Next to back pain, knee pain is one of the most common complaints among both older adults and younger athletes. Knee injuries are one common cause of knee pain, but you don’t have to fall, trip, or get into some type of accident to hurt your knees.
What can cause knee pain without injury? Arthritis, overuse, osteoporosis, certain types of exercises like running, and repetitive movements are all potential causes of knee pain.
How do you relieve knee pain? Identifying the underlying cause of your pain is the first step. Treating health conditions that might contribute to inflammation (such as autoimmune disorders), exercising appropriately, maintaining a healthy weight, stretching, and doing certain knee exercises can all greatly help you find relief.
What Is Knee Pain?
Knee pain describes any type of discomfort that affects the knees, such as sensitivity and throbbing. It’s common for knee pain to also be accompanied by other symptoms affecting the legs, which can include:
- Swelling around the knee
- Discomfort that gets worse when walking, squatting, or doing other exercises.
- Inability to bear weight on the knee
- Stiffness and reduced ability to move the knee, such as having a hard time straightening and bending the knee
- General reduced range of motion of the legs
- Feeling like your knee “gives out” when you try to move
Unusual sounds when moving the knee, such as a popping or crunching sound
The knee joint, a complex part of the body that is formed by interconnecting bones, cartilage, and ligaments, is where the major bones of the upper leg and lower leg meet. The knee is actually the largest joint in the human body and functions as a “hinge joint”, formed by the femur (thigh bone), the tibia (shin bone), and the patella (the knee cap) that are held in place by several joints/tendons. The knees must withstand pressure, weight, and shock, and rely on the muscles in the legs to keep them stable and strong.
Knee pain is sometimes referred to as patellofemoral pain syndrome or runner’s knee, which describes pain and other symptoms affecting the area between your patella (kneecap) and femur (thighbone).
Causes
- Injuries to the legs, including any injury that affects the cartilage, ligaments, tendons, or fluid-filled sacs (bursae) near the knees
- Arthritis, which can include rheumatoid arthritis (an autoimmune condition that affects joints) or osteoarthritis (degenerative arthritis which usually affects older adults); more than 20 million people in the U.S. alone suffer from knee osteoarthritis (OA), which is “one of the top five most disabling conditions that affect more than one-third of persons 65 years of age or older”
- Biomechanical problems, such as poor form, deformities, or muscular compensations that cause the kneecap to fall out of its optimal position
- Gout is characterized by uric acid or calcium-containing crystals forming on the joints
- Joint mice: a rare disorder in which one or more small fragments of bone or cartilage break off and remain floating in the knee joint space
- Infections that can cause fluid retention and swelling, such as septic arthritis
Common Knee Injuries
Knee injuries can slowly develop over time, or happen suddenly due to impact. Injury to the knee can be due to ruptured ligaments, torn cartilage or irritation/inflammation of the knee joint caused by overuse. Examples of specific injuries and conditions that can lead to knee pain are:
- Iliotibial band syndrome, or irritation and inflammation of the IT band, the thick fascia/tissue that extends from the pelvis/hip to the knee
- Torn meniscus, or damage to the meniscus which is a tough, rubbery cartilage that helps absorb shock in the legs
- Patellar tendonitis is caused by inflammation of the patellar tendon, which connects the kneecap to the shinbone
- Knee bursitis, or inflammation in the bursae (small sacs of fluid) that cushion the outside of the knees
- Chondromalacia patella, which refers to damaged cartilage under the kneecap
- Tearing of the ACL (the anterior cruciate ligament which connects the shinbone to the thigh bone); both traumatic and non-traumatic injuries commonly affect the ACL
- Fractures of the patella (kneecap), which can be caused by impact or degenerative diseases
- The dislocated kneecap, when the patella slips out of its normal position
Risk Factors for Developing Knee Pain
What types of health conditions, exercises, and lifestyle habits put you at risk for knee pain? These can include:
- Engaging in contact or risky sports like skiing, football, basketball, soccer, lacrosse or rugby can result in collision, impact, or falling.
