Treatment for Knee Pain
Treatment for knee pain varies and depends on the underlying cause. Knee pain caused by overuse or minor injury often can be treated using conservative measures, including RICE therapy (i.e., rest, ice, compression, and elevation).
- Rest involves avoiding activities that worsen pain and keeping off the knee as much as possible. Crutches or a knee brace may be necessary.
- Ice is used to reduce swelling. Ice packs can be applied for 15–20 minutes at a time every hour, or at least 4 times per day.
- Compression involves supporting the knee using a firmly (not tightly) wrapped elastic bandage, compression stocking, or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately.
- Elevation helps to minimize bruising and swelling. The knee should be kept above heart level (e.g., using a pillow) as often as possible.
Conservative treatment also may include over-the-counter or prescription medications. Common pain relievers include acetaminophen (e.g., Tylenol®) and nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen [Advil®, Motrin®], naproxen [Aleve®, Naprosyn®]). In addition to relieving pain, NSAIDs also reduce inflammation.
These medications should only be used as directed. They can cause side effects, some of which may be severe (e.g., gastrointestinal bleeding, ulcers, liver and cardiovascular damage).
Prescription medications may be used to treat knee pain that does not respond to conservative treatment. For more information about pain medications, please go to Pain Medications.
Knee infections (e.g., osteomyelitis, septic bursitis) are very serious and require aggressive treatment with antibiotics. If oral antibiotics are ineffective, they may be administered through an IV (intravenously). In severe cases, aspiration (removal of fluid) is necessary or the joint must be drained surgically (called surgical debridement).
Cortisone injections can be used to treat some types of knee pain that persist or worsen in spite of other treatments. This therapy involves injecting cortisone (a steroid and anti-inflammatory) directly into the knee joint to reduce pain and inflammation. Over time, cortisone injections can weaken or damage other tissues and structures within the joint (e.g., tendons).
Physical therapy (e.g., ultrasound, electric stimulation, cryotherapy, manual therapy, stretching) also may be used to reduce knee pain and inflammation. Physical therapy can strengthen muscles, reduce friction within the knee, and can help teach the patient proper body mechanics, reducing the risk for recurrence.
Some types of knee injuries (e.g., torn ligament or cartilage, ruptured tendon) are treated with arthroscopic surgery, also called arthroscopy. In this outpatient procedure, the surgeon makes a small incision and uses an arthroscope (device that includes a tiny camera connected to a monitor) to examine the knee joint.
Damaged tissue is then removed or repaired using surgical instruments inserted through additional small incisions. Arthroscopy, which usually takes about 1–1 ½ hours, can be performed under local, regional, or general anesthesia.
Following arthroscopic knee surgery, some patients need to use a cane or crutches for a short time, and other patients can walk carefully without assistance. Over-the-counter or prescription medications can be used to relieve pain and antibiotics may be prescribed to reduce the risk for infection. In most cases, recovery takes about 6 to 8 weeks.
Patients who have severe knee damage that does not respond to other treatments may require knee replacement surgery (also called arthroplasty). In total knee replacement, damaged bone and cartilage in the knee joint is removed and replaced with an artificial joint comprised of metal and plastic materials. Partial knee replacement, which is less common, involves replacing only one part of the joint. Total knee replacement alleviates knee pain in more than 90% of patients.
Knee replacement surgery usually takes about 2 hours and is performed under general or spinal anesthesia. Following surgery, most patients remain in the hospital for several days. Physical therapy is started as soon as possible and in most cases, patients begin exercising the artificial knee the day after the procedure.
Complications include blood clots, injury to nerves of blood vessels, and infection (rare). After knee replacement surgery, steps are taken to reduce the risk for complications. For example, medications to "thin" the blood, compression stockings, and elevating the legs can help reduce the risk for blood clots, and antibiotics can reduce the risk for infection.
Minimally invasive knee replacement surgery is a relatively new procedure that is performed through smaller incisions, using newer surgical techniques. Following this procedure, some patients experience less pain, require shorter hospitalization (usually 1–3 days), and recover more quickly; however, not all patients are good candidates for minimally invasive surgery.
Knee Pain Prevention
Knee pain cannot be prevented in all cases. To help reduce the risk:
- Maintain a healthy weight.
- Exercise regularly (including proper stretching, low-impact activities, and weight training).
- Increase activity levels slowly.
- Protect the knees (e.g., wear knee pads while rollerblading and seat belts in the car).
- Wear proper footwear (especially for exercise).
- Discontinue any activity that causes knee pain.