Knee pain

Knee Pain Dos and Don’ts

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Do: Rest a Sore Knee

Do: Rest a Sore Knee

1/15

Take a break so your knee has time to heal. You’ll only need 1 or 2 days of rest to ease minor knee pain, but severe injuries may keep you off your feet longer. Talk to your doctor if it doesn’t get better after a few days.

Don’t: Stay on the Couch Too Long

Don’t: Stay on the Couch Too Long

2/15

Exercise builds strong muscles around your joints, and that helps prevent injuries. Once your knee has had enough rest, get back out there. Low-impact water workouts or tai chi are good options. But don’t overdo it or you’ll risk more pain.

Do: Use RICE

Do: Use RICE

3/15

Try the RICE formula to treat a knee injury:

Rest for a day or two to heal.

Ice your knee to calm inflammation.

Compress (wrap) your joint for support and to stop fluid buildup.

Elevate it on a pillow or stool to curb swelling.

Don’t: Risk Slips, Trips, or Falls

Don’t: Risk Slips, Trips, or Falls

4/15

Wear shoes with good tread on them to cut your risk of a slip. Choose low-heeled ones with soft, rubber soles. Keep your home’s hallways and stairwells well lit, and clear floors of things you could trip over.

Do: Use a Cane If You Need One

Do: Use a Cane If You Need One

5/15

Feel unsteady? Use something to steady you as you move around. Choose a sturdy, strong, light cane with a rubber tip and a handle that’s easy to grasp. Hold it at a 45-degree angle to be sure it’s the right height. Find one in a color or style you like so you’ll be more likely to use it.

Do: Watch Your Weight

Do: Watch Your Weight

6/15

Extra pounds add strain to your knees and raise your risk of painful arthritis and injuries. But even moderate weight loss can make it better. If you need to drop a few pounds, set a goal to lose just 5% of your current weight over the next few months.

Do: Consider Acupuncture

Do: Consider Acupuncture

7/15

Tiny needles are put into the skin around your sore joint. Research shows it can ease knee arthritis pain, though it’s still unclear how. Look for someone who’s trained and experienced. Many states license acupuncturists.

Don’t: Forget to Stretch

Don’t: Forget to Stretch

8/15

The muscles around your knees can get tight, and that can lead to painful injuries. Daily stretches can prevent that and muscle pain. Ask your doctor or physical therapist for easy moves to help you limber up before you walk or do any other activity.

Do: Use Heat and Cold

Do: Use Heat and Cold

9/15

If your knee pain flares, try hot or cold treatments. Moist heat is better for pain relief than dry. Soak in a warm bath, or zap a damp washcloth in the microwave. To ease a swollen knee, press a bag of frozen veggies wrapped in a towel against the joint.

Don’t: Sleep in the Wrong Position

Don’t: Sleep in the Wrong Position

10/15

This can make your knee pain worse. Try out different positions, and put a pillow between your knees if you sleep on your side. Don’t prop up a bent knee on a pillow, though — that can make it harder to unbend your leg the next day.

Do: Try Braces or Sleeves

Do: Try Braces or Sleeves

11/15

Support a sore, weak knee with a brace, sleeve, or tape. Ask a physical therapist to fit you with one or to tape your knee. A simple sleeve that fits over your knee can offer short-term pain relief, too. You can find them at the drugstore.

Don’t: Wear Out Your Knees

Don’t: Wear Out Your Knees

12/15

You may get knee pain because you overload your joints. Movements you do over and over again, like go up and down stairs every day, can jar and wear down your knees. But don’t sit for long periods, either. That puts extra pressure between your knee and leg bone that can cause pain.

Do: Support Your Arches

Do: Support Your Arches

13/15

Choose shoes that support your arches, or get slip-in inserts at your local drugstore. If those don’t work, you can ask your doctor about custom supports. But those can be expensive and don’t always work better than the ones available over the counter.

Don’t: Keep Wearing the Same Old Shoes

Don’t: Keep Wearing the Same Old Shoes

14/15

Shoes can stretch and wear out after a while. Don’t keep wearing your favorite pair after their support and tread have worn out. You may find that new shoes that support your feet and ankles well ease your knee pain.