- Being a distance/endurance runner or cyclist, which can cause overuse of the knees. Doing lots of jumping or walking uphill and downhill can also put added strain on the knees. Sometimes even recreational running or normal exercise can be enough to trigger knee pain.
- Being a female athlete. Female athletes are more prone to suffering from traumatic knee injuries and experiencing recurring knee pain. It’s believed this is due to the anatomy of the female pelvic region and the way that females activate the muscles in their legs.
- Twisting motions at the knee while bearing weight, such as when exercising or if you have an active job that involves lifting.
- Poor training technique and posture, including sudden changes in the amount, frequency, or intensity of workouts, as well as inadequate rest between workouts.
- Being in an accident, such as a vehicle collision.
- Falling or tripping, such as due to loss of balance in older age.
- Osteoporosis, which can make you more prone to knee fractures and weakened bones in the pelvis and legs.
- Having an autoimmune disorder, especially rheumatoid arthritis.
- Having hip or foot pain, which can cause compensations that put damaging forces on the knees.
- Being overweight or obese, which adds extra pressure to the knees.
- Being sedentary (not exercising, walking, or stretching much), can cause weakness in the legs and loss of flexibility.
- Having a previous injury that affects the knees or legs.
Diagnosis
To diagnose you with a specific type of knee pain, your doctor (such as an orthopedist) will need to perform a physical exam and check to see how you respond to different movements using your legs. You want to talk to your doctor about which specific symptoms you’re experiencing when they started and what types of things make the pain better (taking rest days, stretching, etc.) Pay attention to whether your knee bothers you when you’re sitting down, exercising or just going about your day.
Keep these in mind when discussing your symptoms and treatment options with your doctor:
- If you feel pain in front of the knee (behind the kneecap), this is a sign of patellofemoral syndrome. The pain is due to abnormal tracking of the patella. You’re likely to feel pain when going from a standing to a sitting position. You may notice that pain is worse when you first start moving, but the knee pain gets better when you’ve warmed up and started exercising.
- How do you know if you have a torn meniscus in your knee? You’ll probably have difficulty walking, limited range of motion, swelling, and stiffness. Twisting and rotating your knee will feel very painful. You probably won’t be able to bear weight or fully extend your knee.
- The ACL is the first ligament that becomes tight when the knee is straightened, and it can become torn if the knee is hyperextended or from sudden stops, jumps, or changes in direction during physical activity. Where does your knee hurt with a torn ACL? It can hurt all over, look very swollen, and feel very weak. You might not be able to bend and straighten the knee, walk downhill, or change directions easily, and may feel like your knee gives out easily.
Conventional Treatments
Ron Torrance II, D.O, a Sports Medicine Trained Physician at the New ReGeneration Orthopedics of Florida, says he commonly sees knee pain-related conditions among his younger patients who are generally fit — especially runners, female athletes and anyone who uses their legs in other repetitive ways
When treating knee pain injuries, Dr. Torrance first looks at his patients’ symptoms and then discusses their lifestyle and exercise habits. Knee pain treatment should always depend on which specific part of the knee is injured and the underlying cause of the pain. Even if medications and corrective devices like knee braces are needed to treat knee pain, exercises, stretching, and other functional medicine practices should also be incorporated to help with recovery and injury prevention.
