Knee pain is a widespread issue, particularly among women and older adults. From a sharp, sudden twinge to a persistent, dull ache, discomfort in your knees can significantly impact your daily life. A study featured in Arthritis & Rheumatism highlighted just how common this problem is, revealing that nearly two-thirds of women over 50 experienced some form of knee pain over a 12-year period. If you’re experiencing aching knees, you’re far from alone, and understanding the reasons behind this pain is the first step towards finding effective relief.
Dr. Rebecca Breslow, a sports medicine expert and orthopedic surgery instructor at Harvard Medical School, frequently encounters knee pain in her active older female patients and athletes. While numerous conditions can trigger knee pain, she points to three as particularly prevalent in older women: patellofemoral pain syndrome, chronic degenerative meniscal tears, and early osteoarthritis. Let’s delve into these common culprits and explore strategies to address and alleviate your aching knees.
Common Causes of Aching Knees
To effectively manage your knee pain, it’s essential to identify the underlying cause. Here’s a closer look at the three conditions Dr. Breslow highlights, helping you understand what might be contributing to your aching knees.
Patellofemoral Pain Syndrome: The Front Knee Ache
Do you experience a persistent, dull ache in the front of your knee? Does this pain intensify when you tackle stairs, bend down to pick something up, or squat? If so, you might be experiencing patellofemoral pain syndrome. Often referred to as “runner’s knee” or “jumper’s knee,” this condition is a broad term describing pain originating in the front of the knee, often around or beneath the kneecap.
Woman holding her painful knee, illustrating patellofemoral pain syndrome
The pain in patellofemoral pain syndrome stems from irritation and swelling of the structures in this area. This can include ligaments and tendons crucial for kneecap stability, or the cartilage cushioning the underside of your kneecap. Beyond a dull ache, you might also notice “movie-theater knee”—pain after prolonged sitting—or hear popping or cracking sounds when you move your knee.
Structural imbalances in your legs and knees can also contribute to patellofemoral pain. For instance, if muscles on one side of your knee are stronger or tighter than the other, your kneecap might not glide smoothly within its groove (the trochlear groove). This improper movement, especially during knee bending, can lead to irritation and pain. Weak or unstable hip muscles, or inflexibility in your leg muscles, can also place undue strain on your knees.
“Patellofemoral pain syndrome is often multifaceted,” Dr. Breslow explains. “It can arise from muscle imbalances, flexibility issues, or simply the cumulative effect of wear and tear over time.”
Treating Patellofemoral Pain Syndrome:
The initial approach to managing patellofemoral pain often involves activity modification. Try reducing or avoiding activities that aggravate your knee pain for a couple of weeks and observe if your symptoms improve.
If the pain persists, seeking medical advice is recommended. Your doctor might suggest a referral to a physical therapist. Physical therapy plays a vital role in strengthening the muscles around your knee, enhancing your range of motion, and facilitating recovery. Therapy often extends beyond the knee itself, focusing on improving core strength in your abdomen, back, and hips. A strong core helps redistribute pressure, reducing stress on your knees. Furthermore, a physical therapist can assess your body alignment to address any structural issues that may be contributing to your patellofemoral pain.
It’s important to understand that physical therapy requires commitment and consistent effort. “Physical therapy is highly effective in most cases of patellofemoral pain, but patient engagement is key,” Dr. Breslow emphasizes. “It’s not a quick fix solution.” Partial effort or premature abandonment of physical therapy is unlikely to yield significant benefits.
Chronic Degenerative Meniscal Tear: When Cartilage Wears Down
If you’re experiencing knee swelling, joint line pain, and a sensation of your knee catching, sticking, or locking, a chronic degenerative meniscal tear could be the underlying issue.
Menisci are crescent-shaped cartilage pads in your knee joint, acting as cushions between your thighbone (femur) and shinbone (tibia). Each knee has two menisci. While meniscal tears are often associated with acute injuries, degenerative tears develop gradually over time. “In degenerative cases, the meniscus cartilage simply wears down and frays due to aging and repetitive use, leading to tissue breakdown and tearing,” explains Dr. Breslow. When the meniscus becomes frayed, loose fragments can become trapped within the joint during movement, causing the knee to feel like it’s locking up. If you experience these symptoms, medical evaluation is crucial.
Treating Chronic Degenerative Meniscal Tears:
The treatment paradigm for chronic degenerative meniscal tears has shifted. Surgery is no longer the automatic first-line recommendation. “Traditionally, arthroscopic surgery to remove or repair the torn meniscus was common,” Dr. Breslow notes. “However, current research indicates that non-operative management, particularly physical therapy, can be equally effective in many cases.”
