Have you ever suffered from knee pain? I have! According to statistics published by the National Center of Biotechnology Information, knee pain affects as many as 46% of the American population, with women more likely to experience it than men.
Ironically, knee pain can be caused by being fit and active, which is the cause of my type of knee pain.
As you’ll know if you have read my other articles, I’m a firm believer in exercise – both for health and for weight control. I’m not a “gym junkie” but I do try and workout three or more times a week.
Exercise doesn’t just help me feel and look my best, I also find it helps to bust stress, boost my mood, and it even brightens my complexion.
My preferred form of exercise is running. I love lacing up my sneakers, putting some motivating music on my MP3 player, and hitting the trials near where I live. It’s so nice to be outside in nature!
However, during one run, a tripped and twisted my knee. I managed to limp home, but my knee soon started to swell and was quite painful for several weeks afterward. After speaking to my doctor and doing plenty of Sarah-like research, I learned that I’d damaged a ligament in my knee.
This is not a serious injury, but having knee pain made me realize how much I take my knees for granted.
Almost every movement we make involves our knees – walking, going up and downstairs, getting out of a chair, bending down to lace up our shoes. It’s very hard to avoid using your knees at least a few times a day.
This made me understand just how debilitating knee pain is, and as almost one out of every two people will suffer knee pain at least once in their lives, I decided I wanted to try and help people avoid and treat knee pain naturally and safely.
Of course, I’m not a doctor and so my advice is not meant to replace that of a qualified medical professional. But, if you have mild to moderate knee pain, I think this article will help you. After all, I’ve tried and tested all the information in this article myself and if it worked for you it may work for you too.
But, if you are in any doubt, please speak to your doctor about your knee pain. My advice is not a replacement for proper medical information.
So, back to my knee pain. After a few weeks my knee pain started to heal, and I decided it was time to get back to exercising. However, I was advised to do some special exercises to stop the injury happening again. I had to do plenty of stretching and strengthening exercises to make sure my muscles were able to support my knee joint properly.
Exercise experts call this type of exercise rehab – short for rehabilitation. The idea being that the right rehab will speed up your recovery and prevent the same problem from returning.
I also learned about another type of exercise – called prehab. Prehab exercises are things you can do to prevent a problem from happening in the first place.
It doesn’t matter of you have knee pain or just want to avoid it bothering you in the future, the right type of exercises can really help.
Of course, it’s not just active people who suffer from knee pain, it’s also associated with advancing age, and injuries can cause knee pain too. But, in a lot of cases, no matter what the cause of your knee pain might be, the treatment and prevention is the same. The important thing to remember is that in most cases, being more sedentary will make your knee pain worse and not better.
So, got knee pain? Want to avoid knee pain? Want to learn more about knee pain? Then keep reading!
Knee joint anatomy
Your knee joint is amazing! It’s a major weight-bearing joint that can support enormous loads and carry you great distances. If you walk just one mile, your knees will bend and straighten around 2000 times; that’s a lot of work!
Your knee flexes and extends and can also rotate slightly when it’s bent. Anatomists class the knee joint as a hinge joint because, like a door, it will open and close. It’s also a synovial joint – a name that will make more sense after you’ve read the next paragraph.
It’s made up of two main bones – the femur and the tibia – plus the kneecap or patella. Behind the patella is a fluid sack called a bursa which provides padding between the kneecap and the femur/tibia. The end of each bone is covered with tough, shiny material called cartilage, so it moves smoothly, and is lubricated with a type of oil called synovial fluid, which also nourishes the inside of the joint.
To keep your knee tracking correctly, two fibrous cup or dish-shape structures called menisci act like your intervertebral discs, keeping the ends of the bones apart.
Movement of your knee is controlled by two main muscles; the quadriceps on the front of your thigh and the hamstrings on the back of your thigh. These muscles are attached to your bones by tendons. Ligaments, which are bands or cords of inelastic tissue, prevent unwanted movement and help keep your knee stable.
Why is all this so important? The main reason is that when you know a little about how your knee works, when you have knee pain you’ll have a better understanding of what’s gone wrong and how to fix it.
