Updated: Oct 1, 2020
Capsule, ligament, meniscus, joint surfaces, and underlying bone are the structures that can cause pain in your knees. You can injure these structures in any number of ways such as slipping on ice, playing sports, or due to a direct blow. However specific incidents as mentioned, are not the only way we can injure our knees.
Over time, staying in certain positions or postures can disrupt the normal function of the knees. As a result, the knees gradually become less able to tolerate the loads that we may place on them rapidly such as deciding to go for a walk, run, or maybe retiling our basement. Combine the fact that there are normal aging changes, increased periods of inactivity causing deterioration, and sprinkle in some old injuries... Tadaa you have knee pain.
In order to keep our knees healthy, they require regular activity. We have to nourish all the structures which allow us to participate in a pain-free activity.
So let's look at the most common causes of knee pain.
1.) Inactivity (being out of shape)
As we enter our 30s and 40s, we exercise less, our metabolism slows, and we have a tendency to put on weight. All the structures in the knee also begin to lose hydration and flexibility. You would think you are doomed... But why doesn't everyone develop knee pain? How come some people seem to never stop doing their favorite activities and others have to just give up.
A large part of the reason is activity levels. Your knees (and entire body) responds to normal exercise and load, it actually improves joint nutrition. Think about it, when you were a kid you couldn't sit still, your knees were always being used. Thus, joints, ligaments, tendons and capsules were being stretched, and muscles were being strengthened. All this activity causes increased blood flow, removal of toxins and speedy recovery. Then as you get older you stop a large majority of that activity and you have the nerve to blame it on old age?
Tom Brady is 42 years old and playing in the NFL, in fact there are many pro athletes in their mid to late 30s and 40s still competing at a high level. So how come they can still do it but you can't jog for 3 minutes straight... I'd bet it's because they never stopped using their body and you did. When you limit activity, you lose strength and the tolerance for sustained activity. This causes mechanical pain and makes our knees more susceptible to micro injury and trauma.
Whats the Solution?
At the minimum, start a walking routine. Go for walk at least 3-4 times per week. Start small with a simple 5-10 minute walk at a comfortable pace and build up to a 30-60 minute walk.
From there, you can start any exercise routine, yoga, pilates, cycling, resistance training etc. Just get moving.
2.) Postural Stress (staying in any position for too long)
Prolonged or repetitive activities in the same position can cause excess stress on joint structures. This includes prolonged time in the knee bent position such as during squatting, crouching, kneeling or sitting in a low chair. Standing still for a prolonged period of time, or laying/sleeping with knee positioned incorrectly.
It's a simple concept, if you stay in one posture for too long, the structures of the knee adapt to that position. When you get out of that position, the structures are unable to properly support the new position.
This is why your knees feel achy after sitting, squatting or kneeling for too long. The structures of the knee have shortened, and when you finally get up, they need to lengthen again. Now think about how many hours a day you sit, make sense why you have been developing knee pain when you stand, walk or jog?
-Every 30 minutes straighten your leg and hold it straight for 5 seconds, repeat this 5x for each leg.
-Get up and take a short walk!
When you stand for too long in one position, it's the same part of the knee that bearing all the load. Over time, the same area absorbing all the force will lose shock-absorbing capacity.
-Every 30 minutes, sit down and pull your knee to your chest holding for 5 seconds, repeat 5x to each knee.
-Get supportive sneakers with a cushioned sole to absorb some of the force going through your knee.
-Take a short walk!
Lying and Sleeping
Just as sitting and standing, if you are in the same bad position all night, the structures adapt and your knees hurt in the morning when you move them out of that position. Keeping the affected leg bent >90 degrees or fully straight are the worst positions for the knee. Also having your knees pressed together cause a compressive load causing pain.
Sleep with a pillow between the knees. Do not bent the affected leg bent >90 degrees or fully straight.
3.) Being Overweight
The American Academy of Orthopedic Surgeons (AAOS) found a strong correlation between being overweight and having knee pain... But did you need me to site a fancy organization to figure this one out? The more weight your knees have to carry, the more pressure on the knee, the quicker the load absorbing structures wear out, and the more unstable they are during normal activities. Your knees are giving you a piggy back ride all day long. Think about it like this, if your 5 year old daughter asks for a piggy back ride, you do it and it's fun for everyone. If your grown adult best friend asks you for one, you flip him off. No one wants their knees flipping them off.
Aim to get your BMI (body mass index) below 25, numerous studies have found that a BMI of over 25 is associated with increased knee pain.
BMI Formula: A person's weight in kilograms (kg) divided by their height in meters (m) squared.
4.) Poor Biomechanics
Biomechanics are the internal and external movements that occur at the knee. Basically, it's how stable your knee is during activity and how well it's moving in the intended way. When the knee is moving, you want all the force distributed equally and in the correct areas. If not, these poor biomechanics can cause adverse loads on the knee contributing to pain especially in the front of the knee by the kneecap.
Have an assessment by a physical therapist. I love giving out free advice, and I don't want you to think I'm holding out on you, but the knee joint can get very complicated. You see it is fixed between the ankle and the hip, so any incorrect movement or malalignments at either joint can affect the knee. Not to mention that there are many structures of the knee itself that can be causing impaired biomechanics.
Two good general knee exercises to improve knee biomechanics can be found in the blog post: Keeping The Bees Knees.
There you have it, the 4 most common reasons for knee pain, and what you can do about them. Now start doing something about it so you can get back to enjoying every day pain-free!
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