It’s important not to self-diagnose knee pain and to instead, have it checked out by your GP or a specialist doctor. Some types of knee pain can be managed at home with certain exercises and pain relief medications, whilst others may eventually require surgery.
However, there are things that you may be doing in your day to day life that could be causing the pain in your knee or knees to feel worse.
Changes to your lifestyle to protect your knee joints could help you manage your pain without surgery and even delay a full or a partial knee replacement in the future.
In this article, King Edward VII’s Hospital orthopaedic surgeon and knee specialist, Mr Robert Marston, explains what you may be doing to make your knee pain worse, and what changes you could make in order to look after your knee joints and make them feel more comfortable.
1. Exercising too much, or not enough
The knee joint can withstand many times our body weight in terms of force. For example, when we’re walking, the knee takes the force equivalent to three times our body weight and when we’re running, it takes six times the load.
When we’re putting our lower body under intense force and load, such as when we’re going up and down stairs or an incline or we’re performing squats and lunges, our knees take ten times our body weight.
If we have chronic knee pain, it’s important to make sure we’re exercising to support our knee joints, and to not overdo things.
What exercises can make knee pain worse?
In my experience, the most aggravating activity for patients with knee problems are endless squats and lunges, which put high forces repeatedly through the knee.
Squats and lunges are often prescribed to patients with the idea that a stronger muscle mass around the knee will reduce pain. However, it’s rare that a patient who can walk has musculature around the knee that is so weak, that this weakness is a major contributor to knee pain. Therefore, it’s best to avoid repeating these exercises.
It’s also a good idea to avoid high impact exercises that ‘jar’ the leg, such as running, kickboxing and jumping.
What exercises can help prevent or manage knee pain?
Walking is excellent exercise, not only for the knee, but also for the cardiovascular system. Many cardiologists suggest that a brisk 30 minute walk three times a week is more beneficial for the heart than high intensity gym exercises.
Other non-impact activities such as cycling and swimming are also good for the knee and overall fitness.
If you like to go to the gym, the cross trainer and exercise bike are also great low impact options for increasing cardiovascular health and fitness and losing weight, without putting excess force onto the knee joint.
Whatever exercise you decide on, always ensure that you warm up and stretch your legs and lower body before any workout.
2. Consuming a pro-inflammatory diet
You may not think it, but your diet could be a contributing factor to your knee pain.
What food can make knee pain worse?
As yet, there is no clear evidence that any specific food or ingredient is detrimental to knee pain. However, some people find that consuming acidic fruits and vegetables such as citrus fruits and tomatoes, make their symptoms feel worse.
There is also anecdotal evidence that foods that cause an increase in inflammation may also make joint pain worse. This includes highly processed foods that are high in saturated fat, salt and sugar, red and processed meat, dairy products and alcohol.
What food can help prevent knee pain?
Consuming anti-inflammatory foods can help to reduce levels of inflammation in the body, that in turn, can help to reduce knee pain that’s accompanied by swelling, redness, or a warm feeling to the skin – all signs of inflammation.
Non-acidic fruits and vegetables, wholegrain bread and cereals, plant-based proteins such as beans, peas, lentils and chickpeas and healthy fats from oily fish, avocados, nuts and seeds are all examples of anti-inflammatory foods. Try to include as many as possible each day.
Can being overweight affect my knees?
The most important thing is to eat a healthy, balanced diet and to avoid overeating to help maintain a healthy weight.
It’s worth remembering that if you’re one stone overweight, you’re putting the equivalent of 10 stone of excess weight onto the knee joint when you’re walking up or down stairs or carrying out squats and lunges. If you’re overweight, take steps through diet and exercise to begin to lose weight.
3. Not taking vitamin supplements to help prevent or manage knee pain
Joint supplements that contain active ingredients such as glucosamine and chondroitin can be helpful for protecting the joints.
Glucosamine and chondroitin occur naturally in the cartilage that cushions the joints, keeping them lubricated and preventing the bones from painfully rubbing together.
However, over time, the cartilage within our joints including the knee joint, can become worn or damaged, leading to pain, discomfort and mobility problems. Taking a supplement that contains glucosamine and chondroitin can help to prevent the cartilage wearing down.
Many patients, as many as two thirds of the patients I see in my clinic, say that these supplements are beneficial and help to relieve their knee pain. A recent European study appears to back this up. However, some studies disagree, including an American one, published in 2020 that concluded that they’re no better than a placebo. So it’s down to personal choice.
Omega 3 supplements can also be beneficial for the joints, as can turmeric, a natural and potent anti-inflammatory that helps to reduce joint pain associated with inflammation, such as in the case of rheumatoid arthritis.
