Mundane body decay question
September 29, 2022 7:48 AM Subscribe
Having knee pain. Nothing excruciating, just run of the mill, middle aged pain around one knee. If I don't get regular aerobic exercise, bad things happen to my mental health, so the idea of resting it does not seem good to me. What are the current evidence based strategies for reducing this common kind of joint pain? Knee brace, ice, heat, NSAIDs, elevating, rest, stretching... what do we have some data to support here?
Visiting a physiotherapist to get treatment that’s specific to your knee pain.
Knee pain’s not just one thing where you can put it in a research database and ping out a list of results that will work for every instance. It could be caused by a whole range of different biomechanical problems, some of which originate elsewhere in the body. Looking at your body hands on, working out what’s causing your pain and providing targeted exercises to overcome it is what physios are for.
It’s totally possible that a few weeks of a specific set of relatively simple (in fact often quite tedious) exercises will resolve or reduce this, but they have to be targeted at the right thing.
posted by penguin pie at 8:10 AM on September 29, 2022 [13 favorites]
Knee pain’s not just one thing where you can put it in a research database and ping out a list of results that will work for every instance. It could be caused by a whole range of different biomechanical problems, some of which originate elsewhere in the body. Looking at your body hands on, working out what’s causing your pain and providing targeted exercises to overcome it is what physios are for.
It’s totally possible that a few weeks of a specific set of relatively simple (in fact often quite tedious) exercises will resolve or reduce this, but they have to be targeted at the right thing.
posted by penguin pie at 8:10 AM on September 29, 2022 [13 favorites]
Also, see a podiatrist about your exercise shoes, because a lack of arch support or a lack of ankle support can = knee pain.
posted by chariot pulled by cassowaries at 8:10 AM on September 29, 2022 [8 favorites]
posted by chariot pulled by cassowaries at 8:10 AM on September 29, 2022 [8 favorites]
Seconding Penguin Pie to see a physiotherapist to make sure something else isn't going on.
You may also want to add some gentle "let's keep the knee joint conditioned" exercises; this set of exercises from the free site Darebee is expressly designed to rehab a knee post-injury, and to keep a knee in optimal condition. It also got the thumbs-up from my own physical therapist, when I was graduating away from consults for my own broken knee.
posted by EmpressCallipygos at 8:21 AM on September 29, 2022 [4 favorites]
You may also want to add some gentle "let's keep the knee joint conditioned" exercises; this set of exercises from the free site Darebee is expressly designed to rehab a knee post-injury, and to keep a knee in optimal condition. It also got the thumbs-up from my own physical therapist, when I was graduating away from consults for my own broken knee.
posted by EmpressCallipygos at 8:21 AM on September 29, 2022 [4 favorites]
If I don't get regular aerobic exercise, bad things happen to my mental health, so the idea of resting it does not seem good to me.
Consider that this is a mechanical joint, like wood rubbing against wood with some seaweed holding it all together. If resting is what will keep it functional then that's what has to happen*. You have to figure out how to get the aerobic effect without aggravating it. My advice is that going down a path of "I don't care what this thing wants if I want something directly opposed to that" isn't going to be the best long term strategy.
*Please consult with a professional to make this determination.
posted by bleep at 8:43 AM on September 29, 2022 [4 favorites]
Consider that this is a mechanical joint, like wood rubbing against wood with some seaweed holding it all together. If resting is what will keep it functional then that's what has to happen*. You have to figure out how to get the aerobic effect without aggravating it. My advice is that going down a path of "I don't care what this thing wants if I want something directly opposed to that" isn't going to be the best long term strategy.
*Please consult with a professional to make this determination.
posted by bleep at 8:43 AM on September 29, 2022 [4 favorites]
I was tangentially involved in one of the studies referenced in this NYT piece. The long and short of it is, as weird as it sounds, exercise itself has the best long- and short-range outcomes for managing this kind of pain.