Image source: Wikipedia.com
Causes of knee pain
In my case, knee pain was caused by a trip, and accidents are a common cause of sudden onset or acute knee injury. All it takes is an unexpected slip, trip, twist, or fall and you can damage any aspect of your knee joint. Common knee injuries include:
- Torn meniscus
- Ruptured tendon
- Torn cartilage
- Ruptured ligament
- Patella fracture
If you experience knee pain after a trip, fall, or impact, your first stop should be a doctor because, in some instance, surgery may be necessary to repair the damage. In my case, an X-ray and MRI revealed that the injury was not that serious and would, in time, heal all by itself. Other, more serious injuries won’t heal without surgical repair.
Knee pain is not always the result of a specific accident. Because your knees are such hard-working joints, stresses can accumulate over time so that any pain comes on gradually. This type of insidious, chronic knee pain can be hard to treat because complete rest is not always possible. After all, most of us need to walk around at least a little bit every day. This is why prehab is so important; it’s often easier to prevent knee pain than it is to treat it.
- Osteoarthritis – wear and tear of the cartilage protecting the ends of the bones
- Runner’s knee – pain behind the patella
- Jumper’s knee – pain in the tendon below the patella
- Housewife’s knee – inflammation and swelling of the bursae behind the knee, often caused by long periods of kneeling
- Osgood-Schlatter’s disease – inflammation of the area under the kneecap and common in teenagers
The cause of other types of knee pain is not always so obvious. For example, being overweight increases your chances of having pain in your knees. All those extra pounds put a lot of unwanted stress on your knees and that can soon lead to pain. In fact, a friend of mine was recently told by their doctor to lose weight to relieve their long-term knee pain. 50 pounds lighter, her knee pain has gone!
Want to lose weight? Find out how, here
Long periods of sitting can also cause knee pain. Sitting down makes your muscles tight and weak. Tight and weak muscles mean your knees won’t work properly and that can soon lead to pain and dysfunction.
In contrast, doing lots of repetitive knee bends can also lead to pain. This is known as an “overuse injury” and the pain often disappears when you drop the cause of the stress. For example, your knees might ache during a skiing, hiking, or cycling holiday, but then disappear when you return home. Or maybe you’re laying new carpets and have to spend more time than usual kneeling. Then, once the carpet is down and you stop kneeling so much, your knee pain soon clears up.
Treating knee pain
If you have knee pain, and your doctor says it’s okay to do so, you can often relieve that pain naturally and by yourself. It’s important to understand that treating the pain is different from treating the injury. The cause of your pain might have gone but the underlying problem still exists.
I made this mistake myself; shortly after hurting my knee I was treating the pain and my knee felt good. Mistakenly, as my knee wasn’t hurting, I went for a run. I was okay for a mile or two but then my knee pain came back worse than before. Because of this, I set back my recovery by another week or so. Learn from my lesson – no pain does not mean you are fixed!
Use these strategies to relieve your pain and make life more comfortable while your specific knee pain issue is resolved.
Rest – this is the most obvious way to treat knee pain! If you can identify an activity that makes your knees hurt, you should take a rest from it. After all, doing it again is sure to bring the pain back. This might mean you have to take a break from running, cycling, or doing squats in the gym, but that doesn’t mean you have to become sedentary – which will probably make the pain worse. Instead, seek out activities that don’t make your knee pain worse.
Of course, if your doctor says you need to take a complete rest from physical activity, make sure you follow his instructions. This might not be easy if you are used to being very active, but a few weeks rest could end up saving you a lot more time in the long run.
Ice – putting ice on your knee will reduce swelling, inflammation, and pain. Your body uses nerves to conduct sensations, and placing a source of cold on an injury means that the pain message is blocked. Ice is good for new injuries or treating pain that comes on because of overuse e.g. after exercise.
When using ice, do not place it directly on your skin or you might burn yourself. Ice burns can be very painful! Instead, place a thin layer of material such as a washcloth between the ice and your knee. I use gel-filled ice packs which are reusable, but you could use a bag of frozen peas instead. Just don’t eat them afterward!
Use ice for 20-30 minutes at a time, every couple of hours or whenever needed.
Heat – heat increases blood flow to speed up repair and recovery. This is useful when inactivity or stiffness causes your pain, or there is joint wear and tear. Like ice, you should avoid placing a heat source directly on your skin. Burns are a real risk. Good heat options include:
- Microwavable heat packs
- Hot water bottles
- Electric heating pads
- Infrared lamps
Do not use heat on a fresh knee injury. If you have internal bleeding, heat makes you bleed more, and that will cause more swelling and a slower recovery.
