Knee pain can occur without an accident or injury. Pain can be the result of simple functional activities like getting up from a chair or kneeling, however sometimes there is no clear reason for your knee to hurt. This does not mean that your knees are damaged, and, in most cases, it is safe to keep moving.
Why does my knee hurt?
All joints and soft tissues have a certain amount of activity that they can tolerate. This level can go up and down depending on how much activity you do. For example, following a period of rest or illness your activity tolerance will be reduced. If you then do an activity that takes you above this level, you can present with a painful reaction. This is not an indicator of damage, but an indication that you have exceeded your current level of tolerance.
Activities that can cause a painful reaction can include kneeling, squatting, repetitive stairs or ladder climbing, and a general increase in your normal daily activities. Often you may not get a painful reaction at the time of activity, it can come on over the next 24 hours.
Should I be resting or moving?
For the first 24 to 48 hours after a painful reaction:
- Try to rest your knee but avoid long spells of not moving at all.
- Ensure you gently move your knee, aiming to bend and straighten regularly throughout the day.
- If swollen or warm, apply ice (wrapped in a towel) for 10-15mins, every 2-3hours. Ensure to check the skin at regular intervals during this process to prevent ice burns.
- Continue to walk as able.
After 48 hours:
- You should try to use your knee more.
- Do whatever you normally would and stay at or return to work. It is important to return to normal daily function to prevent deconditioning.
- Aim to return to increased activity as you feel comfortable – once pain has improved and you have regained full movement through your knee.
- Gentle exercise really helps to maintain the movement and strength around your knee – please see PDF link for exercises.
How do I know if my activities are causing a painful reaction?
It is common to get a painful reaction following increased activity. If this pain is more than 6/10 (with 10 being the worst pain imaginable) or pain lasts for more than 24 hours, check what you have been doing and ease back.
Once this has settled you can start to gradually introduce your activities and exercises again. If you have mild aggravation (pain is less than 6/10) and this settles within 24 hours then keep going with your exercises and gradual return to full activities.
Activity Diary and Modifications
It is sometimes useful to make a note of the daily activities that can potentially aggravate your knee. Below are some of the main aggravating factors and some modifications you can make to help reduce the painful reaction.
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Aggravating Factor
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Modification
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Sleeping with knees touching
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- Use a pillow between your legs
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Prolonged sitting with knees bent
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- Try to get up and walk every 30 mins
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Stairs
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- When going upstairs reduce the strain on your knee by leading with your good leg.
- When going downstairs reduce the strain on your knee by leading with your problem leg.
- Make use of handrails.
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Kneeling
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- Use knee pads or alternate kneeling through one knee at a time with the other leg in front of you. Alternatively, you could make use of a small stool to sit on.
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Walking – if painful and causing a limp
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- Try offloading your knee by using a stick (or elbow crutch) for a short period and remember to pace your activity – take regular breaks if required.
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Pivoting (twisting) through the knee
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- Keep nose and toes facing the same direction when turning.
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Should I take painkillers?
Painkillers can help you keep moving. However, it is important to discuss this with your GP, especially if you are taking any other medication.
Should I use ice or a heat pad?
If you have noticed knee pain within the last two days, it is recommended to use an ice pack for the first 48 hours. You can do this every two to three hours. Make sure you use a damp towel between the ice and the skin to avoid ice burn.
After two days, you may find that heat is more beneficial. You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and not directly touching your skin (wrap in a towel). You should apply this for 10 to 15 minutes, three to four times a day.
What about work?
The best thing to do is to keep moving. This may mean that continuing to work, providing your job does not significantly aggravate your symptoms, will be the most beneficial option. However, it would be recommended to discuss any concerns with your employer, as they may be able to support with reduced duties whilst you are recovering.
What about sports?
You should take time before you take part in any sports after a knee problem. You should have no swelling and be able to move your knee properly. You should have full or close to full strength and be able to take your weight through your leg without limping. Remember to stretch and warm up fully before sports.
General Recommendations for Knee Pain:
Exercise
If possible, exercise regularly. This helps to strengthen the muscles around the knee. Aim to walk regularly alongside strength-based activity, which will contribute to overall musculoskeletal health. Other exercise ideas include cycling and swimming.
Weight Management
Increased bodyweight impacts the load placed through our knees. The force transferred through the knee joint during walking ranges between 2-3 times our bodyweight. Even a modest weight loss can make quite a difference in reducing knee pain.
Walking aids
The use of walking aids can be beneficial to help offload a painful knee and thus ease the pain. However, it is important to note that if using a walking aid, to place it in the opposite hand of the affected joint. For example; if your left knee is painful, use the walking aid in the right hand.
What are the aims of physiotherapy?
The focus of physiotherapy is to restore full joint mobility, increase muscle strength and improve overall function. By doing this, it may also improve your pain. We would expect most symptoms to resolve within six-weeks with the recommended management strategies detailed in this leaflet.
However, if symptoms persist, you can be referred into our service for further physiotherapy assessment.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight:
Link: www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity
Link: www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns
Link: www.nhs.uk/live-well/sleep-and- tiredness/how-to-get-to-sleep/
Reducing alcohol consumption
Link: www.nhs.uk/live-well/alcohol- support/calculating-alcohol-units/
Stopping smoking
Link: www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind
Link: www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
• Blackburn and Darwen - https://refreshbwd.com/
• East Lancashire - http://www.upandactive.co.uk/
