What to do About Knee Pain (even if it's arthritis)

I’m a member of a Moms facebook group of an affluent town. Why? Because it generates content- like today’s post.

Just today, I read this:

“I’ve got bad arthritis in my right knee. Last year I did PT for it and am continuing my exercises at home. Anyone else do/use anything regularly to help it? Currently wearing a knee brace at home, exercising regularly and adding in strength training. Thanks to inheriting my Dad’s joints, I know this is my life now and trying to figure out how to manage it.”

Ya’ll- the advice this woman received was downright terrible.

Worse? All the advice she received is mainstream and common… and bullshit.

Here’s what people told her:

I’m bone on bone, with bad arthritis too in my knees. The gel injections worked well for me the first time, but the second time I had an adverse reaction (same with cortisone injections). I take Diclofenac, do Pilates or go to Stretch Lab every day, and try not to sit or stand for long periods. Turmeric at night helps, and I wear Kinesiology tape on my knees vs a brace when they flare or I’m going to be using them strenuously. Oh, and definitely flares up with sugar! Hoping you find relief!

I just got a “gel” shot in my knee after doing all of the above. I was told it works in 75% who get it for arthritis It’s working for me so far. The official name is viscous supplementation injection.

The aqua fit class at LA fitness and VASA is really great for developing functional fitness. After my car accident it helped tons after PT was over.

I have used lidocaine patches.

Biofreeze.

Red light therapy and Magnesuim lotion.

Nope. No. Nopity nope, no.

I mean, do what you want.

None of the above is going to further harm the knee- but absolutely none of the above is going to help longterm nor is any of the above getting to the root cause and fixing the issue.

All of the above is making symptoms of the knee pain.

Here’s the thing with arthritis: most bodies will develop arthritis, as well as micro-tears in the tissue by the time we’re 35. It doesn’t necessarily mean it will cause pain.

You read that right- a loss of cartilage does not inherently mean a joint will hurt.

You can have arthritis and not be in pain. You can also not have arthritis and be in pain.

This is one reason why imaging doesn’t matter. Your results from an image, whether it’s X-ray or MRI does not dictate treatment.

Doctors are obsessed with imaging because they get to bill insurance.

I repeat: imaging does not dictate treatment.

Outside of a catastrophic mechanism of injury, the results of imaging don’t really matter 🤷🏽‍♀️ And even then, it’s not as big of a dial mover as you’ve been lead to believe.

In the movement and pain science world, it’s all about the function of the joint or affected area.

The function of a joint can be tested without imaging.

This is true for all joints of the body- not just the knee.

First, you need to know how the joint is supposed to function. The knee, for example, is supposed to:

Flexion: Bending the knee, achieved primarily by the hamstring muscles.
Extension: Straightening the knee, primarily controlled by the quadriceps muscles.
Internal rotation: Slightly rotating the lower leg inwards when the knee is bent.
External rotation: Slightly rotating the lower leg outwards when the knee is bent.

A good physical therapist or even a good personal trainer (hiii!) can test all of the functions of the affected area.

First, they’ll have you move through your available range of motion (ROM) on your own without assistance. This is called active range of motion.

Then, they’ll assist the joint through it’s intended full ROM- this is called passive range of motion.

Here’s the coolest part: joints and tissue do not work in isolation.

The knee is not just about the knee.

In fact, the knee in particular is a fairly passive joint. It’s the middle sibling of the ankle and the hip. Any good physical therapist or trainer will also examine the ROM of the hips and the ankles.

In 100% of cases of non-injury-specific knee pain, we’ll find limitations of the hip and ankle.

While the original poster mentions she’s strength training- it’s not enough.

First, not all strength training is considered equal. Many people fall prey to high intensity gyms like CrossFit and Orange Theory which pay no mind to function. It’s all about getting through the workout as fast and as hard as you can, pushing with high intensity, burning as many calories as you can, or getting on the leader board.

Exercising and strength training, albeit random and hard just for the sake of it, is better than nothing. But without a body-focused approach (not a fitness focused approach) it’s not going to help her knee in the way she needs it to.

The other thing? She’s wearing a brace at home. One of the worst things you can do for joint pain is limit movement.

Things like braces, topical treatments, light therapy, and balms is they do absolutely nothing to improve the way the knee works nor do they address the root cause.

I’ve helped literally hundreds (maybe thousands at this point) of clients successfully reduce and eliminate knee pain over my career as a personal trainer.

If this woman was my client, here’s what I would have her to do reduce and eventually eliminate her knee pain:

Assess Active and Passive ROM of both knees
Assess Active and Passive ROM of both hips
Assess Active and Passive ROM of both ankles
Assess gait pattern
Assess squat pattern (coordination of hips, knees, and ankles working together)
Assess mindset, thoughts, and belief about her body and pain (pain science shows us that our experience of pain is largely mental. That’s not to say it’s “all in your head.” However, your brain will offer you increased pain signals if you’re afraid of pain, believe you’re destined to always have it (she mentions this!), don’t trust your body, and believe that pain is ‘bad’ versus knowing that pain is how your brain is simply trying to keep you safe and get your attention.

Then, I’d have her include the following movements into her routine to begin:

(enjoy the thumbnails- lol. Thanks, Youtube!)