5 tips to help you avoid knee pain

Avoid knee pain by improving leg muscle strength, flexibility

Your knee joint is the largest joint in your body, your knee takes a lot of load through it, even just doing everyday things like walking up and downstairs, bending to load the washing machine or kneeling to put on your shoes. Not surprisingly, knee pain is a common complaint among people of all ages. The most common causes include inflammation, poor flexibility, bad shoes, muscle weakness, starting high-impact fitness routines without a proper warm-up. For some people, structural knee problems, such as arthritis, torn cartilage or ligament damage can also put additional stress on their knee joints.

“Many people with inflammation in their knees will respond well to simple interventions such as physiotherapy, medication and rehabilitation, and most will never need major surgery,” says Gareth Stables FRCS T&O, specialist knee surgeon and director of My Knee Doc specialist knee clinic. “Those with structural damage may be more likely to need surgery, but with early diagnosis and treatment many can avoid it”.

So how can you tell the difference between simple inflammation and structural damage such as a cartilage tear or osteoarthritis? According to Gareth, people who are able to extend their knees straight without pain typically have less serious inflammation issues. Whereas people often have structural damage when their knees are visibly swollen or they cannot get into a squatting position easily, or if their knees feel unstable and give way under them.

"Knee pain can happen to anyone at any age," says Gareth. "Usually if a patient's knees are swollen and they are in pain, I suggest icepacks, stretching and perhaps to take some anti-inflammatory medications for seven to 10 days. If their knees are still visibly and persistently swollen for longer than that, then further assessment, including imaging tests like an X-ray or MRI are sometimes needed."

There are things you can do to help you avoid knee pain, here are five tips from Mr Stables.

1. Don't avoid exercise, even if you have a structural problem

The key is to know your limits. Strength training that focuses on building up muscles in the thigh (quadriceps and hamstrings) can decrease pain and help people better manage knee arthritis and other structural knee problems. Staying active helps control weight and build muscle, both of which can help protect your knees from further damage.

The best exercises for people with structural knee problems include nonimpact aerobic exercises, such as walking on level ground, training on a cross-trainer machine, using a stationary bike, swimming or doing water aerobics. It might be  sensible to avoid activities that put extra stress on the knees such as kneeling, deep knee bends and downhill running.

2. Stretching is good for the knees

Stretches that focus on the calf, hamstring and quadriceps muscles can take pressure off your knees and kneecaps. A well-conditioned, flexible body is less likely to develop overuse problems in the knees.

Some good stretches to protect the knees include step-ups, hamstring curls and straight-leg lifts. Additionally, stretches that focus on building flexibility in the hips, including a butterfly stretch and a standing hip flexor with a resistance band, can help with knee pain.

People who do not like to stretch before a workout can still protect their knees by warming up slowly rather than jumping full speed into their workout.

"Warming up the muscles helps prevent injury," says Mr Stables. "If you like to run but you don't have the time to warm-up and stretch out, you should start your run with 10 to 15 minutes of walking or slow jogging before getting up to top speed"

3. Losing weight can improve knee pain.

Your weight plays a major role in knee pain. If you walked around all day with a backpack that had a 5 kg weight in it, you would feel how achy your back, hips and knees are at the end of the day. That shows you the impact extra weight can have on your joints.

With each step people take, two to four times their body weight is transmitted through the knee joint. Therefore, the more you weigh, the harder the impact is on your knee joint.

However, people who are overweight and have arthritic knee pain can lessen the impact — and ultimately, relieve knee pain — by losing weight. In fact, people with arthritic knees lose about 20% of their pain with every 10 pounds of weight they lose. For some, this can mean they can avoid the need for major surgery.

"If you are 20 pounds overweight and you have arthritic knee pain, almost half of your pain will go away by losing 20 pounds," says Gareth. Of course, losing 20 pounds isn't easy. But, if people are able to lose even 10 pounds and add in some stretching and flexibility training, they'll experience significantly less pain, according to Gareth.

4. Wearing proper shoes is important for healthy knees.

Supportive and comfortable shoes help take the pressure off your knee joint by promoting proper leg alignment and balance. So it's no surprise that wearing high heels is a common cause of knee pain.

High heels lift your heel up, your weight-bearing line tips forward so your quadriceps (the large muscles on the front of your thigh) have to work harder to hold your knee straight, which then leads to knee pain. If your heel is closer to the floor in pumps or flats, your thigh muscles don't have to work as hard to maintain stability, which is easier on the knees.

While strength training and stretching can help build up the muscles around the knees to minimize knee damage from heels, it's best to save the stilettos for special occasions.

Proper shoes are particularly important during exercise. If you are taking up running or starting a new form of aerobic exercise, getting shoes professionally fitted from someone at a running or sports store can help with knee problems and will certainly lower your chances of having overuse problems due to footwear.

5. Posture - Stand up straight to feel better.

When you slouch you usually lean forwards and walk bent over at the waist. That posture will lead to knee pain.  Ideally, try to have your head centred over your shoulders and your shoulders centred over your abdomen and pelvis. The more your body is off-centre, the more you have to compensate for that with muscle activity. Those muscles eventually fatigue, causing strain on your joints.

Having strong core muscles in your abdomen and lower back helps promote good posture and, ultimately, lessens the pressure on your knees. Exercises such as planks, back extensions, yoga and Pilates can help strengthen your core.

6. Will I need surgery?

Good question!! The most important person in the clinic room who decides when you should have a knee surgery is you.  Knee surgery is predominantly a quality of life procedure.  Only you can decide if your quality of life is affected enough that you are willing to accept the significant risks associated with for example joint replacement surgery.  If a surgeon tells you to have knee replacement surgery simply because you have bone on bone changes on your X-rays, then you should look for another surgeon!

About the author:

Mr. Gareth Stables MB ChB, FRCS (Ed) T&O

Cheshire Orthopaedic surgeon, Mr Gareth Stables, is a fully UK trained Consultant Orthopaedic Surgeon specialising in knee surgery. Gareth has the highest qualifications possible for an orthopaedic surgeon in the UK, FRCS (T&O), and is on the GMC specialist register for Trauma and Orthopaedic surgery.

Gareth specialises in; keyhole or knee arthroscopy surgery, ligament reconstruction surgery, knee osteotomy and knee replacement surgery.