Do: Talk to Your Doctor

Do: Talk to Your Doctor

15/15

You don’t have to deal with knee pain alone. Your doctor might prescribe medication or give you a steroid shot to help. They also might talk with you about surgery to replace worn joints or ligaments.

Knee Pain: Treat With Lifestyle Changes

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(RossHelen/Shutterstock)

A review of 47 studies on 22,037 patients with knee osteoarthritis treated for at least 12 months showed no clear difference in controlling long-term pain between medications and placebos (JAMA, 2018;320(24):2564-2579). There was a slight time-limited pain control with a non-steroidal (celecoxib) and glucosamine.

With the exception of immune suppressants that have lots of serious side effects, medications, and health supplements do not prevent progressive damage to joints and are used only to help lessen pain. The list of medications for osteoarthritis is huge, including:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and other pain medicines.
  • Antioxidants.
  • Bone strengtheners such as bisphosphonates.
  • Joint injections such as hyaluronic acid and corticosteroids.
  • Chemicals found in cartilage such as glucosamine and chondroitin sulfate.
  • Disease-modifying agents such as cindunistat or sprifermin.

Know the Cause of Your Joint Pain

If you do not already have a diagnosis, check with a doctor to see if you have rheumatoid arthritis, psoriatic arthritis, gout, reactive arthritis from an infection, or some other known cause of joint pain. If you have sudden locking of your joint that gets better and then recurs, you may have “joint mice,” loose pieces of cartilage that slip between your cartilage to cause horrible pain. This can usually be cured by removing the loose pieces with arthroscopic surgery.

Osteoarthritis is the most common cause of chronic and progressive joint pain. It can eventually destroy the cartilage in joints and is among the most prevalent chronic diseases and a leading cause of disability worldwide (JAMA, 2018;319(14):1444-1472). Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. More than 700,000 people in North America have their knees replaced each year, mostly for this condition.

What Causes Osteoarthritis?

A diagnosis of osteoarthritis used to mean that your doctor had ruled out other known causes of knee pain and had no idea what was causing your joint pain. Now we know that people with osteoarthritis have high blood levels of galectins that turn on a person’s immune system to cause inflammation, just as in rheumatoid arthritis or reactive arthritis (Journal of Immunology, Feb 15, 2016;196(4):1910-1921). If your immune system stays overactive, the same chemicals and cells that are used to attack germs can attack and destroy the cartilage in your joints.

A review of 68 studies showed that osteoarthritis is associated with everything that increases inflammation, such as obesity, high blood pressure, high cholesterol, diabetes, and metabolic syndrome (Rheumatology, May 1, 2018;57(suppl_4):iv61–iv74; Rheumatology, Jan 1, 2016;55(1):16–24), and that this joint pain is reduced temporarily by anything associated with the control of inflammation:

  • Omega-3 oils in fish.
  • Leafy green foods such as kale, spinach, and parsley.
  • Weight reduction in people who are overweight (but not in thin people).
  • Strengthening and flexibility exercises (Arthritis Care & Research, Dec 5, 2017;69(12) and aerobic exercise (The Knee, January 18, 2018).
  • Avoidance of smoke.
  • Restriction of alcohol.

Several studies have shown that exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (BMJ, July 20, 2016; N Engl J Med, 2013;368:1675-84). See: Arthroscopic Knee Surgery is Usually Useless.

