Those Aching Knees! Tips for Managing Your Pain

In Brief

• Many people have achy knees but don’t need something as drastic as joint replacement surgery. Orthopedic surgeons say that men and women should not put off scheduling an appointment with a physician when they have knee pain because of a fear of surgery.
• Many knee problems are preventable with simple measure like keeping weight at a healthy level and keeping your legs and core strong and flexible. Some problems can’t be prevented, however.
• Knee pain can often be managed with changes in workouts, RICE (Rest, Ice, Compression and Elevation), anti-inflammatory medicines and cortisone shots.

There have been several studies recently showing that more and more people are having knee joint replacement surgery– no great surprise given the still-active number of baby boomers who have and continue to put a pounding on their knees.

But there are plenty of people out there with achy knees who don’t need something as drastic as joint replacement surgery.

Jeffrey Malumed,
M.D.

“Ninety-five percent of people who have knee injuries don’t need an operation,” says Jeffrey Malumed, M.D., chief of the Section of Orthopedic Surgery at Taylor Hospital and president of Premier Orthopaedics.

Some of them, like Sixers’ center Andrew Bynum, may need exotic European treatments and plenty of rest. Other people may just need to take it easy for a few days.

And there’s the great in-between. For patients – or would-be patients – figuring out where they fall on the spectrum of pain isn’t easy. How much pain is too much to bear? And then there’s the fear factor – a lot of patients are afraid of going to an orthopedic surgeon because they believe they’ll be steered toward surgery. That fear often makes people reticent to see the doctor and to endure unnecessary pain.

Nicholas DiNubile,
M.D.

According to Nicholas DiNubile M.D., chief of the Section of Orthopedic Surgery at Delaware County Memorial Hospital, people should not be afraid to see a doctor due to fear of surgery. “The good news is that many knee problems are preventable with simple measures like keeping your weight at a healthy level and keeping your legs and core both strong and flexible,” he says. “There are problems that can arise that can’t always be prevented – like certain ligament tears or meniscal tears, but newer technologies allow for a much better repair or even regeneration of injured parts.”

There is a wide range of knee issues, and Malumed says that most of them involve the knee cap. The most common knee issue he sees is chrondomalacia, in which the cartilage is irritated on the underside of the kneecap. Age is a significant factor; the Centers for Disease Control and Prevention estimate that half of us will suffer from knee osteoarthritis at some point in our lifetime; the problem is that the cartilage just wears out. Malumed points out that the knees bear a lot of weight – the force on your knees with an activity as simple as walking up the steps is six times your body weight.

So, odds are that your knees are going to hurt at some point. But if they do, don’t panic. The continuum of pain management is pretty straightforward. It starts with that old formula – RICE (Rest, Ice, Compression and Elevation).

Frank Giammattei,
M.D.

Frank Giammattei M.D., chief of the Division of Orthopedic Surgery at Crozer-Chester Medical Center, believes that through mild exercising and the use of an anti-inflammatory like Advil or Aleve you can manage that pain ― but stresses that if these techniques do not help then you must see a doctor.

“There are procedures that a doctor can run through with his or her patient to manage knee pain, like cortisone shots, which can help with issues like arthritis,” Giammattei says. “An X-ray is always a sure way to ensure that the damage isn’t bad enough that you need surgery, so make sure that your doctor’s visit is followed up by an X-ray.”

“The bottom line is if your knee hurts and you ice it down and take two ibuprofen, and the pain goes away, you don’t have to worry about it,” Malumed says. “If it doesn’t go away, that’s something you need to get checked out.”

In his book, "FrameWork for the Knee ― A Six Step Plan for Preventing Injury and Ending Pain,” DiNubile notes that bad knees do not need to slow you down. He says, “We may need to modify your activities, but staying fit and active is essential, and with a proper evaluation and treatment, we can keep you going even if your knees are not always cooperative.”

Adding to that, Giammattei believes that managing your weight will in turn help manage your knee pain. “The less weight that is bearing on your knees the less likely you are to suffer from knee problems early on in life,” he says. “The strengthening should be divided into thirds; 1/3 upper extremity, 1/3 core, and 1/3 lower extremity. Making your workout about cardio can help control weight and ultimately fight knee pain.”

Only if these measures fail to provide relief is surgery considered. And then, rapid advances have made the surgery much easier on patients.

For more information or for a referral to an orthopedic surgeon of the Premier/Crozer-Keystone Orthopedic Partnership, call 1-855-CK-JOINT (1-855-255-6468) or visit http://orthopedics.crozerkeystone.org.