About 31 million people live with the pain of osteoarthritis, the wear-and-tear form of arthritis, according to the Arthritis Foundation. Osteoarthritis is the most common cause of disability among adults, and it frequently appears in the knee joints. Once the disease process has started, there’s no way to reverse the joint damage — which is why it's so important to prevent knee osteoarthritis from progressing.
The likelihood of developing knee osteoarthritis symptoms increases with each decade of your life, especially between the ages of 55 and 64, says a 2018 report by the Arthritis Foundation. The number of people affected by osteoarthritis has been steadily increasing in recent decades, possibly due to the growing rates of obesity and an aging population. In American military veterans, the prevalence is even higher: The Arthritis Foundation says that one out of every three veterans suffers from arthritis.
The symptoms of osteoarthritis tend to develop slowly over time. Your knees may hurt while (or after) you move them, and may feel tender when you apply even light pressure to them. If you’ve been inactive for a period of time, your knees might start to feel stiff, or you might not be able to move your knees through their full range of motion. You may even feel or hear a grating sensation when you move your knees. These symptoms occur because of changes to cartilage, the firm tissue between your joints that helps with motion. When the cartilage becomes rough or wears down completely, this causes bone to rub on bone.
Besides age and obesity, other factors can also put you at greater risk for developing osteoarthritis knee pain. For example, the Arthritis Foundation says that former athletes who may have done repetitive movements or sustained injuries from playing sports can be susceptible to knee osteoarthritis, even if these occurred years ago; jobs that cause repetitive stress injuries to your knees also pose a similar risk. And some people are genetically predisposed to develop the condition, possibly because they inherited a trait that interferes with the body’s production of cartilage, speeding up the damage that could be done to the knee joint, according to the Arthritis Foundation.
Fortunately, there are a number of ways to manage osteoarthritis and get knee pain relief. Lifestyle changes — such as engaging in regular joint-friendly exercise and maintaining a healthy weight, along with listening to your body and taking medication as directed — can all help you manage osteoarthritis knee pain. Let’s take a look at some of these changes.
Low-impact aerobic exercises such as walking, biking, and swimming are considered joint-friendly. “They help build strength around the affected joints and keep them aligned and functioning properly,” says David Pisetsky, MD, PhD, a professor of medicine and immunology at Duke University School of Medicine in Durham, NC, and past president of the U.S. Bone and Joint Initiative. “See a physical therapist to get individualized instruction on how and when to exercise.”
Joint-pounding exercises such as running and tennis can tax your already damaged knees, Dr. Pisetsky says. It’s a vicious cycle because this type of exercise causes more pain. “You stop using your muscle because it hurts, you lose strength, and then your alignment isn’t good either,” he says. This can also result in needing joint replacement surgery. “Listen to your body,” he says. “If it is painful, don’t do it.”
A fitness plan for osteoarthritis should include strength and flexibility training along with aerobic exercise, says James Wyss, MD, a sports physiatrist at the Hospital for Special Surgery in New York City and an assistant professor of clinical rehabilitation medicine at Weill Cornell Medical College. “Strengthening exercises help support the muscles around the joint, while stretching can maintain and sometimes improve flexibility around the knee," Dr. Wyss says.
Don’t jump right into your workouts if you have knee osteoarthritis, Wyss says. In general, a warm-up lubricates your joints so you're less stiff and it’s easier to move, which lowers the risk of sustaining any injury during your workout. Cooling down helps you reset after exercise. A physical therapist or trainer can instruct you on the appropriate warm-up and cool-down exercises for you, he says.
Excess weight puts greater pressure or stress on your already damaged knees, Pisetsky explains. If you're overweight, losing weight can relieve knee pain and even slow down the rate of cartilage degeneration, according to a study in the August 2017 issue of Radiology. The research showed that the more weight participants lost, the greater their improvements were. “If you’re overweight, weight loss can help with knee pain,” Pisetsky emphasizes.
There are a fair number of studies that suggest shoe choice matters if you have knee osteoarthritis, Pisetsky says. In fact, flat, flexible shoes that mimic the foot’s natural mobility can decrease the force placed upon the knee during daily activities, according to a study published in the May 2013 issue of Arthritis and Rheumatology.
Canes and knee braces can play a role in decreasing knee osteoarthritis pain and improving function, Pisetsky says. “There can be a period of time when knee pain is disabling but it’s not the right time for surgery, so that’s when assistive devices can make a difference,” he explains. An occupational therapist can work with you to choose appropriate assistive devices.
“A medical team that treats knee osteoarthritis should include a physician, such as a physiatrist, rheumatologist, or sports medicine specialist, to guide non-operative treatment,” Wyss says. “A physical therapist and possibly a nutritionist can [also] be important members of the team.”
Over-the-counter or prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) are among the mainstays of knee osteoarthritis treatment, Pisetsky says. While effective, they do come with their share of side effects, he explains. “We typically tell patients to take them as needed for pain but emphasize that they’re not used to slow disease progression,” he says.
Other treatments are also available to help relieve knee pain, stiffness, and swelling, including analgesics such as acetaminophen and injections of corticosteroids and hyaluronic acid into the joints. While corticosteroid injections are commonly performed, their long-term effects are still under investigation. Using heat and cold therapy can also help relieve symptoms; try moist heat for joint stiffness and ice for joint pain and swelling, says Wyss. Just be sure to work with your doctor to develop the best treatment strategy for you.
Knee osteoarthritis is a chronic condition, which means that pain is always possible, Pisetsky says. “However, if pain grows more severe and occurs at rest instead of after periods of activity, or if it awakens you from sleep, it could mean that your knee osteoarthritis is progressing,” he says. Other symptoms such as swelling, a locked knee, or one that just gives way are concerning, too. Let your doctor know about new or worsening symptoms, as an adjustment to your treatment plan may be necessary.