What Should I Do To Get Rid of My Knee Pain?
There are many options for pain relief for your knee. So which one is right for you? Painkillers, heat treatments and exercise are just three of the many methods that can help reduce or prevent pain. Keep reading to help you choose which one is for you.
I get it you want your pain gone but not too sure what to do or where to go to even find it.
As you can see there are so many options. And this isn't’ even a complete list… I’m sure there are other things that I missed.
Not all options work for everyone. One thing may work for another person but not you. It’s important to know there are many options out there to try and to know which options are best for what type of problem.
Should you get cortisone injections?
Cortisone injections are a steroid injected directly into the painful area for anti-inflammatory benefits.
I’ve found the people who get the most relief from cortisone injections are the ones who have so much pain they can’t sleep. They have pain most, if not all of the day and their knee keeps them up most of the night, they can’t stay asleep longer than 2 hours because the pain wakes them up.
People who don’t end up saying they got good relief from cortisone injections are people who have occasional pain, pain that comes and goes. Am I saying that these people shouldn’t get cortisone injections… no, I’m not saying that. I’m saying that the people in this category who get cortisone injections end up saying that pain didn’t really go away much compared to the people who got it because their pain was all the time.
Some considerations to consider with cortisone injections:
Long-term steroid use can worsen arthritis degeneration.
The inflammation needs to be localized to the area of injection.
Insurance may not cover it until other options are exhausted
Limited to 3x/year
Price can be expensive
Should you take NSAIDs?
NSAIDs, Non-Steroidal Anti-Inflammatory Drugs, include medications like Aleve, Advil, Motrin, and their generic forms, and aspirin. These are typically taken in pill form, though could be creams, and are used to decrease inflammation.
Many NSAIDs can be found over the counter and can help reduce pain and inflammation.
They work by targeting the inflammatory mediators at the site of inflammation. (This is different than how Tylenol works).
Some considerations for NSAIDs include:
Long-term NSAID use can cause GI and Kidney problems
NSAIDs shouldn’t be used in combination with medications that alter the blood such as blood thinners, anti-coagulants, etc
Anti-inflammatory benefits need a higher dosage than the pain relieving dosage
Over time your body adjusts to how much you’re taking and you may need more to have the desired effect
Should you take Tylenol?
Tylenol, Acetaminophen, is a pain and fever reducing medication. It is taken in pill form and can be found over the counter.
Tylenol reduces pain, though it does not touch inflammation. So if inflammation is the cause of your pain Tylenol will have little to no effect.
Tylenol works by modulating (changing) how your body perceives pain in the brain (this is different from how NSAIDS work).
Some considerations for Tylenol:
Long-term Tylenol use can affect the Liver
Tylenol is mostly broken down by the liver so beware if using alcohol heavily while taking Tylenol
Over time your body adjusts to how much you’re taking and may need more to have the desired effect
Should you ice?
Ice in the form of ice cubes in a bag, cold gel packs, cryotherapy units, etc is common for pain and inflammation. Growing up I would always hear “ice an injury” and my mom would put a bag of ice cubes on whatever I injured (it was a lot as an athlete).
Ice is easy, affordable and readily accessible for most people. It stops inflammation by cooling down the area so the blood vessels constrict to not allow more of the anti-inflammatory response from your body which involves bringing fluid to the area which makes it swell. Ice also numbs an area which stops the pain.
Some considerations for ice:
Ice in the form of ice cubes in a bag and gel packs need to be used for 20-30 minutes to be effective.
Ice needs to be used frequently in the first 1-2 weeks of the starting to use it for it to be effective. This typically looks like 5x/day for 14 days.
Use a thin layer of cloth between the gel pack and your body, ice cubes in a bag can go directly on your skin.
Should you use heat?
Heat in the form of a microwaveable heating pad, electric heating pad, warm cloth, hot bath, etc is common for pain, inflammation and tightness.
Growing up I always heard use ice, not heat for pain. But more and more I’m finding that’s not true. Some people respond better to ice and some respond better to heat, so find out which one you are and use that one.
Heat works by expanding the blood vessels to let more blood to the area. This can help bring nutrients to a healing area and take away toxins to help the body heal.
Some considerations for heat
Heat needs to be used for 20-30 minutes at a time for it to be effective
Heat needs to be used frequently in the first 1-2 weeks of using it for it be effective. This looks like a hot bath every night for 14 days, or a moist heating pad 5x/day for 14 days
Someone who has impaired sensation and cannot tell the difference between temperatures should not use heat as it can burn them without knowledge
Electric heating pads should not be left on while sleeping due to burn potential
Swelling should not get worse when using heat if it’s working correctly
Should you use a TENS unit?