Remember the rule: Ice first, heat last.
TENS machines – short for Transcutaneous Electrical Nerve Stimulation, TENS machines block pain by passing a very mild electrical current through your nerves. This basically blocks the pain message in the same way ice does. These machines are small, portable, and light, and are used by physios to relieve pain. You can buy a home unit for as little as $30.00. You can read more about the effectiveness of TENS machines for pain relief here.
Knee sleeves – normally made from elasticated fabric or neoprene, knee sleeves give warmth and support for painful, injured joints. They are reassuring and can help give you confidence in your otherwise weak or unstable knee. You can wear a knee sleeve all day to help take the stress of your injured knee and the heat they give they can prevent your knees from stiffening up.
On the downside, knee sleeves can fool you into thinking your injury has healed when it hasn’t. Because of this, you might be tempted to return to activity too soon. Use knee sleeves with caution and never to mask an existing injury.
I sometimes wear neoprene knee sleeves for running – especially on cold days. This is a preventative strategy that may lower the risk of re-injury.
Fish oils – fish oils or, more specifically, omega 3 fatty acids, are natural anti-inflammatories and can reduce swelling and pain. People used to think that eating fish oil lubricated their joints but that’s not true. However, your joints may feel better because of swelling is reduced, lessening pain.
I take around 1000 mg of high quality, mercury-free fish oil per day. It’s not just good for your joints, but your brain, heart, and skin too.
Chondroitin, glucosamine, and MSM – a lot of knee problems are caused by worn cartilage. Worn cartilage means the inside of your knee joint becomes roughened when it should be glassy-smooth. This can lead to osteoarthritis. Aging, being overweight, and lots of exercise can speed up wear and tear, and once damaged, cartilage takes a long time to heal because it has no significant blood supply.
Chondroitin, glucosamine, and MSM are supplements that may speed up cartilage regeneration, leading to less knee pain. The effects are not immediate and may take as long as three months to appear, but these supplements give a good level of relief for some knee pain sufferers.
Massage – massage stimulates blood flow, promotes the removal of waste products from your muscles, increases muscle flexibility and elasticity, and helps reduce pain. Sports massage therapy is specifically used to help treat a variety of problems – including knee pain. If you do choose to have a massage, make sure your therapist is qualified and insured. Thai massage, which involves a lot of forced joint manipulation, is not recommended and may make existing joint problems worse.
Stretching for reduced knee pain
Tight muscles can have a big effect on the health and function of your knees. When muscles become overly tight, they can pull your knee out of correct alignment, putting stress on areas of the joint that then cause pain and inflammation. In many cases, restoring lost flexibility can help alleviate pain, and regular stretching can help prevent some types of knee pain in the first place.
With any type of stretching, make sure you:
- Warm up either with some light exercise or using a heat pad/hot water bottle
- Ease gently into each stretch
- Increase the depth of each stretch gradually – never rush
- Back off if your muscles start to shake of you feel any pain
- Avoid holding your breath
- Keep the rest of your body relaxed – don’t tense up your shoulders, neck, or face
- Stretch both legs – not just the one with knee pain
- Hold each stretch for 30-60 seconds
- Stretch every day, or more often if you can
- Be patient – it will take several weeks of consistent stretching to regain lost flexibility
1. Quadriceps stretch
Your quadriceps are the large muscle on the front of your thigh. It’s called quadriceps because it’s made up from four separate sections, quad meaning four. Tight quadriceps can pull your patella out of alignment, so this is an important muscle to stretch.
Lie on your front with your knees together. Bend one leg and gently pull your heel in toward your butt. Don’t worry if they don’t touch; just get as close as you comfortable can. If you can’t comfortably reach your foot, lasso it with a belt or stretching strap.
2. Hip flexor stretch
The hip flexors are the muscles that are on the front of your hip, right at the top of your thigh. If your hips are tight, your knees won’t be able to function properly. Long periods sat down can soon lead to tight hip flexors, so this is a crucial stretch for most people. Tightness in this muscle can also cause lower back pain.
Kneel and place one foot out in front of you. Keeping your torso upright, ease your hips forward to stretch the front of your rearmost leg.
