Unlocking Solutions to Chronic Knee Pain

Knee pain is one of the top reasons men visit their doctor. While the pain and soreness often can go away with rest, ice, and over-the-counter pain medications, if it becomes too severe or fails to abate in a timely manner, you may need to take further action.

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“If your knee pain is not a result of some kind of structural or mechanical issue that requires surgery, or due to osteoarthritis, there are other options that may help eliminate or better control the pain,” says Dr. Lars Richardson, a sports medicine orthopedic surgeon with Harvard-affiliated Massachusetts General Hospital.

“It depends on the person, the source of the pain, and its severity, but sometimes applying certain treatments and making lifestyle modifications can
offer relief.”

Changing your habits

Knee pain becomes more common as you age from simple wear and tear. Years of walking, running, and routine activities can cause the joint to weaken and become prone to inflammation. While you cannot turn back the clock on your knees, you can make changes to lessen the stress.

Here are some suggestions:

  • Manage your weight. Your knee supports about one-and-a-half times your body weight with each step. And every pound of excess weight exerts about four pounds of extra pressure on the knees. That means a man who is 10 pounds overweight places 40 pounds more pressure on his joints.
  • Modify your exercise. If you participate in high-impact activities like running, or sports that require quick starts and stops like tennis or aerobic classes, you might want to switch to low-impact exercise, such as swimming, biking, elliptical training, or walking. “There are many ways to stay active while placing less stress on your knees,” says Dr. Richardson.
  • Retrain your gait. Your usual habit of standing and walking may put excess strain on your knee that can lead to pain. A physical therapist can analyze your gait and teach you how to move more efficiently.
  • Build your core. While strengthening the thigh muscles can help keep your knees stable for easier range of motion, research has shown that strengthening your core and hip muscles can offer protection, too. “Think crunches and planks for your core and step-ups that work the gluteus maximus and medius muscles around your pelvis, which together keep your gait steady and prevent your knees from rotating inward,” says Dr. Richardson.

Common injury: Torn meniscus

Sometimes the source of your knee pain is an injury, the most common of which is a torn meniscus—the cartilage between the bones in the knee. (See “Meniscus tear”) This too is often a result of normal aging. “Over time, the meniscus loses its blood supply, dries out, and becomes more susceptible to tearing,” says Dr. Richardson. “Something as simple as a quick twist or locking knee can cause a tear.”

A meniscus tear cannot naturally heal and pain tends to come and go. You often can manage the pain with the traditional treatments previously mentioned. However, if it becomes too severe and/or begins to interfere with daily life (and depending on the type of tear) you may need arthroscopic surgery to diagnose and fix the damage.

Arthroscopic surgery at work

During the surgery, two small incisions are made in your knee. Saline fluid is then pumped into your knee to stretch it. The surgeon then inserts an arthroscope (a small instrument, about the size of a pencil, with a miniature camera on its tip) through one of the incisions and into your knee joint.

The camera sends an image to a television monitor so the surgeon can see the knee structure in detail. Tiny instruments—such as scissors, motorized shavers, or lasers—are inserted through the other incision to repair damage or remove tissue. The entire process takes up to an hour, on average. During recovery, you elevate the leg as much as possible for several days. Ice application and medication can help with swelling and pain.

You can return to most physical activities after six to eight weeks. However, you might be able to drive after one to three weeks, according to Dr. Richardson.

Besides correcting this injury, the surgery also can address other pain-related knee issues that tend to affect older men.

For instance, the surgeon might remove loose fragments of bone or cartilage. He or she also might smooth or trim torn pieces of articular cartilage, the smooth, white tissue that covers the ends of bones. This elastic material helps absorb shock that occurs when walking down hills and climbing stairs, and it allows the knee joint to move freely. Pain due to articular cartilage problems can occur under and around the kneecap (patella).

Limits of surgery

As with almost any kind of surgery, arthroscopy has its limits. For instance, it may not guarantee long-term relief. A recent meta-analysis of nine trials published in 2015 in The BMJ found that after two years, arthroscopic surgery produced only a small effect on pain relief for older adults with a torn meniscus, which was equivalent to taking over-the-counter acetaminophen.

Also, the surgery cannot help with pain due to osteoarthritis, says Dr. Richardson. “In this case, pain medication and lifestyle changes may help alleviate the pain; otherwise, a total or partial knee replacement may be required,” he says.

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