A TENS unit, Transcutaneous Electrical Nerve Stimulation, is a type of pain modulation. When used properly this can modulate the way the brain perceives pain and can help localized swelling.
This is typically seen in the physical therapy clinic when they hook you up to a small or medium sized machine with 4 pads on the skin connected through wires to the machine, then you feel a buzzing or tapping sensation. This is often using simultaneously with ice or heat.
Some considerations for TENS units
Should not be used during activity
Should not be used in a way other than as described in the instruction manual
Should not be used if someone doesn’t have sensation in that area of the body
A TENS unit usually modulates that pain while the machine is on and working and for a brief time after (1-2 hours)
Should you exercise?
Exercise can include a wide array of activities. Exercise can help reduce soreness, tightness and stiffness when done correctly.
The thing with exercise is that it’s not good for getting rid of pain-pain… it is good for getting rid of soreness-pain, or tightness-pain, or stiffness-pain. So if you have a sharp, shooting, unrelenting type of pain exercise isn’t great at getting rid of that.
Gentle exercise gets rid of soreness, tightness and stiffness by moving and stretching muscles and joints to help stretch out a muscle or joint, or improve circulation to decrease stagnation or lactic acid build up.
Some considerations for exercise
Exercise may worsen symptoms when done too aggressively, incorrectly or too much
Exercise should be tolerable, it’s not “no pain, no gain”
Exercises may need to be modified to be more tolerable
Should you get a massage?
Massage is a common treatment used for muscle soreness, tightness and feelings of stiffness.
Massage doesn’t do a great job at relieving pain-pain… it is good for getting rid of soreness-pain, or tightness-pain, or stiffness-pain. So if you have a sharp, shooting, unrelenting type of pain massage isn’t great at getting rid of that.
Massage helps get rid of soreness, tightness and stiffness by improving circulation to improve blood flow and decrease lactic acid build up. It also helps work out muscle knots that can be uncomfortable.
Some considerations for massage
There are different types of massage, one may work better for you than another
Different massage therapists will have a different amount of pressure, one may work better for you than another
For someone with heart or kidney problems get clearance from your physician before getting a massage
Massage typically needs to be done for 60-90 minutes 1x/week for 1 month initially to be effective and then a regular massage 1-2x/month can be maintenance level.
Should you do acupuncture?
Acupuncture is a part of Chinese Medicine and can help relieve pain. From my basic understanding of acupuncture it works to modulate how your body perceives pain and may release endorphins.
Some considerations for acupuncture
Not for someone with significant needle phobia
May not be for someone with bleeding disorders
May not be for someone with skin infections or disorders
More: https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know
Should you eat an anti-inflammatory diet?
Anti-inflammatory diet is a general term used to describe following a plan that involves eating foods that have anti-inflammatory properties and/or avoiding foods and ingredients that increase inflammation.
An anti-inflammatory diet isn’t one particular diet… there are many of them out there. Whole30, paleo, AIP and the varying Wahls Protocols are all considered anti-inflammatory diets. There are food groups or ingredients that many people believe increase inflammation for everyone, for example gluten and dairy. However, this may or may not be true. Different foods and ingredients may affect different people differently. Two types of foods or ingredients that seem to be very consistent across most or all groups talking antiinflammatory are limiting refined sugars and processed foods because the way these types of foods break down in the body create a reaction that increases inflammation in the body.
Some considerations with anti-inflammatory diets
Good at controlling inflammation, does not cure disease so someone on an anti-inflammatory diet may still need medical management throughout their life
A significant lifestyle change
Requires reading all food labels and asking questions when dining or ordering out
It’s not just cutting out one or two food ingredients (like candy and bread)
Many options to follow based on your specific likes and needs
https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
Should you do gel injections?
Gel injections are a type of shot to relieve pain and improve cushioning in your knee. These are typically used for someone after they have tried and failed other treatments like steroid, NSAIDs, creams, Tylenol, etc. These work by injecting a substance into your knee that naturally occurs to help lubricate your knee and improve shock absorption.
Some considerations for gel injections
The inflammation needs to be localized to the area of injection.
Insurance may not cover it until other options are exhausted
Limited number of injections per year
Price can be expensive
Should you stretch?
Stretching is something everyone should do as part of a balanced routine, but in terms of stretching for knee pain relief it may or may not help.
Stretching helps improve flexibility and decrease muscle tension. If your pain stems from tight muscles or being in the same position for too long then stretching can help.