As with any supplement, consistency is key. Aim to take supplements at around the same time every day for at least three months to see if you notice any benefit.
4. Sleeping in the wrong position
Our weight, what we choose to eat and what level of exercise we undertake can all affect our knee joints. However, how we sleep can also have an impact.
What sleeping position can make knee pain worse?
Patients with arthritis or another type of knee pain often find that if they lie on their side with the inner surface of each knee touching, it causes pain that can disturb sleep. Therefore, it’s best to avoid this position if you have persistent pain in one or both knees.
What sleeping position can help with knee pain?
If you like to sleep on your side, special pillows are available that can be placed between the legs that separate your knees and prevent direct contact between them.
Certain knee conditions, for example, a cartilage tear can cause the knee to become painful if the leg is fully extended. Therefore, I recommend placing a small pillow or a rolled up towel under the affected knee if you prefer to sleep on your back.
5. Wearing the wrong footwear to support the knee joint
Prolonged episodes of either standing or walking in certain shoes can negatively impact on the knee joint.
What shoes can make knee pain worse?
High heels, that change the centre of gravity of the legs and feet, any footwear that makes the lower limbs unstable or ill-fitting shoes, could be making your knee pain worse.
What shoes can help to prevent and manage knee pain?
Flat, supportive, well-fitting shoes are the best option for preventing and managing knee pain.
If you do a lot of walking on hard pavements, such as during your commute to work, a silicone heel support that fits inside your shoes and cushions the heel as your foot strikes the ground is a good idea. Or, wear flat shoes during your commute, and change them when you arrive at your workplace if you prefer.
6. Not taking pain relief for knee pain
Simple over the counter pain relief medications such as regular paracetamol can be helpful for knee pain. It can be easy to dismiss paracetamol as we tend to only use it to cure the odd headache.
But if taken regularly, this simple but effective and very safe painkiller can be very beneficial for persistent knee pain. Take paracetamol with breakfast, lunch, dinner and just before bed for the most benefit during a flare up of knee pain.
Non steroidal anti-inflammatory drugs (NSAIDs), such as over the counter ibuprofen (or naproxen or diclofenac on prescription) can also be very helpful for managing pain and reducing inflammation and swelling.
They can be taken alongside paracetamol. However, if taken for prolonged periods, NSAIDs can cause damage to the stomach lining, liver and kidneys. Therefore, they should be taken with care and under the guidance of your doctor if you think you may need them on a long term basis.
If you find that paracetamol, either alone or alongside an NSAID, isn’t helping your knee pain and you still feel pain and discomfort, speak to your GP or specialist. They may be able to prescribe a different kind of pain relief, such as codeine.
7. Not being aware of the lifestyle habits that can make knee pain worse
When sitting or driving, have your leg at a 45° angle rather than flexed to 90° (as you may automatically do with your left leg when driving an automatic car). Also, adjust your seat so that your right leg is at a more relaxed angle, rather than highly flexed and bent at 90°.
If you experience knee pain when sitting, make sure you sit with your knee at 45° rather than 90° or further, since this reduces the static force across the joint.
It’s also important to take steps to avoid tripping and falling, such as keeping walkways and stairs free from clutter, keeping common areas well lit and using the handrail when going up and down the stairs.
8. Not using a walking stick for knee pain
A walking stick or crutch isn’t something to be embarrassed about, and can be of great benefit by helping to take the weight off your painful knee. Knee braces can also be helpful in stabilising the knee.
If you have a walking stick or crutch that’s too high or too short for your frame, you could end up experiencing pain in the arm and hip, too. So make sure you’re measured up correctly by a doctor, or in your local pharmacy. If you begin to develop arm or hand pain, switching it to the other side will help.
9. Avoiding medical advice and support
One of the main reasons knee pain can become worse is not seeking medical attention soon enough.
The right time to seek medical advice is when you feel that conservative measures, such as avoiding exercise that aggravates your knees, managing your weight, taking supplements and using pain relief including an NSAID, are no longer working to relieve your pain.
You should also seek medical help if you experience sudden knee pain, or you’ve twisted or fallen onto it during physical activity.
If you ever feel that your quality of life is suffering or you cannot do the things you enjoy because of your knee pain, it’s time to speak to a doctor.
● If you have knee pain that isn’t getting any better or is getting worse, speak to your GP who may refer you to a specialist. (Don’t have a GP?)
● The King Edward VII’s Hospital Specialist Knee Unit is fully equipped with cutting edge diagnostic and treatment equipment and is staffed by experts. Don’t let knee pain get in the way, make an enquiry today.