This is a very active research area in public health. If you're interested in doing a deep dive, drop me a line and I can give you a recommended reading list from the scientific literature. And, yes, good contact with your healthcare providers—along with a PT if you have access—is A+ prevetion and management.
posted by late afternoon dreaming hotel at 9:03 AM on September 29, 2022 [5 favorites]
This is a very active research area in public health. If you're interested in doing a deep dive, drop me a line and I can give you a recommended reading list from the scientific literature. And, yes, good contact with your healthcare providers—along with a PT if you have access—is A+ prevetion and management.
posted by late afternoon dreaming hotel at 9:03 AM on September 29, 2022 [5 favorites]
With the caveat that as pointed out above, not all knee pain is identical: My doctor told me that one thing I can do to minimize knee pain is strengthen the muscle on the front of the thigh (like the muscle above your kneecap), She told me to do the thing where you sit on a chair and then raise your foot straight out in front of you and then take it down. Presumably a weighted version of this would strengthen the muscle even more. She said that ME knee pain was caused by the joint wearing down and rubbing and that be strengthening this muscle it would pull the knee up in a way or something like that so it rubbed less. My experience of this is that when I have done this exercise it has helped.
posted by If only I had a penguin... at 9:21 AM on September 29, 2022 [2 favorites]
posted by If only I had a penguin... at 9:21 AM on September 29, 2022 [2 favorites]
I saw an orthopedist who diagnosed a meniscal tear and sent me to PT. The source of your knee pain may be different, but the route to fixing it almost certainly goes through PT.
posted by fedward at 9:31 AM on September 29, 2022
posted by fedward at 9:31 AM on September 29, 2022
Strength training!! Find a PT/trainer combo. I have had zero serious knee pain since starting strength training. I might get a tweak every so often but I just modify what I’m doing and it’s better in a few days.
posted by haptic_avenger at 9:42 AM on September 29, 2022
posted by haptic_avenger at 9:42 AM on September 29, 2022
About PTs: it is important to seek out a PT who works with athletes and understands the importance of staying active and not getting deconditioned. Most PTs assign very minimal home exercises for the kinds of injuries that active people get, and even discourage activity. Like, I had one PT instruct me to do wall sits for 5 seconds (when I was regularly doing 60 seconds with no pain).
posted by haptic_avenger at 9:45 AM on September 29, 2022 [3 favorites]
posted by haptic_avenger at 9:45 AM on September 29, 2022 [3 favorites]
You really need to know WHAT the pain is. Physical therapy - even a single out-of-pocket visit if you have to and can swing it, but any GP should be glad to authorize PT for middle-aged creaks - could get you that answer and some kind of solution. Because a tight tendon is a very different thing than bone grinding on bone, or actual soft tissue damage that needs treatment or intervention. (And a tight tendon should be loosened safely so you don't snap it.)
That assessment is also going to explore if you have underlying issues with bone density or a connective tissue disorder. Those require additional medical treatment, nothing you do at home will be enough.
But even if you DO have arthritis or similar, PTs can give you homework exercises that will strengthen the compensating infrastructure and keep the damaged parts more protected, and also advise what kind of exercise is and isn't a good idea with that kind of damage.
Things like rest, ice, heat, supportive braces and/or restrictive braces, stretching, and strengthening; those aren't each some one-stop shop for fixing things. If you have damage, you have to a) stop damaging it b) let it recover using various tools including rest, compression, temperature treatment, anti-inflammatories etc c) proceed in ways that do not damage it more. If you have an underdevelopment, you have to a) start developing it b) treat the resulting (temporary, is the goal) damage/pain/inflammation properly so it doesn't become permanent using the various tools c) keep it up on a routine that balances cumulative effort versus damaging over-exertion.
