Oh, my aching knees

Years of wear and tear can take a toll on your knees, but there are strategies to relieve pain.

Whether it's a sharp pain or a dull ache, knee pain is a common problem in women — particularly older women. One study of women ages 50 and older, published in Arthritis & Rheumatism, found that nearly two-thirds had some type of knee pain during the 12-year study period.

Dr. Rebecca Breslow, a sports medicine doctor and an instructor in orthopedic surgery at Harvard Medical School, says many of the active older women and the female athletes she sees in her practice have knee pain. While there are numerous pain-inducing knee conditions, three seem to be the most common culprits in older women:

  • patellofemoral pain

  • chronic degenerative meniscal tears

  • early osteoarthritis.

Below is a guide on how to recognize these conditions and how to treat them.

Patellofemoral pain syndrome

If you have dull, aching pain at the front of your knee that occurs when you climb stairs, bend down, or squat, it could be patellofemoral pain syndrome, sometimes referred to as runner's knee or jumper's knee.

"This is a blanket term for pain at the front of the knee, sometimes under or around the kneecap," says Dr. Breslow. The pain is caused by swelling and irritation to structures in this area, including the ligaments and tendons that help to hold your kneecap in place or the cartilage underneath your kneecap. In addition to a dull ache, you might also feel pain if you stand up after sitting still for a long period of time, a condition sometimes called movie-theater knee. Or you might hear a popping or cracking noise in your knees when you move.

Structural issues in your legs and knees can also lead to this inflammation and pain. For example, if the muscles on one side of the knee are stronger or tighter than on the other side, the kneecap does not move properly in its channel, known as the trochlear groove. This might happen when you bend your knees, leading to irritation and pain. If the muscles around your hips are not as strong or stable as they should be, or if the muscles in the front and back of your legs are not flexible enough, this can also put strain on your knee.

"Patellofemoral pain syndrome can arise for multiple reasons, including imbalances of strength and flexibility or simply wear and tear over time," says Dr. Breslow.

How to treat it: If you're experiencing pain, try modifying your activities for a couple of weeks to see if your knee pain gets better.

If the pain persists, you might want to see your doctor. He or she may refer you to a physical therapist to build up the muscles in and around your knee and improve your range of motion, which can speed your recovery, says Dr. Breslow. Physical therapy may also focus on improving your core strength in your stomach, back, and hips, which can help take pressure off your knees. Your physical therapist can also make sure your body is in proper alignment to prevent the structural problems that often underlie patellofemoral pain syndrome.

It's important to note that physical therapy requires time and effort. "Physical therapy is quite effective in most cases, but the person really has to buy in," says Dr. Breslow. "It's not a quick fix." If a person gives physical therapy only a half-hearted try or abandons it after a short period of time, it likely won't help.

The pros and cons of cortisone shots

If you're experiencing pain that makes it difficult for you to start physical therapy to address your knee problem, your doctor might recommend that you get an injection of cortisone to lessen the pain.

The shot injects a corticosteroid drug and a local anesthetic into the joint to temporarily relieve pain and swelling. But it isn't a long-term fix. "Often people think that injections, especially cortisone injections, will fix a knee problem. What they do is provide a window of pain relief so you can make progress with rehabilitation," says Dr. Rebecca Breslow, an instructor in orthopedic surgery at Harvard Medical School. "But when cortisone injections are overused, there is some evidence that they can actually accelerate osteoarthritis."

In short, while cortisone shots put you on the path to healing, they should be used judiciously and aren't a permanent solution to the underlying problem that's causing your knee pain.

Chronic degenerative meniscal tear

If you've experienced swelling, joint pain, and a sensation that your knee is sticking or locking, the problem could be a chronic degenerative meniscal tear.

A meniscus is a rubbery cartilage cushion in your knee that helps to pad the joint. Each of your knees has two of them. "Sometimes these structures are torn during an injury, but in degenerative cases, the cartilage just becomes frayed and worn over time, resulting in a breakdown or tearing of the tissue," says Dr. Breslow. When a meniscus is frayed, ragged edges or loose pieces may get stuck in the joint when it's moving, causing a sensation that your knee is locking up. If this is happening, be sure to see your doctor.

How to treat it: Surgery is no longer the first-line treatment for this condition, says Dr. Breslow. "It used to be that most people got referred for an arthroscopic procedure to remove the torn meniscus or repair it," she says. "But now research is showing that, in many cases, the condition can be treated non-operatively just as effectively."

Clinicians are now more likely to recommend treating the condition with physical therapy. As is the case with patellofemoral pain syndrome, building up the muscles around the joint and in other parts of the body can ease pain, without the risk of complications. However, you may need surgery if a piece of the meniscus is interfering with the motion of the joint.

Anti-inflammatory medication, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can also improve pain in the short term. "But it will not fix or heal the problem and can have dangerous side effects if used for more than a couple of weeks," says Dr. Breslow.

Can you prevent knee problems?

Not all knee problems are avoidable, but you can lessen your chance of problems by participating in regular strength training. To protect your knees, it's important to have a very strong core and strong legs, says Dr. Rebecca Breslow, an instructor in orthopedic surgery at Harvard Medical School. Make an effort to perform strength training at least twice a week. In addition, work on increasing joint flexibility, which can also help you head off an injury.

Early osteoarthritis

If you have stiffness, pain, and swelling in your joints that is worse in the morning or when you haven't moved for a while, suspect early osteoarthritis. Most often, osteoarthritis affects people over age 50, but it can be a problem in younger people as well.

Osteoarthritis, or chronic joint inflammation, affects more than 27 million Americans over age 25, according to the American College of Rheumatology. "Early knee osteoarthritis also results from wear and tear on the cartilage, but a previous knee injury is a big risk factor for the condition," says Dr. Breslow. This may be the case if you played sports in your youth and suffered a tear of a meniscus or a ligament (such as the anterior cruciate ligament).

These injuries are known to accelerate the development of osteoarthritis. While the pain, swelling, and stiffness associated with osteoarthritis can affect any joint, it's very common in the knees and occurs when the knee cartilage wears down, causing the bones in the knee to rub together, resulting in pain.

Bone spurs can also develop as part of the degenerative changes that occur in osteoarthritis. Symptoms typically get worse over time as the knee deteriorates further.

How to treat it: The recommended treatment for knee osteoarthritis often depends on a person's age, says Dr. Breslow. "The only definitive thing we can do surgically is perform a knee replacement," she says. But artificial knees break down over time, so doctors like to wait until you're at least in your 60s to perform the surgery, to avoid having to repeat it later. "The goal in most cases is to avoid surgical intervention as long as possible," says Dr. Breslow. Doctors typically focus instead on pain management, using nonsteroidal anti-inflammatory medications and sometimes cortisone shots, in which the clinician injects a corticosteroid medication and a local anesthetic into the joint to help relieve pain and swelling (see "The pros and cons of cortisone shots").

Physical therapy is another option. "I recommend physical therapy for patients, to strengthen the area around the knee, the pelvis, and the core," says Dr. Breslow. Stronger muscles in these parts of the body serve as scaffolding to take pressure and strain off the knee. "You can't get back the cartilage that is already worn down, but you can take measures to slow the progression," she says.

Image: © spukkato/Getty Images

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