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Your , providing support, stability, and balance, while allowing you to sit down, stand up, and move around on two legs.

A hinge joint that moves in only one direction with limited side-to-side rotation, each knee consists of three bones, five ligaments, four main tendons, two large muscle groups (plus a number of other muscles in the “knee complex”), a joint capsule containing membranes and fluids, three bursae, and two kinds of cushioning cartilage.

Wow! It’s not surprising that knee pain is the .

Hmm. What could possibly go wrong? For starters, evolutionary biologists say the human knee was originally optimized for four-legged creatures, and , which makes it extraordinarily vulnerable to a wide array of problems.  

The problems include bumps and bruises, strains and sprains, tears, dislocations, ruptures, fractures, syndromes, cysts, bursitis, infections, inflammations, loose bodies (pieces of bone or cartilage floating around in a joint space). Many chronic conditions cause the knee-joint’s cushioning cartilage to deteriorate: many forms of arthritis, gout, and more.

In addition to flawed evolution, the more immediate causes of knee pain include acute injuries, overuse, aging, genetic factors, biomechanics (how and why your body moves the way it does), disease processes, and being overweight. 

When Knee Pain is Serious

Some knee pain is easy to treat yourself, even if you don’t know its cause. But seek prompt care from a medical professional if:

• you experience intense ongoing pain after an injury,
• you’ve lost consciousness, even briefly, or feel confused, in addition to hurting your knee
• you hear a popping sound or experience a popping sensation in your knee,
• you experience painful grinding or crunching sensations in your knee,
• your knee “gives out,” locks up, or feels unstable,
• you have severe swelling and/or signs of infection (the painful, swollen area turns red, feels warm to the touch, and/or is accompanied by fever,
• your knee won’t stretch or bend,
• your leg looks deformed, 
• you can’t put weight on it

Relieving Everyday Knee Pain: Get Moving!

If you don’t fall into one of these emergency categories, here’s what to do:

Temporarily lay off your normal exercise routine and/or other activities that worsen the pain. That does NOT mean you’ll need to stop moving. In fact, many orthopedic doctors and physical therapists, including Dr. Gabe Mirkin, the sports-medicine physician who first proposed it in the late 1970s, have —rest, ice, compression, and elevation. Examination of the research revealed no hard evidence for the effectiveness of this protocol, and plenty of science describing its potential harms. New research also discourages routine use of braces and casts, which limit a joint’s range of motion and slow its healing. 

The RICE protocol aimed to reduce inflammation. Yet inflammation is the body’s natural defense system, sending immune cells to an injured area to begin tissue repair, fighting off attack by viruses and bacteria, and clearing cellular debris from the body. Suppressing it with anti-inflammatory medication, compressing the injured area, and frequent icing may ease the pain and temporarily improve your ability to move, but they will slow both the movement of inflammatory cells to the area, and also impede the lymphatic drainage that carries waste products from the body. Mirkin now says, “Anything that reduces inflammation also delays healing.”

The newer protocol goes by various acronyms, but what they all have in common is to , even when it hurts. It seems counterintuitive, but active rehabilitation will help a hurt knee heal faster. Even chronically hurting knees will benefit from exercise.

Active Rehabilitation

After an initial period of evaluation, elevation, and relative rest (sometimes even maybe a few minutes of wrapping your knee in an ice pack, or a dose of anti-inflammatory medicine), take stock of what you can do to keep moving. Ice or Heat? Learn more about what’s best.

Go at a gentle pace at first, gradually building up the frequency, duration, and intensity of your movements. The rule: if the pain increases the day after, do less the next time. If it keeps improving, keep moving forward.

What to Do for Knee Pain

Here are a few suggestions on what to do with knee pain:

1. Ride a stationary bicycle in a very low gear. This is good exercise any time of year, even if you aren’t injured. You can listen to music, podcasts, or audiobooks as you pedal. I have my road bike set up on a bike trainer that’s been specially fitted for my body, but if you’re investing in or have an exercise bike of some kind, make sure to properly so you don’t worsen your injury.
2. Walk or run in shallow or deep water. If you have nearby access to a pool (or pond in warm weather), water exercise can help you build or maintain cardiovascular fitness and muscle strength. As you recover, you’ll be able to increase your speed and time in the water.  Just can bring benefits. (aka aqua jogging) usually requires some sort of flotation device to keep you from sinking.
3. Walk with poles. I’m a huge fan of walking with trekking poles, also known as .  I’ve used my poles almost every day for many years, rehabbing two total joint replacements (knee and hip), as well as for normal walking exercise up to 10 miles a day , and (”floating on snow”) in winter.

Indoor biking is okay (though many of us find it boring), and water exercise isn’t always possible, but pole-walking will get you safely outdoors in all kinds of weather. All you need is a good pair of lightweight trekking poles. They tend to be pricey, but will last for decades. Look for poles with telescoping segments that allow you to adjust for your height and shrink for easy portability when you travel. They should have spring-loaded tips that give a little to take the pressure on your wrists, elbows and shoulders while you press downward.

Poles provide stability and balance, and take pressure off your lower body, transferring it to the muscles in your arms and shoulders, giving you a full-body workout that burns more calories than ordinary walking. As you improve, you can increase the aerobic intensity of a pole-walking workout simply by moving your arms faster.

Causes of Knee Pain

If your knee pain doesn’t improve or gets worse, take a moment to ask yourself a few questions and jot down the answers:

• Where exactly does the knee hurt? When did it begin hurting?
• Did you do some unusually hard work (e.g., sports competition/training, snow shoveling, moving furniture) that might have put too much stress on some part of your knee? Does the pain seem to move around?
• How does it limit your activities?
• Does the pain seem to be getting worse?
• Did you have a recent injury? If so, how long ago and how did you do it ?
• How would you describe the pain? Throbbing, stabbing, aching, nagging, gnawing, shooting, burning, radiating?
• Does it hurt all the time, or only when standing, moving, bending, sitting, or lying down?
• Do certain activities hurt more than others?

Doing this may offer some insight into what happened and what to do differently. If you need to see a medical professional, you’ll already have many of the answers to the questions they will ask. Learn how to talk to your doctor about pain.

Chronic knee pain: Will I need a joint replacement? 

I’ve had my share of knee anguish. As I write this, I’m a few days away from surgery for my second knee replacement.

My first brush with knee problems was 20 years ago, when I headed into an orthopedic office to check on my ankle pain that wouldn’t go away and was getting worse. Without even an examination, the doctor said, “Oh that’s ,” which .  (Referred pain: pain that originates in another part of the body than where you feel the pain.)

At the time, I was training for and competing in triathlons, running and biking long distances, swimming several times a week, lifting heavy weights. His recommendation: “You’ll just have to alter your exercise routine,” including no more running. Devastating. It felt like a death sentence.

I returned a few months later to the “knee guy” in that practice, Dr. Stephen Fox. He told me that running didn’t cause my arthritis and wouldn’t hasten the joint destruction. He encouraged me to stay active, though warning me to quit the heavy weight training, “Run a couple of miles. If it hurts worse the next morning, run slower and less distance the next time. Keep up with your normal biking, swimming, gardening, etc. Come see me about a joint replacement when the pain begins to interfere severely with your quality of life.”

So I did, and I’ve since had successful right knee and left hip replacements with Dr. Fox as my surgeon. I keep doing whatever I can. If you have chronic knee pain, visit a rheumatologist to help with a diagnosis, and try to find an orthopedic doctor like Dr. Fox.

One last note: If your doctor, any doctor, prescribes physical therapy, do it. Do it until they throw you out for good behavior.

Now read how to prevent back pain, another biggie!