Is this you?
You’re probably over 40. Your knees sometimes feel stiff for a little while when you get up in the morning or if you’ve been sitting for too long. Walking up or down stairs can be painful and you are starting to find longer walks uncomfortable. Maybe you still want to run or be involved in sport, even if it’s just with the kids, but find your knees don’t agree.
You might have heard terms like osteoarthritis, a degenerative meniscus or wear and tear to describe your knees.
Your knees are not alone.
Suffering with knee pain is undeniably unpleasant and through experience can impact on work, family, sport and recreation as well as your mood. Your knee pain actually represents one of the most common reasons people stop being active and seek help from their doctor or an experienced physiotherapist.
But our approach to helping people like you is changing. Knee pain doesn’t have to result in you stopping altogether the activities you enjoy or visiting an orthopaedic surgeon. In fact, it is often simple treatments and management strategies that can help you manage your knees and remain engaged in the things that make life worth living.
How do I know this? Because it is what the researchers who study knee pain have found and it is also my experience from over twenty-five years as a physiotherapist working with people with knee pain. What’s more, how you manage your knee pain does not usually need to involve expensive scans, fancy treatment techniques or surgery. Simple approaches can and do work.
Reading the professional information on this page and completing the self-assessment questions might be a helpful start in making sense of the knee pain you are experiencing.
Red Flags.Occasionally pain may be an indication of a more serious, underlying condition. Doctors and physiotherapists will ask a series of Red Flag questions to help guide their decision making but it is important to realise that Red Flags do not necessarily mean you have a serious underlying disorder, simply that you should consult your doctor for further assessment.
It’s quite normal to feel a bit down or worried when you have pain and you shouldn’t feel guilty for this. However, what you believe, think and feel about your pain can have consequences on your recovery in very real ways.
These are sometimes referred to as Yellow Flags and should be discussed with a caring professional who takes the time to listen to you and understand your fears and concerns.
So, what should you do?
With a little knowledge, you can make some choices.
If you have concerns that you have Red Flags or Yellow Flags, you should seek further assessment from an experienced physiotherapist or your doctor. This can be done in person or effectively over telehealth.
So what’s causing the pain?
Osteoarthritis involves some changes to the surface of a joint and can also involve other soft tissues around the joint. Changes over time to the shock absorbing cartilage in your knee, called the meniscus, are part of this picture and unless your knee locks so that you can no longer bend or straighten it, we treat this as the same condition. Traumatic injury to your knee, such as a sporting injury years earlier or a family history of joint pain can increase your chances of developing knee pain. We also now understand that knee pain is not always a simple case of wear and tear, and that other health and medical issues, such as inflammation and obesity can contribute.
Interestingly, in the early stages of osteoarthritis, there is quite a poor relationship between the amount of change seen on an x-ray and the amount of pain you experience. Many of these changes are just a normal part of aging and do not necessarily represent damage. In most cases there is little need for an x-ray to confirm a diagnosis, however if you have had a recent fall an x-ray may be wise to rule out a fracture.
Our approach to managing your sort of knee pain has changed over the past decade. In Australia there was a well-trodden path from General Practitioners to orthopaedic surgeons, sometimes pausing for an xray on the way.
This resulted in a large number of people undergoing arthroscopic key hole surgery to clean out the joint (called a debridement) or trim the meniscus (called a partial
meniscectomy). However, research was beginning to show that this sort of surgery was not overly effective and not any better than simple rehabilitation approaches.
The number of arthroscopies performed in Australia peaked in 2011-2012 and has been falling ever since. However, the number of knee replacements in older Australian’s continues to rise.
General knee pain
Don’t feel you’re getting better?
Sometimes people do need more help and support to manage pain and participate in the things that make life worthwhile.
An experienced physiotherapist should act as a coach, helping you:
- address the fears or concerns you have about your knee
- guide your understanding of your pain and stiffness
- work with you to discover how you can remain active and engaged
- help you determine the rehabilitation approach you are most able to perform and
believe will help (there is no single magic exercise for everyone).
If you would like to learn more about Specialist Physiotherapist Matt Lancaster FACP and how to book an individual consultation:
A final thought.
You may well have wear and tear or bone on bone in your knee but so do a lot of people who don’t always experience a high degree of pain and suffering. You may also have one leg a bit shorter than the other, believe you have terrible posture, been told you have a weak or lazy core, have gluteal muscles that are not active and don’t even work, that your spine is locked, your pelvis is out and your alignment is wonky, that your ying is at odds with your yang or that your fascia needs releasing because you are so tight it’s amazing you can even function and if someone doesn’t adjust your spine every week for the next twelve months you’ll probably end up in a wheel chair!
Have you ever wondered what any of these things mean? Or if they are even real? How many people believe, or are told they have these problems but don’t experience your pain?
There are thousands of fancy approaches, magic treatments and bold claims on the internet. Not many of them are well supported by research, but most of them have the potential to cost you a lot of money. Health care should be delivered ethically. And sometimes keeping it simple and evidence-based is the best, most cost-effective thing we can do to help.