Aside from resting the knee after an acute injury, conventional treatments for chronic knee pain that lasts more than several weeks include:
- Compression, icing, and elevation of the affected knee
- Physical therapy and specific exercises (more on these below)
- Use of orthotics or a knee brace if needed
- Steroids, such as an injection used to reduce inflammation; hyaluronic acid might be used to lubricate the knee and treat swelling
- Platelet-rich plasma (PRP) can be used to promote the repair and growth of tissues in the knee; PRP involves injecting different growth factors into the damaged area to reduce inflammation and promote natural healing processes
- Rarely, if someone is experiencing chronic knee pain that doesn’t improve with other treatments, surgery may be needed to help repair a tear; but surgery is considered a last resort option
Natural Treatments
1. Exercise and Proper Time to Recover
Weak muscles and stiffness are two of the leading problems associated with knee injuries. So while exercise is important for keeping your knees healthy, you also need to rest enough and give your body time to heal. Some people will need to take a break from most exercise or several weeks to heal a damaged knee, or at least limit high-impact activities for a period of time. Before trying more drastic treatments, see if taking a few days off from your usual exercise helps. If you see improvements with rest, then you should plan to decrease your mileage/length of workout when you return.
To protect yourself from injury, always warm up lightly and stretch before exercise. Before engaging in running, biking or another knee-bending exercise, walk a quarter- to a half-mile. After your exercise, be sure to stretch again and then give yourself enough time to recover properly, at least 1–2 days (especially after intense workouts).
Doing low-impact exercises is best for people with chronic knee pain or conditions that affect the joints. Examples of low-impact workouts include:
- Swimming
- Water aerobics
- Brisk walking
- Elliptical training
- Cycling
- Yoga
On the other hand, these activities can negatively impact the knees and should be avoided if you’re having knee issues:
- Running
- Jumping
- Skiing
- Intense biking
- Activities that involve repetitive movements of the legs
- High-impact sports
2. Physical Therapy (Stretching and Exercising the Knees)
If you’ve experienced weakness or loss of flexibility in your knees or other limitations that affect your ability to move, it’s a good idea to work with a physical therapist, trainer or coach who can help you with conditioning and recovery. A therapist (such as a neurokinetic therapist) can help you gradually build strength in your lower body and also work on achieving proper form to reduce your risk for future injuries. Having a gait analysis done can be beneficial for correcting pronation problems and other postural issues.
Performing exercises that help strengthen the quadriceps, hamstrings, lower back, and hips can all support the knees. In addition to building strength and stretching, work on balance and stability exercises helps to train the muscles in your legs to all work together. This can reduce the risk of falling and developing compensations that take a toll on the knees. Your therapist might also recommend using both cold and hot treatments to ease pain and support healing after exercising your knee, such as ice packs or a warm compress applied to the painful area.
3. Good Footwear, Insoles, and if needed, a Knee Brace
In general, people with knee pain should try to avoid wearing sandals, flip flops, Crocs™, boat shoes, high heels, and boots. These types of shoes are not very supportive and can aggravate back knee or hip pain.
If you’re having knee pain when exercising and suspect your shoes might be contributing to the problem, it’s helpful to visit a running store to speak with a specialist about your specific stance, stride, and needs. You can have a free, simple test done on your feet that will identify which types of shoes are best for your posture and gait. You can also visit a podiatrist (a doctor that specializes in treating foot-related problems) for custom insoles.
Superfeet insoles, an over-the-counter insole option that can be purchased online, are recommended by certain doctors, including Dr Ron Torrance. These insoles are sturdy and provide support for the knees, unlike some over-the-counter insoles that are cushiony but not as stable. Soft insoles are not always as helpful for some people because they don’t help with stabilizing the ankles or knees, which can further aggravate knee pain.
4. Foam Rolling
Foam rolling is very beneficial for breaking up adhesions in the legs that can contribute to knee pain. Dr. Torrance recommends foam rolling the quadriceps and IT bands to help with knee pain relief, especially if you’re a runner or avid exerciser. You can also use a foam roller on other muscles that support the knees, especially the gluteus maximus (the largest muscle in the buttocks) and the tensor fasciae late (a muscle that runs along the outer edge of the hip).
- To foam roll your quads — Place your foam roller on the floor and lie on your stomach with the front of one thigh over the foam roller and the other leg on the floor for support. Roll the entire front of the thigh from the top of the hip to the top of the kneecap in an up-and-down motion.