But if you did something like twist your knee or injure it in another way stretching will do very little to help you right now.
Or if you try stretching the area that hurts and you don’t feel the stretch or feel it in the area that hurts… stretching is unlikely to help for this problem.
Stretching works by elongating your muscles and pulling the muscle fibers from each end where the muscle attaches and over time prolonged stretching changes the resting position of the muscle, so the muscle is longer at rest.
Some considerations for stretching
It can take about 1 year of regular stretching to change resting length of muscles
You can see an immediate change in muscle length that lasts temporarily after you stretch
Stretching helps pain and soreness caused by muscle tightness
Forcing a stretch can create rebound tightness and soreness
Pain caused by another incident other than muscle tightness unlikely to respond to stretching
Should you use creams?
Creams are a low cost solution to superficial pain.
Creams can be medicated or not. Medicated creams are often NSAIDs and work by the medication being absorbed through the skin. Non-medicated creams may have essential oils or something else infused into them including menthol to give a cooling effect.
Medicated and non-medicated creams can work for pain that stems from a superficial source, so something close to the skin. If the pain stems from deeper than the skin or directly under the skin creams are unlikely to help.
Some considerations for creams
They go a little deeper than your skin
Low cost option
Medicated or non-medicated options
If a problem stems from deeper than just under the skin creams can’t reach it
Should you rest?
Complete rest may be necessary temporarily after a broken bone, torn ligament, surgery, illness, etc. outside of those factors complete rest for any length of time should be used sparingly.
Complete rest rarely helps pain by itself. Complete rest may be necessary for the healing process but it’s usually not the part of the treatment plan that helps get rid of and keep pain away.
Instead of complete rest consider active rest: this is where you don’t participate in the activities that worsen pain and you find alternatives in the meantime.
Rest can help your body get the break it needs to help heal.
If you break a bone you feel pain from the inflammation and the break, resting the area that’s broken is needed to allow the bone to fuse together again but if you jump right back into your usual activities without doing other treatments you’re going to have pain in other ways even after the break heals.
And if your knee hurts to walk or run on and you lay on the couch for 2 weeks to let it heal and jump right back into the walking or running you were doing your knee is likely to have that pain again when you walk or run.
Considerations for rest include
Complete rest alone is unlikely to heal pain from minor problems
Complete rest may be necessary temporarily after major injury or illness
Consider active rest instead of complete rest
Definitely work your way back up to activities after a period of complete or active rest to prevent pain from coming back or popping up in other areas
Should you lose weight?
Weight loss may help your pain. When it comes to knees they feel 3-5x your body weight when you walk and up to 10x your body weight when you run so losing some weight may help. Consider this: skinny people also have pain.
The weight may not be the whole problem causing the knee pain because if there were no other factors that cause knee pain it would likely be that skinny people wouldn’t have it either.
It could be that the changes made during the day loss journey (eating differently, exercising, stretching, focusing on the equipment you’re using during this transformation, etc) may be the thing(s) helping your pain in addition to (or more than) the weight loss.
Some considerations for weight loss
Weight loss does take pressure off your knees from walking and running
Skinny people also have knee pain
The other changes you’re making at the same time may play a big role in your pain management
Should you go to physical therapy?
Physical therapy can help with pain relief from modalities they use for pain management and by modifying the way you move.
Not all physical therapy is created equal and you’ll want to pay attention over the course of physical therapy if it’s helping your pain.
Physical therapy should include various treatments that make at least a slight difference within 2 weeks.
For example if all that is being done is strength exercises and stretches with no other treatments, I’ve found that these treatments alone don’t fix pain but instead are better at preventing the pain from worsening or coming back.
Modalities like ice, heat, TENS, etc can help with pain relief in the moment so if an exercise or stretch is being used to prevent the pain from worsening then modalities can help by being used before or after to calm down or prevent pain from the exercise or stretch.
When in doubt ask your physical therapist what the goal of each tactic is and keep an eye on it for 2 weeks, because if they say this tactic they’re doing is for pain relief it should be helping get rid of the pain.
Some considerations for physical therapy
Physical therapy must be completed with a physical therapist, if you google physical therapy for knee pain and do some exercises and slap some ice on you’re knee that isn’t physical therapy that is exercise and ice.
If you don’t like your physical therapist or you aren’t seeing the results you want find a new physical therapist
Even if you are doing the same exercises at home and in the clinic doesn’t mean you can just quit PT: there is a method to the madness
Just because physical therapy “didn’t work” before doesn’t mean it won’t work now. You may not have had the right physical therapist, or the right programming or been following the directions right
Should you get a knee brace?
