patient’s knee joint.

Although patients are much more likely to respond immediately to cortisone, the effects of PRP may last much longer.

Unlike cortisone, PRP promotes a healthier knee environment and does not have systemic side effects. After multiple injections, cortisone can:

  • Damage cartilage

  • Raise blood pressure (hypertension)

  • Increase blood sugar

However, Dr. McInnis reminds patients that PRP cannot stop or reverse degeneration. If you receive PRP injections, you may experience discomfort or pain in the area where you were injected. This pain can last up to a week. Serious side effects and complications are rare, but include:

  • Allergic reaction

  • Bleeding

  • Nerve damage

  • Infection

  • Paralysis

“Our focus with PRP in knee arthritis is eliminating pain and improving function, not regenerating tissue,” she says. “We have to set expectations and separate facts and science from fiction.”

Preventing knee pain

Cross-training can help prevent knee pain. Mixing impact with non-impact exercises improves core, gluteal, and quadricep strength. The strengthened muscles minimize the amount of force placed on the knee joints.

In addition to high-intensity exercises, such as biking and swimming, Dr. McInnis offers several low-intensity exercises to build those same muscle groups, including:

  • Straight leg raises: Lie flat, face upwards, bend one knee, and keep the other leg straight. Raise the straightened leg and hold for several seconds before slowly lowering it to the floor.

  • Side-lying straight leg raises: Lie sideways and straighten legs. Raise the upper leg and hold for several seconds before slowly lowering.

  • Side planks: From a sideways position, use one forearm to hold body weight. Lift hips and torso off the mat. Place the forearm perpendicular to body. Keep body as straight as possible for 30 seconds.

Dr. McInnis warns patients not to halt activity completely. Not using the knee can do more harm than good.

“Exercise is medicine,” she says. “The best way to keep your knee strong and healthy is to stay active with the right exercise.”


Learn about Mass General Brigham Sports Medicine services


Kelly McInnis, DO

Contributor

Sports Medicine Specialist