Physical Therapy is the evidence-based training that determines the appropriate course of action. I wish everybody had immediate access to PT, because there are SO many complaints we're all walking around with that can be treated with what is basically prescription movement. When I broke my leg just below my knee, my PT didn't only give me those thigh-strengthening exercises and advice for reducing my pain, she gave me some stretches for all the parts of me that hurt because I had to walk funny - my back and neck were miserable, I was also struggling with getting up and down from chairs/bed and they showed me how to do that safely for my body and also for lowering my risk of falling. She's also walked me through specific stretching for being a person who uses computers and devices all day. It's good stuff, if you have access to it.
posted by Lyn Never at 9:56 AM on September 29, 2022 [1 favorite]
That assessment is also going to explore if you have underlying issues with bone density or a connective tissue disorder. Those require additional medical treatment, nothing you do at home will be enough.
But even if you DO have arthritis or similar, PTs can give you homework exercises that will strengthen the compensating infrastructure and keep the damaged parts more protected, and also advise what kind of exercise is and isn't a good idea with that kind of damage.
Things like rest, ice, heat, supportive braces and/or restrictive braces, stretching, and strengthening; those aren't each some one-stop shop for fixing things. If you have damage, you have to a) stop damaging it b) let it recover using various tools including rest, compression, temperature treatment, anti-inflammatories etc c) proceed in ways that do not damage it more. If you have an underdevelopment, you have to a) start developing it b) treat the resulting (temporary, is the goal) damage/pain/inflammation properly so it doesn't become permanent using the various tools c) keep it up on a routine that balances cumulative effort versus damaging over-exertion.
Physical Therapy is the evidence-based training that determines the appropriate course of action. I wish everybody had immediate access to PT, because there are SO many complaints we're all walking around with that can be treated with what is basically prescription movement. When I broke my leg just below my knee, my PT didn't only give me those thigh-strengthening exercises and advice for reducing my pain, she gave me some stretches for all the parts of me that hurt because I had to walk funny - my back and neck were miserable, I was also struggling with getting up and down from chairs/bed and they showed me how to do that safely for my body and also for lowering my risk of falling. She's also walked me through specific stretching for being a person who uses computers and devices all day. It's good stuff, if you have access to it.
posted by Lyn Never at 9:56 AM on September 29, 2022 [1 favorite]
Nthing a physical therapist. In addition to giving me helpful diagnostic information and exercises to remediate my knee and ankle issues, mine answered questions like, "What kind of pain is ok to work through, and what kind of pain is a signal to rest? How do I tell the difference?" That knowledge alone was worth its weight in gold.
posted by ourobouros at 10:34 AM on September 29, 2022 [1 favorite]
posted by ourobouros at 10:34 AM on September 29, 2022 [1 favorite]
Diagnostics are just really important… I’ve had various knee issues, the most recent one ended up being a high grade chondral fissure. With that, basically I can never apply shear force (lift weights) or kneel again, at least unless I get a total knee replacement in a couple decades. I went in going, “ok, so what are my exercises” and was told “uh, sorry, no exercises are going to be helping with that”. So, best to be cautious imo.
(Like the particulars of treatment etc might be different in the US, for example people there can get other kinds of surgeries for my issue, younger - but either way it might be a surgery or activity restrictions you’ll need).
posted by cotton dress sock at 11:07 AM on September 29, 2022 [2 favorites]
(Like the particulars of treatment etc might be different in the US, for example people there can get other kinds of surgeries for my issue, younger - but either way it might be a surgery or activity restrictions you’ll need).
posted by cotton dress sock at 11:07 AM on September 29, 2022 [2 favorites]
Non-empirical, but helps my wife who has no remaining cartilage in one knee: Barefoot/minimalist shoes
I gave myself an ulcer with ibuprofen when I was using it to treat anxiety/insomnia/migraines, so you may wish to explore turmeric with bioperine
posted by mecran01 at 11:35 AM on September 29, 2022 [1 favorite]
I gave myself an ulcer with ibuprofen when I was using it to treat anxiety/insomnia/migraines, so you may wish to explore turmeric with bioperine
posted by mecran01 at 11:35 AM on September 29, 2022 [1 favorite]
Adding to the chorus for a PT to see what is *your* issue. But ideas that haven't been mentioned are
- do something different for a while. If you run, bike. If you bike, swim. Vary it up to keep the stress from being the same all the time.