Anti-Inflammatory Lifestyle to Treat Osteoarthritis

  • Eat an anti-inflammatory diet that includes lots of fruits, vegetables, whole grains, beans, nuts, and other seeds, and restricts red meat, processed meats, foods with added sugar, all sugared drinks including fruit juices, and fried foods. People who eat an anti-inflammatory Mediterranean-style diet are at reduced likelihood to get osteoarthritis (Clin Nutr, Oct 8, 2016).
  • Lose weight if overweight. Excess weight causes inflammation, and obesity is a major risk factor for osteoarthritis (Int J Obes Relat Metab Disord, 2001;25(5):622-627); Osteoarthritis Cartilage, Oct 27, 2015. S1063-4584(15)01364-3; Arthritis and Rheumatism, Sept 15, 2008;59(9):1207-13). Losing as little as 11 pounds reduced risk of developing knee osteoarthritis among women by 50 percent (Arthritis and Rheumatism, August 1998;41(8):1343-55).
  • Move more. Osteoarthritis almost always worsens with inactivity. Exercise increases cartilage quality in osteoarthritis (Med and Sci in Sprts and Ex. Mar 23, 2017), and a review of 55 studies showed that weight-bearing exercise reduced pain and improved joint function (British Journal of Sports Medicine, September 24, 2015). Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, Aug. 30, 2016). A review of six studies of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it didn’t make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203). However, you need to be guided by pain and always stop if the pain worsens.
  • Avoid impact sports. The force of your feet hitting the ground can break off cartilage in your knees. Do not run, jump, or participate in sports that involve the strong impact of your foot hitting the ground. Non-impact sports include cycling, swimming, water aerobics, and use of machines such as ellipticals or stair-steppers where your feet are supported by the equipment as you move.

Use Medications As Needed to Control Pain

It is acceptable to try to control your pain with NSAIDs [non-steroidal anti-inflammatory drugs] or other pain medications, but realize that they do nothing to stop progressive joint destruction and do not cure the pain. Take the lowest dose that helps to relieve your pain and use them only when needed.

If the pain becomes so unbearable that it keeps you awake at night, it may be time to consider a knee replacement. However, joint replacements do not last forever; at this time most replacements last about 15 years, so put off the surgery as long as you can. Your surgeon should caution you that replacement joints increase risk for infections because any infection in your body can settle in the replaced joint since it has no local immunity.

Knee Pain Dos and Don’ts

Posted by

0


Do: Rest a Sore Knee

Do: Rest a Sore Knee

1/15

Take a break so your knee has time to heal. You’ll only need 1 or 2 days of rest to ease minor knee pain, but severe injuries may keep you off your feet longer. Talk to your doctor if it doesn’t get better after a few days.

Don’t: Stay on the Couch Too Long

Don’t: Stay on the Couch Too Long

2/15

Exercise builds strong muscles around your joints, and that helps prevent injuries. Once your knee has had enough rest, get back out there. Low-impact water workouts or tai chi are good options. But don’t overdo it or you’ll risk more pain.

Do: Use RICE

Do: Use RICE

3/15

Try the RICE formula to treat a knee injury:

Rest for a day or two to heal.

Ice your knee to calm inflammation.

Compress (wrap) your joint for support and to stop fluid buildup.

Elevate it on a pillow or stool to curb swelling.

Don’t: Risk Slips, Trips, or Falls

Don’t: Risk Slips, Trips, or Falls

4/15

Wear shoes with good tread on them to cut your risk of a slip. Choose low-heeled ones with soft, rubber soles. Keep your home’s hallways and stairwells well lit, and clear floors of things you could trip over.

Do: Use a Cane If You Need One

Do: Use a Cane If You Need One

5/15

Feel unsteady? Use something to steady you as you move around. Choose a sturdy, strong, light cane with a rubber tip and a handle that’s easy to grasp. Hold it at a 45-degree angle to be sure it’s the right height. Find one in a color or style you like so you’ll be more likely to use it.

Do: Watch Your Weight

Do: Watch Your Weight

6/15

Extra pounds add strain to your knees and raise your risk of painful arthritis and injuries. But even moderate weight loss can make it better. If you need to drop a few pounds, set a goal to lose just 5% of your current weight over the next few months.

Do: Consider Acupuncture

Do: Consider Acupuncture

7/15

Tiny needles are put into the skin around your sore joint. Research shows it can ease knee arthritis pain, though it’s still unclear how. Look for someone who’s trained and experienced. Many states license acupuncturists.

Don’t: Forget to Stretch

Don’t: Forget to Stretch

8/15

The muscles around your knees can get tight, and that can lead to painful injuries. Daily stretches can prevent that and muscle pain. Ask your doctor or physical therapist for easy moves to help you limber up before you walk or do any other activity.