Knee braces can give your knee some external support it’s not getting elsewhere. Knee braces come in a variety of different materials from rigid plastic to neoprene sleeves. the way they work depends on what they’re made out of so a hard rigid brace blocks movement in certain directions to prevent the knee from overstretching that way.
For example a brace that is fitted after ACL injury or reconstruction will limit a forward movement of the shin bone because that’s the direction the ACL gets torn, it could also limit other directions, too.
Some people with significant knee deformity wear offloaded braces that are rigid that prevents the knee from moving in a direction that would collapse the knee joint because when the knee joint collapses that way it causes pain for those people.
Other knee braces like a neoprene sleeve may add compression to control swelling or add sensory input to make the knee feel more comfortable.
Sometimes braces are needed temporarily to decrease pain or prevent further injury but many can be discontinued or avoided completely when proper strengthening is incorporated into your routine.
As I said above some knee braces are adding external support that your body needs because it isn’t getting it somewhere else: that somewhere else could be in the form of internal support from the muscles.
Some considerations for knee braces
Neoprene sleeves don’t have external support like rigid braces do so they don’t help control motion
Rigid braces alone don’t add compression so they don’t help control swelling
Rigid braces may be necessary for someone who has a bony deformity or a previous ligament out injury that strengthening won’t fix or prevent the movement
If you can control the positioning of your knee with focused attention on maintaining that position rigid knee braces may be helpful temporarily while you work on strengthening your muscles to be able to hold your stability better
Knee braces should never be used alone, but always in conjunction with a balanced plan to address all aspects of the stress on your knee
Should you take supplements?
Supplements may or may not help pain. Dietary supplements are used in addition to something you’re already doing.
Supplements could be adding collagen powder/liquid, adding vitamins and minerals, more natural pain relief treatment, etc. If you’re adding collagen powder to your morning coffee or your smoothies that won’t take away your pain.
Collagen supplements the collagen in your body: collagen is found in muscles, tendons, ligaments and cartilage. So there is potential for collagen to help support your srthritic joints, but if pain is caused by inflammation then collagen doesn’t help.
Supplementing vitamins and minerals could improve your dietary health if you are low in certain vitamins and minerals and cannot get them from your normal food sources, but if pain is from inflammation then this won’t help.
Adding magnesium may help with muscle pain and soreness, though there are other ways of getting magnesium than ingesting it, like taking an epsom salt bath. Supplements for natural pain relief treatments may or may not work.
These types of supplements may not be FDA approved and there may not be enough testing done on them to show efficacy on pain relief. I have not seen results that adding a pain relief supplement alone was the thing to take away pain, and it’s in the name itself: supplement: it should be used to supplement other techniques you’re doing.
Some considerations for supplements
Natural pain relief supplements may or may not help
May or may not be FDA approved
May or may not have testing done to show significant efficacy
Supplements like collagen support muscles, tendons, ligaments and joints but don’t help for short term pain relief
Supplements like vitamins and minerals typically aren’t used for short term pain relief
You may be able to find other ways to use minerals like magnesium in other ways like in epsom salt baths
Supplements help when you aren’t getting enough of that ingredient in your normal diet
Supplements are just that: supplements and should be used to supplement where you aren’t getting enough
Considerations for any treatment you use for pain relief:
Very few treatments work alone.
They are often used in conjunction with other things you are doing.
When we talk about knee pain the pain has come on because of some kind of stress to the knee: whether that be from an injury (fell down while running… getting banged up from the fall definitely adds stress) or from repetitive nature of overtraining, over or under strengthening, under stretching, wearing the wrong shoes, etc it’s all added stress to your knee.
To manage the pain is handle the amount of stress is put on your knee by balancing out stress with the relief things (also stress just the good kind) in the form of ice, heat, hot epsom salt baths, massage, foam rolling, eating to fuel and support your body,etc).
To get rid of pain decrease exposure to what is causing the pain.
If the pain is caused by inflammation instead of trying to get rid of the pain why not get rid of the inflammation and prevent it from coming back?
It’s like if you hit your head on something every day and you take an Advil: will the Advil get rid of the pain and inflammation?
Yes it will.
But wouldn’t it be better to avoid hitting your head every day so you don’t even have the inflammation and pain? Yes I would think that’s a better option. For many women with arthritis inflammation in the body is worsened by food and drinks.
For women with arthritis consider eating and drinking ingredients that support your body and don’t fuel inflammation so you can limit external treatments to get rid of the inflammation and pain.
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