- Topical CBD might also help. They take the edge off mine so I can sleep.
posted by cfraenkel at 12:41 PM on September 29, 2022
- do something different for a while. If you run, bike. If you bike, swim. Vary it up to keep the stress from being the same all the time.
- Topical CBD might also help. They take the edge off mine so I can sleep.
posted by cfraenkel at 12:41 PM on September 29, 2022
Can you replace some of your activities with lower impact activities? Swimming is extremely easy on the joints. Other options could be switching from running to cycling or downhill skiing to cross-country. Off-course a doctor or PT can guide you on your options!
posted by Gor-ella at 1:57 PM on September 29, 2022
posted by Gor-ella at 1:57 PM on September 29, 2022
She told me to do the thing where you sit on a chair and then raise your foot straight out in front of you and then take it down.
My myotherapist gave me the same advice, with the addition of lightly pressing a finger onto the kneeward end of the vastus medialis muscle while you're doing the raise so that you can make sure you're activating it every single time.
I haven't been remembering to do the six reps twice per day that she said I should be, but even so I have been finding that my knee pain is reducing and soon I expect to be able to do my regular walks again without further damaging my knee in the process.
You won't get much mental health benefit from going for a walk if your knees end up hurting so much that you can't walk fast enough to raise your heart rate, which could easily happen if you fail to prioritize the needs of your legs over those of your mind.
While you're resting your legs, perhaps you could pick up some kind of upper-body workout and raise your heart rate that way? I have a djembe that's good for this for me.
posted by flabdablet at 3:29 PM on September 29, 2022 [1 favorite]
My myotherapist gave me the same advice, with the addition of lightly pressing a finger onto the kneeward end of the vastus medialis muscle while you're doing the raise so that you can make sure you're activating it every single time.
I haven't been remembering to do the six reps twice per day that she said I should be, but even so I have been finding that my knee pain is reducing and soon I expect to be able to do my regular walks again without further damaging my knee in the process.
You won't get much mental health benefit from going for a walk if your knees end up hurting so much that you can't walk fast enough to raise your heart rate, which could easily happen if you fail to prioritize the needs of your legs over those of your mind.
While you're resting your legs, perhaps you could pick up some kind of upper-body workout and raise your heart rate that way? I have a djembe that's good for this for me.
posted by flabdablet at 3:29 PM on September 29, 2022 [1 favorite]
Agreed on all the above with regards to PT. My PT has gotten both Ms. Windo and I through ACLs, and is now helping me with this sciatica I've gotten. She is just the best. She is very anti-pain, which is also pretty great.
Good Luck!
Knees Suck!
posted by Windopaene at 5:10 PM on September 29, 2022
Good Luck!
Knees Suck!
posted by Windopaene at 5:10 PM on September 29, 2022
Nthing "see a physio". There's no such thing as General Knee Pain that will be solved by all or any General Knee Pain solutions. You need to know what's causing your knee pain and what exercise or rest or medication or applications will fix it over time.
posted by fabius at 4:49 AM on September 30, 2022 [1 favorite]
posted by fabius at 4:49 AM on September 30, 2022 [1 favorite]
I caved to peer pressure and got a Peloton during the pandemic, and it has been awesome for my knees, which were never in great shape and got much worse in the last couple of years. That plus strength training and PT has gotten my knees back to about 80% functionality, and still improving. Cycling has been a lot better for me than running, and it satisfies that craving for intense exercise.
posted by decathecting at 5:36 PM on October 1, 2022
posted by decathecting at 5:36 PM on October 1, 2022
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Slow walking is better than fast walking; fast walking is better than jogging. The faster you go, the more impact on your knees.
Source = my physiotherapist.
also avoid stairs as much as possible. Stairs are hell on knees. Source = my physiotherapist.
posted by chariot pulled by cassowaries at 8:09 AM on September 29, 2022