3. Hamstring stretch
Your hamstrings are the long muscles on the back of your thighs. If this muscle becomes excessively tight, you won’t be able to fully extend your knee which means it won’t work be able to properly. If you spend a lot of time sat down, it’s a safe bet that you have tight hamstrings. Like tight hip flexors, tight hamstrings can also contribute to lower back pain.
Lie on your back with your legs together and flat on the floor. Raise one leg as loop a belt or stretching strap over your elevated foot. Use your arms to gently stretch your leg.
4. Adductor stretch
Your adductors are your inner thigh muscles. Like your quadriceps and hamstrings, tight adductors can stop your knees from working properly, pulling them out of proper alignment.
Sit on the floor with the soles of your feet together. Use your arms to gently push your legs apart and down toward the floor. If you can’t sit up straight, raise your hips up by sitting on a cushion.
5. Glute stretch
Your glutes, short for gluteus maximus, is basically your butt. If your glutes are tight they affect the alignment of your hips, and that affects the alignment of your knees. If you have pain on the outside of your knees, this could be the solution.
Lie on your back with your legs bent and feet flat on the floor. Cross your left leg over your right knee. Hold on behind your right knee and pull it toward you. Keep your head and shoulders on the floor if possible.
6. IBT foam rolling
This exercise is less of a stretch and more of a massage for the muscles and fascia on the outside of your thigh. Fascia is a type of tissue that can become tight and inflamed, leading to pain. Your iliotibial band, or ITB for short, is a leading cause of knee pain and this exercise is especially useful for gym-goers and runners.
Lie on your side so your foam roller is under your hip. Roll along the length of your outer thigh to just above your knee. Spend extra time on any localized painful areas you find, which are called trigger points. Foam rolling your ITB can be painful at first, trust me; I know! But after a few tries it gets easier and your knees will thank you for it.
Strengthening exercises for reduced knee pain
Weak muscles can cause knee pain. If your muscles are strong, your joints are more likely to be stable and stable joints are more injury-resistant. When I hurt my knee, stronger muscles might have meant I didn’t twist it so badly when I tripped. Lack of strength meant that my knee twisted more than it should have.
When most people think of strength training, they imagine going to the gym and lifting weights. While there is nothing wrong with going to the gym, you can easily strengthen your knees at home instead, using nothing more than your bodyweight.
Here are some tried-and-tested exercises for increasing knee joint strength and stability. Do these exercises after a knee injury to recovery faster (rehab) or to avoid a knee injury in the first place (prehab).
1. Terminal knee extensions
Of all the exercises I did to strengthen my knees, this one was the first and probably the most effective. Targeting the quadriceps, doing terminal knee extensions every other day helped stabilize my knees so now they are stronger than ever.
Sit on the floor with your legs extended in front of you. Place a foam roller or a folded towel under your knee. Straighten your leg and lift your foot off the floor. Hold it up for a few seconds and then lower it. Do as many reps as it takes to fatigue your quads.
2. Hip thrusters
Your glutes help to stabilize your hips, and that means that they indirectly stabilize your knees too. If your glutes are weak, your knees are more likely to roll inward when you walk or run, and that can cause knee pain. This exercise will strengthen your glutes, so your hips and knees are under much less stress.
Lie on your back with your legs bent and feet flat on the floor. Push your hips up and lift your butt off the floor. Lower it back to the floor and repeat. If you find this exercise too easy, try doing it one leg at a time.
3. Single leg standing
Poor balance is a leading cause of knee pain and can also be affected by knee injury. In my knee injury, my trip while running was partly caused by a loss of balance. After injuring a knee, the nerves that control balance are often injured too and can be the cause of re-injury. Practicing standing on one leg will restore balance and strengthen your knees at the same time.
Simply stand on one leg for as long as you can. I do this while I brush my teeth in the morning and before I go to bed. Do both legs – your balance should be the same on both sides. If you can do more than 60-seconds, try closing your eyes for a greater challenge.
Squats are one of the best knee exercises you can do. They work all your major leg muscles at the same time, so they are very efficient. Most of us do squats without realizing it – when we get out of a chair or out of bed for example. For that reason, practicing squats is very important.