Do: Use Heat and Cold

Do: Use Heat and Cold

9/15

If your knee pain flares, try hot or cold treatments. Moist heat is better for pain relief than dry. Soak in a warm bath, or zap a damp washcloth in the microwave. To ease a swollen knee, press a bag of frozen veggies wrapped in a towel against the joint.

Don’t: Sleep in the Wrong Position

Don’t: Sleep in the Wrong Position

10/15

This can make your knee pain worse. Try out different positions, and put a pillow between your knees if you sleep on your side. Don’t prop up a bent knee on a pillow, though — that can make it harder to unbend your leg the next day.

Do: Try Braces or Sleeves

Do: Try Braces or Sleeves

11/15

Support a sore, weak knee with a brace, sleeve, or tape. Ask a physical therapist to fit you with one or to tape your knee. A simple sleeve that fits over your knee can offer short-term pain relief, too. You can find them at the drugstore.

Don’t: Wear Out Your Knees

Don’t: Wear Out Your Knees

12/15

You may get knee pain because you overload your joints. Movements you do over and over again, like go up and down stairs every day, can jar and wear down your knees. But don’t sit for long periods, either. That puts extra pressure between your knee and leg bone that can cause pain.

Do: Support Your Arches

Do: Support Your Arches

13/15

Choose shoes that support your arches, or get slip-in inserts at your local drugstore. If those don’t work, you can ask your doctor about custom supports. But those can be expensive and don’t always work better than the ones available over the counter.

Don’t: Keep Wearing the Same Old Shoes

Don’t: Keep Wearing the Same Old Shoes

14/15

Shoes can stretch and wear out after a while. Don’t keep wearing your favorite pair after their support and tread have worn out. You may find that new shoes that support your feet and ankles well ease your knee pain.

Do: Talk to Your Doctor

Do: Talk to Your Doctor

15/15

You don’t have to deal with knee pain alone. Your doctor might prescribe medication or give you a steroid shot to help. They also might talk with you about surgery to replace worn joints or ligaments.

How to Keep Sore Hips, Knees, Shoulders from Ruining Your Sleep .

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If you roll out of bed bleary-eyed each day, thinking, “Oh, my aching [insert painful joint here],” you’re not alone.

Research shows that between 50 and 90 percent of people with chronic joint pain don’t sleep well. And, that sleep deprivation can lead to other health issues, including low energy, mood disorders and eating problems.

young female sleeping

If you have chronic pain in your hips, knees or shoulders, there are things you can do to limit how much the discomfort affects your nighttime rest, says Michael Schaefer, MD, Director of Musculoskeletal Physical Medicine & Rehabilitation at Cleveland Clinic.

“A healthy brain is a well-rested brain. It can deal better with pain, such as arthritis, on an ongoing basis,” he says. “Lack of sleep, on the other hand, can directly affect your mood, and a bad mood can make it harder to cope with pain. This can become a vicious cycle.”

When you need a doctor

women with neck back ache pain

Some problems with broken sleep patterns are normal as we age, Dr. Schaefer says, but you shouldn’t wake up and stay awake every night because of pain. If that’s your situation, consult your primary care physician.

“If the pain goes on for more than three or four days in a row or intermittently for two to three weeks, it’s time to get it addressed,” he says. “If the pain is so severe that you require alcohol or over-the-counter sleep aids to fall sleep, then it’s worth getting it looked at.”

See your doctor if you have joint pain and:

The pain isn’t in a typical spot for arthritis
You’re losing weight unexpectedly
Have a fever or chills
Experience night sweats
Have a history of cancer
Any of those problems can indicate a more serious condition in need of immediate medical attention, Dr. Schaefer says.

Get into a good sleep position

young female sleeping

Finding the right position can be the most crucial part of avoiding pain during sleep. Twisting and turning to find a comfortable spot is normal, Dr. Schaefer says, but even the slightest twinge of pain can disrupt your rest. He recommends you start out sleeping on your side – avoiding a sore shoulder if you have one – with a pillow between your legs. Try to avoid lying flat on your back.

Side-sleeping won’t work for all shoulder pain, though. Minimize that discomfort by wrapping your arm in a bandage or wearing a sling to bed. It will keep your arm immobile and prevent you from sleeping with your arm in an awkward position.

