Knee Pain
Strategies for Pain Relief
“Running ruins your knees.” It’s a statement therapists have been repeating for more than 30 years. The reality is quite different from what we’ve been led to believe. Let’s start with a quick anatomy lesson.
Cartilage is a firm, flexible type of connective tissue that cushions the bones of the knee and other joints. Cartilage doesn’t have any nerves or a blood supply. So if you run a lot and repeatedly stress the cartilage, doctors believed it simply broke down.
But that’s not what clinical studies found. Researchers went through 43 MRI studies to determine what effect running had on cartilage. They discovered that running caused a “small and moderate decrease” in knee cartilage volume, but the effect was short-lived. “Repeated running exposure did not cause changes to foot and ankle cartilage thickness or composition.”
It turns out that walking and running are precisely the actions required for cartilage to heal. When you take a step, your joints compress and squeeze the cartilage like a sponge. That pushes waste product out and draws in nutrient and oxygen-rich fluid. When someone abruptly stops running or walking, they may be making things worse because now the cartilage will no longer be squeezed. That prevents waste products from being pushed out, and it’s no longer drawing in nutrients to heal.
A study published in June of 2022 highlights the advantages walking gives. 1,212 people participated in the study, and researchers found that “New frequent knee pain... was less common in those who walked.” Researchers concluded that “Walking for exercise should be ENCOURAGED for people with knee osteoarthritis.”
If you’re considering a surgical procedure called arthroscopy, think again. When an expert panel reviewed what happened after arthroscopic procedures, they concluded, “We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation.”
Here’s where a lack of regulation causes problems. This may surprise many people, but no state or federal agency regulates surgical procedures.
When you take prescription medicine, numerous tests, drug trials and safety protocols are put in place to ensure that the prescription will help more than harm. No such system exists for surgical procedures. You’re at the mercy of your doctor and their experiences.
The results were shocking when clinical trials were conducted to see if meniscus surgery was beneficial. Surgery offered little relief for the majority of patients. Yes, patients reported less pain after surgery, but less pain was reported no matter what treatment was involved, even fake surgery.
Researchers said knee arthroscopies are “A highly questionable practice without supporting evidence of even moderate quality.” Regular exercise was seen as significantly more beneficial, less costly and with far fewer risks of side effects.
Our bodies have limits. Doing too much of anything can cause repetitive stress injuries or overload your body’s ability to heal. If knee pain continues for more than an hour after exercise, that’s a sign you’ve done too much. Consider fewer long-duration runs and try more short, high-intensity intervals.
If you’re overweight, dropping a few pounds can help a lot. Extra weight constantly squeezes the cartilage, preventing it from expanding and drawing in the nutrients necessary to heal.
You also need to strengthen the muscles around the knee. Numerous variations of squats and lunges can be done with and without weights.
Don't ice the problem area. Soft tissue injuries must go through three stages of healing; inflammation, repair and remodeling. If you don't experience the first, you can't get to the second or third. Since icing a soft tissue injury reduces inflammation, you're slowing down how fast you can heal.
Finally, say NO to anti-inflammatory drugs. Inflammation is part of the healing process, so you're delaying recovery if you take medication to reduce inflammation. Nursing organizations now recommend acetaminophen for mild to moderate pain relief rather than anti-inflammatories.
BOTTOM LINE: Exercise will NOT raise your odds of developing knee pain or arthritis. Regular exercise can LESSEN arthritis by strengthening the muscles around the knee, improving repair and healing to the cartilage and reducing inflammation. PLUS, if you keep moving, your weight will probably be less, reducing the load your knees will have to bear and extending the benefits of exercise even further.
Reference Links:
The Influence of Running on Lower Limb Cartilage: A Systematic Review and Meta-analysis
Michaela C M Khan, James O'Donovan, Jesse M Charlton, Jean-Sébastien Roy, Michael A Hunt, Jean-Francois Esculier
Sports Medicine, 2022 Jan;52(1):55-74. doi: 10.1007/s40279-021-01533-7. Epub 2021 Sep 3.
Functional adaptation of knee cartilage in asymptomatic female novice runners compared to sedentary controls. A longitudinal analysis using delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC)
A. Van Ginckel, N. Baelde, K.F. Almqvist, P. Roosen, P. McNair, E. Witvrouw
Osteoarthritis and Cartilage, VOLUME 18, ISSUE 12, P1564-1569, DECEMBER 01, 2010
Medial knee cartilage is unlikely to withstand a lifetime of running without positive adaptation: a theoretical biomechanical model of failure phenomena
Ross H. Miller, Rebecca L. Krupenevich
Peer J, Published August 5, 2020
Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals with Knee Osteoarthritis: Data from the Osteoarthritis Initiative Cohort
Grace H. Lo MD MSc, Surabhi Vinod MD, Michael J. Richard BS, Matthew S. Harkey PhD, Timothy E. McAlindon MD, Andrea M. Kriska PhD, Bonny Rockette-Wagner PhD, Charles B. Eaton MD, Marc C. Hochberg MD, Rebecca D. Jackson MD, C. Kent Kwoh MD, Michael C. Nevitt PhD, Jeffrey B. Driban PhD
Arthritis & Rheumatology, 08 June 2022 https://doi.org/10.1002/art.42241
Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline
Reed A C Siemieniuk, Ian A Harris, Thomas Agoritsas, Rudolf W Poolman, Romina Brignardello-Petersen, Stijn Van de Velde, Rachelle Buchbinder, Martin Englund, Lyubov Lytvyn, Casey Quinlan, Lise Helsingen, Gunnar Knutsen, Nina Rydland Olsen, Helen Macdonald, Louise Hailey, Hazel M Wilson, Anne Lydiatt, Annette Kristiansen
the BMJ, 10.1136/bmj.j1982 on 10 May 2017.
Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis
Jeffrey N. Katz, M.D., Robert H. Brophy, M.D., Christine E. Chaisson, M.P.H., Leigh de Chaves, P.T., O.C.S., Brian J. Cole, M.D., M.B.A., Diane L. Dahm, M.D., Laurel A. Donnell-Fink, M.P.H., Ali Guermazi, M.D., Ph.D., Amanda K. Haas, M.A., Morgan H. Jones, M.D., M.P.H., Bruce A. Levy, M.D., Lisa A. Mandl, M.D., M.P.H., et al.
The New England Journal of Medicine, May 2, 2013, N Engl J Med 2013; 368:1675-1684, DOI: 10.1056/NEJMoa1301408
Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms
J B Thorlund, associate professor1, C B Juhl, assistant professor, E M Roos, professor, L S Lohmander, professor
the BJM, 2015; 350 doi: https://doi.org/10.1136/bmj.h2747 (Published 16 June 2015)
Arthroscopic surgery for knee pain
Teppo L N Järvinen, professor, Gordon H Guyatt, distinguished professor
the BMJ, 2016; 354 doi: https://doi.org/10.1136/bmj.i3934 (Published 20 July 2016)
Recreational Physical Activity and Risk of Incident Knee Osteoarthritis: An International Meta-Analysis of Individual Participant–Level Data
Lucy S. Gates, Thomas A. Perry, Yvonne M. Golightly, Amanda E. Nelson, Leigh F. Callahan, David Felson, Michael Nevitt, Graeme Jones, Cyrus Cooper, Mark E. Batt, Maria T. Sanchez-Santos, Nigel K. Arden
Arthritis and Rheumatology, 03 November 2021 https://doi.org/10.1002/art.42001
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7/24/2022
Updated 4/24/2023