Physical therapy is increasingly favored as the initial treatment approach. Similar to patellofemoral pain syndrome, strengthening surrounding muscles and addressing biomechanics can alleviate pain and improve function without the risks associated with surgery. However, surgery might be necessary if a meniscal fragment is significantly obstructing knee joint motion.
Short-term pain relief can be achieved with anti-inflammatory medications like ibuprofen (Advil, Motrin) or naproxen (Aleve). “However, these medications are not a long-term solution and do not address the underlying problem. Prolonged use can also carry potential side effects,” cautions Dr. Breslow.
Early Osteoarthritis: Morning Stiffness and Joint Swelling
Do you experience stiffness, pain, and swelling in your knees, especially noticeable in the morning or after periods of inactivity? Suspect early osteoarthritis. While osteoarthritis is most common in individuals over 50, it can also affect younger people.
Osteoarthritis, a chronic condition characterized by joint inflammation, affects millions of adults. “Early knee osteoarthritis, similar to other degenerative conditions, arises from cartilage wear and tear. However, a prior knee injury is a significant risk factor,” says Dr. Breslow. Past injuries, such as meniscus or ligament tears (like ACL tears), particularly from sports, can accelerate osteoarthritis development.
Osteoarthritis can affect any joint, but the knees are frequently involved. The hallmark of knee osteoarthritis is the gradual breakdown of cartilage, leading to bone-on-bone friction within the joint, causing pain, stiffness, and swelling. Bone spurs can also develop as part of the degenerative process. Symptoms typically worsen progressively as the knee joint deteriorates further.
Treating Early Osteoarthritis:
Treatment strategies for knee osteoarthritis are often tailored to individual factors, including age. “The only definitive surgical intervention for knee osteoarthritis is knee replacement,” Dr. Breslow states. However, artificial knee joints have a limited lifespan, making surgeons hesitant to perform replacements in younger individuals to avoid the need for revision surgeries later in life. “The primary goal is typically to delay surgical intervention as long as feasible,” she adds.
Non-surgical management focuses on pain control. Nonsteroidal anti-inflammatory drugs (NSAIDs) and, in some cases, cortisone injections are used to manage pain and inflammation (see sidebar on cortisone shots below).
Physical therapy is also a cornerstone of osteoarthritis management. “I strongly recommend physical therapy to osteoarthritis patients to strengthen the muscles surrounding the knee, pelvis, and core,” Dr. Breslow advises. Stronger muscles act as a support system, reducing stress and strain on the knee joint. “While we cannot regenerate lost cartilage, we can implement measures to slow down the progression of osteoarthritis and manage symptoms effectively.”
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The Role of Cortisone Shots in Knee Pain Management
Cortisone shots, involving injections of a corticosteroid drug and a local anesthetic into the knee joint, are sometimes recommended to alleviate pain and inflammation. These injections can provide temporary pain relief, creating a window of opportunity to engage in physical therapy and rehabilitation. “People often believe cortisone injections will ‘fix’ their knee problem. In reality, they offer pain relief to facilitate progress in rehabilitation,” clarifies Dr. Rebecca Breslow.
However, cortisone shots are not a long-term solution. “Overuse of cortisone injections has been linked to potential acceleration of osteoarthritis in some studies,” Dr. Breslow cautions. Therefore, while cortisone shots can be a valuable tool to manage acute pain and enable rehabilitation, they should be used judiciously and are not a substitute for addressing the underlying cause of knee pain.
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Proactive Steps: Can You Prevent Knee Problems?
While not all knee problems are entirely preventable, you can significantly reduce your risk through proactive measures, particularly regular strength training. “Strong core and leg muscles are crucial for knee health,” emphasizes Dr. Rebecca Breslow. Aim for strength training exercises at least twice a week. In addition, incorporating flexibility exercises can further protect your knees and help prevent injuries. Prioritizing overall physical fitness and muscle strength is a key strategy in maintaining healthy, pain-free knees.
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Seeking Professional Guidance
If you are experiencing persistent or worsening knee pain, it is crucial to consult with a healthcare professional. Accurate diagnosis is essential to determine the underlying cause of your aching knees and to develop an appropriate and effective treatment plan tailored to your specific needs. Don’t hesitate to seek medical advice to get back on the path to pain-free movement and improved knee health.
Image: © spukkato/Getty Images depicting knee pain