- To foam roll your IT band — Place your foam roller on the floor. Lie on your side with the outside of your thigh the outside of the thigh over the foam roller and your other leg in front for support. Roll the entire outside of your thigh from your pelvis to your knee in an up-and-down motion.
- To foam roll your hamstrings — While lying face up, place the back of one thigh over the foam roller and the other leg on the floor for support. Roll the entire back of your thigh from the bottom of the buttock to your knee in an up-and-down motion.
- To foam roll your adductors — Lie on your stomach with the inside of one thigh over the foam roller and your other leg straight on the floor for support. Roll the entire inside of your thigh from your groin to your knee in a side-to-side motion for about 2 minutes.
5. Eating An Anti-Inflammatory Diet
Eating a nutrient-dense, anti-inflammatory diet is important for overall joint health for a few reasons: it helps you to maintain a healthy weight (which decreases strain on your joints), reduces inflammation, improves recovery from exercise, and lowers the chances you’ll develop a condition like arthritis or osteoporosis.
- Consume plenty of fruits and vegetables, especially those high in vitamin C, sulfur, and antioxidants like leafy greens, carrots, peppers, berries, onions, broccoli, garlic, asparagus, and cabbage.
- Get omega-3 fatty acids from wild-caught fish, especially benefit-packed salmon. Other food protein sources include grass-fed meat, pasture-raised poultry, fish like sardines or mackerel, fermented dairy products, and eggs.
- Include healthy fats in your diet like coconut oil, olive oil, ghee, grass-fed butter, avocado, nuts, and seeds.
- Drink bone broth or use protein powder from bone broth.
- Add antioxidant-packed herbs and spices to your meals.
- Limit or avoid excess sugar, hydrogenated oils (soybean oil, cottonseed oil, even canola oil), processed/refined grains, flour products, synthetic additives, processed meats, and fast food.
6. Anti-Inflammatory Supplements
Certain herbs and supplements can help to reduce inflammation and support recovery from injuries or degenerative diseases. Some of the best supplements for knee pain include:
- Turmeric
- Glucosamine and chondroitin
- Bone broth, or protein made from bone broth sources
- Collagen protein
- Omega-3 fatty acids
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Exercises and Stretches
The type of knee exercises that will help you find relief from knee pain depends on the underlying cause of your condition. Dr. Torrance has found that for his patients to get the most results from knee pain exercises and stretches, they first have to identify if they’re generally more strong or more flexible.
If your legs are very flexible but not so strong, you want to work on strengthening and activating the correct muscles in your legs to support your knees (especially your quads). On the other hand, if you’re strong but also tight, you want to improve your flexibility/mobility. If you have a condition that causes pain, gently working on improving both strength and range of motion is important.
Below are some of Dr. Torrance’s favorite (that he uses to treat his patients with knee pain) knee-strengthening exercises and stretches:
1. Clam Shells
This is a great exercise for younger athletes and females who have weak gluteus medius muscles. It’s also helpful for those who have flat feet, which creates stress in your ankle that travels up to your knees. Start by laying on your right side with your knees bent and feet and hips stacked.
You want your feet to be in line with your butt and your shoulders stacked. Engage your core and keep your feet together as you raise your left knee out to the side while keeping your right knee down on the floor. Hold your lifted knee for one second, then lower and repeat. Try to complete 20 reps on each side.
2. Quad Sets
The quadriceps are the muscles above the knee that help to control patella tracking, so it’s important to strengthen them. To perform quad sets, lay on your back and put a rolled-up towel behind your affected knee. Activate the thigh muscles in order to straighten the knee and hold the contraction for 5 seconds.
You can activate your quad by visualizing your knee pushing down into the ground (you’ll also be able to see your quad contract if you watch it). Release after 5 seconds and repeat 10 times on each side.
