Harvard Health Letter

Can you put off that knee surgery?

Don't assume surgery is necessary if knee pain sidelines you. Physical therapy may be all it takes.

Image: iStock

Physical therapy and weight loss can relieve knee pain and protect your mobility.

Knee pain caused by worn or torn cartilage can be so debilitating that you find yourself unable to exercise, walk across a room, or go to a grocery store. While surgery is often the fix, it's not always necessary to relieve knee pain. "I see success stories without surgery every day," says Dr. Clare Safran-Norton, clinical supervisor of rehabilitation services at Harvard-affiliated Brigham and Women's Hospital.

The evidence

Safran-Norton is a physical therapist and a firm believer in having someone try physical therapy before resorting to knee surgery. There's science to back up that concept. For example, although Americans undergo 460,000 surgeries each year to trim and remove torn meniscal cartilage, Safran-Norton and her colleagues wrote in The New England Journal of Medicine that physical therapy was just as effective as surgery when it came to improving knee function and reducing pain from a torn meniscus.

A study published last year in Arthritis and Rheumatology found that about a third of total knee replacements in the United States are inappropriate, suggesting that some people undergo knee replacements unnecessarily. There are about 700,000 total knee replacements each year in the United States.

Putting off surgery

Safran-Norton recommends that a person with knee arthritis or a torn meniscus undergo at least three months of physical therapy as a first line of treatment. "There's a lot we can do with stretching and therapeutic exercise," she says.

The first step is to begin a series of exercises to strengthen muscles that work with the knee, including the quadriceps and hamstrings in the thigh, the gluteal muscles in the buttocks, and the abdominal muscles. If these muscles are stronger, they'll absorb more of the pressure you place on your knee, which will relieve pain.

The second step is to stretch the muscles that support the knee, such as the thigh and calf muscles, as well as the iliotibial band—a thick cord of connective tissue that runs along the outside of your leg—to keep them all healthy, flexible, and resistant to injury. This type of strengthening and stretching program provides relief within weeks. "You'll feel a difference after going to physical therapy once or twice a week for two to four weeks," says Safran-Norton.

Other treatments

Physical therapy can be complemented with other means of pain relief:

  • Weight loss. Shedding pounds reduces the pressure you place on your knees.

  • Injections. Corticosteroid injections can temporarily reduce pain and swelling, which can make it less painful to take part in physical therapy.

  • Acupuncture. Studies about whether acupuncture relieves knee pain are mixed, but Safran-Norton says the treatment is helpful to some people.

  • Supplements. Research is mixed on whether chondroitin and glucosamine supplements relieve pain, but Safran-Norton says some people feel the pills make a difference. 

Move of the month:  Ball squeeze

Image: Michael Carroll Photography

This exercise works your abdominal muscles and inner thigh muscles, and can be done on a mat, a bed, or even a couch.

Lie on your back with your knees bent and feet flat. Put a small ball (roughly 12 inches) between your knees. Place your arms at your sides. Tighten your abdominal muscles. Squeeze your knees together against the ball. Hold, then release. Repeat eight times.