Other tips offer sleep relief for all

pills

There are additional, pain-specific steps you can take to decrease nighttime discomfort, Dr. Schaefer says. He also offers some general sleep recommendations to help nearly anyone, not only pain sufferers.

Find the right mattress. For back, hip and knee pain, Dr. Schaefer recommends a firm mattress. Add a foam pad on top if you need it to help evenly distribute your weight and keep your joints in alignment.
Take appropriate medication. If you’re using regular acetaminophen or ibuprofen and your pain breaks through the night, consider switching to a different pain reliever. Dr. Schaefer recommends pain killers that last between 12 and 24 hours, such as naproxen (Aleve®).
Maintain good sleep hygiene. Keep your sleep schedule as consistent as possible – turn off the television, put all electronics away, turn off lights and keep your room as quiet as you can.
Avoid substance aids. Alcohol might make you drowsy, but it won’t give you restful sleep. People often wake up after a few hours of drinking.
Minimize how often you use over-the-counter sleep aids. If you take them too long, you’ll need higher doses and may have trouble breaking this habit.
Do low-impact exercises. Regularly scheduled low-impact exercise, such as walking, bicycling or swimming, can help with both pain and sleep disorders.
Why sleep can hurt

Normal joint pain, especially in the hips, knees and shoulders, frequently worsens at night, he says. Your sleep position and the alignment of your body are responsible for most of the pain, but some comes from being so still at night.

“Joints swell at night, and motion gradually lubricates them and keeps the fluids moving round,” Dr. Schaefer says. “When you stop moving, they can swell more.” This can cause stiffness and pain, he says.

 

Need a Nerve Block? 4 Things You Should Know.

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For many people who suffer with severe pain, nerve blocks have become part of their treatment. These injections of local anesthetic and steroid directly to the area of the affected nerve can help with pain control and improve function and quality of life. Often, the goal is to help people avoid surgery and to take an active role in physical therapy.

Pain management specialist Paul Shin, MD, offers insights for patients considering having a nerve block. He says your doctor will help you determine the best procedure for the pain you have, but in general, here are four things to expect if you have a nerve block.

1. Fear of the injection is almost always worse than the injection itself

Patients are often hesitant when it comes to needles. Some procedures for arthritic conditions may involve up to six needles, but most procedures are well tolerated and brief. Generally, they only last five to 15 minutes. A local anesthetic or even IV sedation are sometimes used.

A fluoroscope, or low powered x-ray, allows whoever administers the nerve block  to visualize the bony structures. This enables accurate placement of the needle and reduces complications. You’ll spend most of your time preparing and recovering from the procedure afterwards.

2. Everyone responds differently to a nerve block

For some people, a nerve block gives immediate relief. For others, it takes a series of injections before it helps the pain. It’s very unpredictable. This is because pain is a personal perception and everyone responds differently.

Also, if you have had chronic pain for 10 or more years, it could involve multiple pain generators. There are many anatomic structures and the pain could come from more than one joint or nerve. In the spine, it’s possible that your first injection will take away some of the pain but that other injections will offer more improvement.

This also means that the sooner you can get an injection before your pain becomes chronic, the better your result. In addition, injections are typically combined with other forms of treatment such as physical therapy to increase your chances of getting better.

3. You might have some post-procedure soreness

You can expect some post-procedure discomfort or soreness that will also improve within days of the injection. The local anesthetic doesn’t last long and for some people, it may take a while for the steroid to work and provide a long-term benefit.

The peak effect of the steroid will usually be between three and 10 days. It is slowly released into the body, and for some people, there is an interval before you start to feel the improvement. Your response to the first injection helps guide your doctor about future treatments as he or she works to pinpoint the nerve that is causing your pain.

4. Your injection frequency depends on your medical history

Based on your medical history and physician preferences, you can usually repeat this procedure from three to six times in a 12-month period. Medical conditions, such as diabetes, will mean that your doctor will need make injections less frequent. Your doctor will determine the exact number of injections that you can receive.

Ultimately, the goal of nerve block injections is to decrease pain, increase your function and, for some patients, allow more aggressive physical therapy. They work well for many patients.