If you have knee pain, only squat down as far as far as is comfortable. Deep squats may make your knee pain worse. Use your arms for balance and assistance by holding onto the back of a sturdy chair.
Stand with your feet roughly shoulder-width apart, knees and toes turned slightly outward. With your weight on your heels, push your hips back, bend your knees, and squat down as far as you can. Try not to round your lower back. Stand back up and repeat.
5. Calf raises
Although they aren’t an obvious choice, your calves have a big impact on your knee stability and joint health. Like your hips, if your ankles are unstable, it can have a knock-on effect to your knees. For this reason, strengthening your calves can help reduce knee pain and lower your risk of injury.
Stand on a step with the balls of your feet on the edge. Lower your heels down toward the floor as far as you can and then push up onto your tip-toes. If this is too easy, try the exercise using one leg at a time.
Step-ups are a sort-of one-legged squat. They not only strengthen your leg muscles and knees, they will also improve your balance. For this reason, only do step-ups if you have mastered the earlier exercise.
The higher the step, the harder this exercise becomes so adjust the height of your step accordingly.
Stand facing your step. Place one foot flat on the top. Step up onto your platform and then back down leading with the same leg. Continue leading with the same leg and then swap sides or, if you prefer, change legs step-by-step.
Preventing knee pain
If you do the stretching and strengthening exercises I discussed earlier, you are well on your way to avoiding a lot of knee pain. By addressing your biomechanics, you ensure your knee joint functions properly.
However, there are several other things you can do that may help you avoid knee pain.
1. Wear supportive, cushioned shoes for walking and running
Good quality shoes will support your feet. Proper foot support will prevent your feet from rolling in or out, both of which put a lot of stress on your knees. Being flat footed or walking on the outsides of your feet can lead to knee pain and supportive, cushioned shoes can help prevent this. Go and see a podiatrist to see if you need specially made insoles to fix any existing footfall issues.
2. Achieve and maintain a healthy weight
I’ve said it before but it’s worth saying again; being overweight puts a lot of stress on your knees. When you walk, your feet hit the floor with roughly double your bodyweight. When you run, that number increases to eight times!
Being overweight is a leading cause of knee pain so, if you want your knees to last a lifetime, make sure you don’t load them up unnecessarily.
3. Look where you are going!
Do you spend most of your time looking down at your cellphone when you are out walking? Big mistake! By not watching where you are going, you are much more likely to trip over a raised curbstone, step into a pothole, or catch your foot on some other obstacle.
Accidents happen regardless, but some are avoidable. Put down your phone, raise your head, and look where you are going to reduce your chances of injury.
4. Foot and knee alignment
As a hinge joint, your knees mostly open and close, but they can also twist too. However, the degree of twist is very small, and too much twisting can soon lead to knee pain. Avoid twisting your knees excessively by making sure your feet and knees always point in the same direction. This is especially important during exercise. As I learned to my cost, twisting your knee is never a good thing so pay attention to where your feet and knees are pointing.
5. Stay active
Your knees are synovial joints which means they are lubricated with a substance called synovial fluid. Synovial fluid also nourishes the inside of your joints, keeping the cartilage healthy. However, this fluid is only produced in meaningful amounts when you are active. If you sit or stand still, very little synovial fluid is produced, and that means your knees will be dry and creaky.
Keep your knees supple and healthy by staying active. That doesn’t just mean exercise, but try and move little and often all day long.
- Take the stairs and not the elevator
- Walk to see nearby work colleagues instead of emailing or phoning them
- Walk journeys of less than one mile instead of using your car
- Get up and move every hour or so when working at your desk
- Look for other ways to sit less and move more e.g. walking meetings at work, stand up for phone calls, play sports with your kids instead of video games etc.
6. Increase the length and intensity of your workouts slowly
Exercise is an important part of treating and avoiding knee pain, but if you do too much too soon, you may end up making things worse. For example, if you ran two miles today, it would be a bad idea to run four miles tomorrow. Instead, increase the duration and intensity of your workouts by no more than 10% at a time. This small increase means you won’t overstress your body, and that includes your knees.
7. Be adaptable
Knee pain is often worse one day, and then better the next. If you have a history of knee pain, make sure you adapt your lifestyle to reflect how you feel on that particular day. If your knees feel good, go and do all the activities you want to. But, if you wake up and your knees feel more sore than normal, give yourself a break and avoid doing anything that makes them feel worse. Listen to your body and if it needs a rest, make sure you give it one!
