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Knee Pain – A Common Problem as We Age

Joseph Gerald (Jerry) Reves, M.D.
October 18, 2021
Person in athletic wear holding their right knee.

Aging, as everyone who reads this column knows, brings predictable problems. One of them is joint pain, and the most frequently affected joint is the knee. That’s because our knees are crucial to a most important daily function – walking. Being ambulatory gives us independence and allows us to pretty much do what we want to do when we want to do it. It’s essential for exercise, which helps us live longer and healthier.

One or more symptoms can occur with knee movement, particularly in people over 55. In fact, about 25% of people over 55 will experience knee pain during this year, and the incidence increases with age. Thus, it’s useful to review the causes, risk factors, diagnosis and treatment for this common problem. Knee pain can include a variety of painful sensations, ranging from a constant, dull aching to severe burning and piercing pain.

Other knee pain symptoms can include

Weakness or instability: Your knee may give way when you put pressure on it, or it may wobble.

Swelling with or without warmth: Enlargement of the knee from swelling, and sometimes a palpable warmth to the touch may be present.

Unusual noises or feelings: Your knee can actually make a crunching sound or give you the feeling of a crunching action when you move it.

Restricted movement: Your knee may lose flexibility, restricting your movement.

Knee pain has many causes. In addition to trauma, such as automobile crashes and acute athletic injuries that result in broken bones, torn ligaments, and damaged cartilage, chronic diseases can accompany knee pain.

Knee pain causes include

Arthritis: Several forms of arthritis that can affect the knee. Osteoarthritis is the most common. Other forms of arthritis are rheumatoid, which is the most debilitating, and septic arthritis, which is an active infection that require immediate treatment.

Osteoarthritis is by far the most common cause of knee pain and the most common reason for knee replacement surgery. It’s characterized by destruction of cartilage, bone thickening and new bone formation and can limit daily activities. The knee does not function properly and is painful with changes in position or walking. Osteoarthritis progresses as we age and ultimately can result in the need for surgery after all medical treatments have proven ineffective. The operation is common and usually successful.

Bursitis: Bursitis is the inflammation of the bursa, or fluid sacs, in the joint and is generally caused by excessive or repeated use.

Tendinitis: Tendinitis is the inflammation of any of the tendons in the knee and, like bursitis, is most often caused by excessive or repeated use.

Gout: Gout is a type of arthritis caused by the accumulation of uric acid crystals in the joint.

Prior Injuries: Old knee injuries, whether treated or untreated, tend to produce knee pain later on. This can be from injury to any structures in the knee, including the bones, ligaments, bursa, and meniscus. With time, the old injuries may form scars and or other structural changes that impair normal knee function.

Age: Aging is a major risk factor for most of the common causes of knee pain.

Weight: Extra pounds often lead to knee pain because they put wear and tear on the knees, which aren’t designed for the burdensome weight.

Previous knee injury: As mentioned above, a prior injury can predispose someone to chronic or new knee pain.

Reduced muscle flexibility or strength: Both predispose someone to knee pain since muscles are required to keep the knees aligned properly.

Activities: Sports such as jogging, basketball, and tennis or activities such as gardening that produce repeated wear and tear on the knees can lead to knee pain.

The good/bad news is that you don’t need to see a doctor to diagnose knee pain. You either feel it or you don’t. You may be able to treat the problem with some of the treatments mentioned below. For new-onset pain, try the following steps.

The mnemonic for the initial treatment of knee pain is PRICE, which means:

Protection – keep the knee protected from over-use or injury;

Rest the knee – stay off of it for a week or so; Ice the knee for about 20 minutes three times a day;

Compress the knee with an ACE bandage or compression cloth;

Elevate the knee, keeping it above the heart if possible.

In addition to PRICE, a week’s trial with over-the-counter ibuprofen, a non-steroidal anti-inflammatory drug, can be tried. It’s important to take ibuprofen after eating to avoid stomach irritation. This conservative treatment is often effective in reducing knee pain, but about 4% of the population will seek medical attention for knee pain.

If your pain persists for more than two weeks or worsens and has several of the associated symptoms listed above, see a physician.

A physician will do a careful history and physical exam and may order blood tests or imaging such as an X-ray or magnetic resonance imaging (MRI.) Sometimes fluid from the knee is withdrawn for culture and chemical analysis, or arthroscopy is performed.

Generally, the history and physical exam plus or minus a radiologic study are all that is needed for a diagnosis.

Treatment depends on the cause of the knee pain, and for this a physician’s guidance is warranted.

The physician may determine that rheumatoid arthritis or an orthopedic problem may require regular physical therapy or surgical intervention. Only about 2% of the 25% of people with knee pain will require a surgical procedure.

About a quarter of us will have knee pain; it’s one of the “perks” of living longer and all the years of mileage we’ve put on our two knees. The good news is that knee pain is treatable. You don’t have to suffer, whether you treat the pain yourself or see a physician. You have options, and isn’t that we want as we age?