3. Straight Leg Raises
Also great for strengthening the quads. Lay on your back and stretch both legs out on the floor. Lift the right leg up to about 6 inches off the floor and hold the contraction for 10 seconds, then gently return it to the floor and repeat on the other side. Try to complete 5–10 reps on each side.
4. Pistol Squats (also called single-leg squats)
Stand with your feet hip-distance apart. Keeping your balance, start with your left toe touching the ground and focus on something in front of you that is not moving. Begin to sit back on the right leg while raising the left foot and extending the left leg in front of you. Go down as far as you are able to, lowering for about 5 seconds, then lift back up. Repeat about 10 times on each side.
5. Hip Raises (also called glute bridges)
Lay on your back on the floor with your knees bent. Your knees should be hip-distance apart and heels should be close to the butt. Push off with the heels, lift the hips towards the ceiling, and hold for 5–10 seconds. Release and repeat 10–20 times.
6. Step-Ups
Start standing with feet hip-distance apart. With your right foot, step up onto the bench or step and follow with the left foot. Step back down with the right foot and alternate feet so the next one will start with the left foot and so forth. Do 20 reps.
7. Lunges (backward or forwards)
Stand with feet hip-width apart, then step backward with your right foot and lunge down, making sure that your knee does not extend beyond your ankle. Push off with your heel back to starting position. Repeat on the other side. Do 10 on each leg. You can do the same stepping forward instead of backward, which would be a normal forward lunge.
8. Kneeling Quad Stretch
Bring one shin/knee down to the ground and bend the opposite leg so the knee is right over the ankle and thigh in parallel to the ground. Use a blanket under your knees/shins if you’re uncomfortable. Try to reach your arm back and grab the foot of the leg that’s on the ground. Bring your heel closer to your thigh to stretch your quad. Hold for at least 20–30 seconds on each side.
9. Glute Activation
Lie on your stomach with your knees bent and turned outward. Push the heels together to contract your buttocks. Do not arch your lower back. Hold the isometric contraction for the required time. Repeat about 10 times in a row, completing 3 sets per day.
10. Side Step With Band
Wrap a mini-band around your legs just above your knees. Turn your feet out slightly and bend your knees just deep enough so they are over your toes. Keep your back straight and hips slightly bent. Make sure you bend the knees in line with the feet.
In this position, the side step is nice and slow while maintaining the half-squat and the slight external rotation of the legs. Step in one direction, then come back to work on both sides. Complete 10 times in a row, working up to 3 sets daily,
11. Yoga Exercises
Dr. Torrance recommends benefit-rich yoga to his patients with knee pain because it helps stretch nearly every part of the legs and builds strength. Some of the best yoga poses for knee pain include the child’s pose, hero’s pose, low lunge, crescent lunge, warrior 1, warrior 2, and eagle poses (where one leg is crossed over the other).
Precautions
When is it time to see a doctor if you’re experiencing knee pain? Talk to your doctor, physical therapist, or an orthopedist if you notice lots of swelling that won’t go away, if you can’t extend or flex your knee, or if you’re having a hard time getting around and going about your normal activities.
If you’ve had a knee injury in the past, then you’re more likely to experience knee pain again in the future, especially if you never got treatment and fully recovered. Back off of any exercise that increases pain, make sure you take time to recover from tough workouts, and get your knee evaluated if symptoms last more than two weeks.
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Final Thoughts
- Knee pain is a common problem among both young active people and older adults. Knee pain symptoms include throbbing, tenderness, stiffness, swelling, loss of flexibility, and weakness in the legs.
- Underlying causes of knee pain can include injuries, arthritis, obesity, repetitive movements, overtraining, and inflammation from chronic disease or unhealthy lifestyle habits.
- Doctors commonly treat knee pain with physical therapy, steroids, painkillers, knee braces, shoe insoles, and rarely surgery.
- Natural treatments for knee pain include exercises, stretches, reducing inflammation caused by an underlying disease, exercising/recovering appropriately, maintaining a healthy weight, foam rolling, and wearing supportive shoes.