Knee pain is no fun. I know; I’ve had it myself. If you have knee pain, make sure you get it checked out by your doctor before following the advice in this article. But, once you’ve had the all-clear, use these tips and strategies to treat existing knee pain and prevent it from bothering you in the future.
Questions & answers
1. I have a sharp pain in my knee. What should I do?
Sharp pain is never good, so I’d make an appointment to see your doctor as soon as possible. Although it’s impossible for me to diagnose your knee issues, sharp pain is often an indicator of a torn cartilage. There might also be a small floating body inside the knee joint. Either way, your doctor will be able to assess your knee and explain what’s going on.
2. My knees click but they don’t hurt. Should I worry?
Clicking knees are very common and it doesn’t necessarily mean there is anything wrong with them. Pops and cracks are often caused by gas bubbles breaking inside the joint, or a ligament or tendon catching on a bony prominence. However, if you have pain or you experience more grinding than clicking, make sure you get your knees checked by your doctor as that could be the onset of osteoarthritis.
3. My knees hurt when I run; what should I do?
Short answer? Don’t run! If something you do causes pain, you should stop doing it. There are lots of other ways to exercise, stay fit, and lose weight so choose something that doesn’t hurt you. When I had my injury, I did a lot of swimming in place of my normal runs. That kept me fit without stressing my knees.
4. Are squats bad for your knees?
A lot of people think so but it’s not true – providing you do your squats properly that is. A very old study done on American football players once reported that squats caused knee pain. The trouble with this study was that the participants played top-level football and had already suffered knee injuries. American football is a rough, tough sport! Providing you do your squats with good technique and don’t use too much weight too soon, squats are actually very good for your knees.
5. What exercises can I do at the gym for stronger knees?
There is a long list of exercises you can do for your knees, so I’ll just give you ten to get you started!
- Leg presses
- Hip Thrusts
- Leg curls
- Cross trainer
Don’t try and do all these exercises in the same session – you’ll just end up tired and sore. Instead, make sure you include 3-4 of them in each workout.
6. Can’t I just take painkillers for my knees?
Painkillers mask pain, they don’t fix the cause of the pain. Taking painkillers might mean you can exercise or do whatever it is you want to do without discomfort, but once they wear off you may find yourself in much more pain than before. In my opinion, it’s much better to address the cause of pain, rather than mask the symptoms.
7. I have knee pain and my doctor says I need surgery – should I have it, or is there an alternative?
The answer to this question really depends on what the cause of the knee pain is. Personally, I’d consider getting a second opinion and exploring less invasive strategies before agreeing to surgery.
For example, an injection of your own platelets into painful knees can help speed up the repair and recovery process, putting off an operation by several years. This is called platelet-rich plasma therapy. Surgeons usually want to do surgery – that’s their job – but it’s not the only way.
8. I need to lose weight to take stress off my knees. Should I take up running?
Probably not! When you run, your feet hit the floor with around eight-times your bodyweight and most of that stress is absorbed by your knees. That’s a lot of force if you weigh 150 LBS, but a huge amount if you are tipping the scales at 200 LBS or more.
Go for low impact exercises such as cycling, rowing, swimming, and walking. Wait until you’ve lost some weight before you try running.
9. Is knee pain inevitable as you age?
It’s true that knee pain is more common as you age but it’s not inevitable. If you avoid accidents, strengthen your knees, keep the muscles around your knees flexible and supple, and avoid gaining weight, you can significantly reduce your risk of knee pain. However, even if you do everything right, you might still have knee pain as you get older. Genetics and luck both play a part. All you can do is take steps to avoid knee pain, and hope for the best! At the very least, following the advice in this article will ensure that any knee pain you do get is as mild as possible.
10. How long does it take for knee injuries to recover?
While I’d love to be able to give you an answer to this question, the truth is it’s impossible to say. Mild sprains, where there is light ligament damage, can heal in a couple of weeks, while cartilage damage could take several months. In some instances, surgery is needed to repair badly injured knees and recovery can be much longer. The bottom line is this: it takes as long as it takes, and recovery cannot be rushed. If you try and force recovery, it can end up taking even longer.