Aging & ArthritisImportant ConceptsJust PostedKneePain


         Many people simply accept pain as a natural part of aging and having arthritis.

They also come to me to try to eliminate their pain, and this is usually not possible. If it were, then I would have discovered a cure for arthritis. We can only “treat” the arthritis. Kind of like we can only “treat” hypertension. We can’t cure it. Even a total joint replacement is not the end of the problem. Patients who have total joint replacements usually have become de-conditioned. They often do not recover from surgery as they expected. Younger patients undergoing total knee replacement, have expectations of being able to resume activities they did before surgery, like walking long distances, playing tennis, and skiing. And when they fail to achieve what they think is an acceptable recovery, they are often disappointed. The pain after total knee replacements is greater, and because of that, patients often don’t achieve full range of motion. You could outlive your total knee replacement, which would require a revision, which are always more susceptible to complications and a poor outcome.

So why am I telling you this? To make you feel bad about this particular operation, or the decision you make to have it? No. I’m telling you this because I want you to hang on to your own knee as long as you can. You need to have convinced yourself and your surgeon that you’ve persevered with a conservative course of treatment and now the ONLY alternative is to have a total knee replacement. This surgery is not the first choice for treatment of arthritis. You have it after you have tried medications, injections, therapy, and yes…modification of the activities which cause your pain. You try to get older too. There is NO GUARANTEE that this surgery is going to allow you to return to the state you were in when you were 20, or even 50!

But there are other things you can do besides medications and injections. Here’s a short list of the things I advise my patients to do…or in some cases, not to do.

  • Of course, my mantra…stop doing squats, deep knee bends and lunges. Sometimes, simply doing this will make a huge difference in the pain you are experiencing. Just say “NO!” Stop that ridiculous exercise program that has you doing squats and jumping jacks. And these damaging exercises have a way of sneaking into even the most seemingly harmless dance programs.
  • Limit stair climbing. Everyone is always shocked at this recommendation. Stair climbing puts a lot of stress on the knee, so just don’t seek out stairs as a source of exercise, especially if it hurts to do it! If you must climb stairs, then so be it. But when you are at the mall and want to go to the second floor, take the escalator. And let your grandchildren run upstairs to get things you need.
  • Get a handicap parking permit. Oh my gosh! She can’t be saying this. Walking is good for my knees, right? No. In my opinion, there is no exercise that is actually “good” for your arthritic knees, other than exercises to maintain flexibility. Exercise is good for you, but not if the exercise you are doing puts you under the knife. Remember, surgery is not without potential for complications. But bottom line. I would rather you save your walking steps for a vacation, or to do the things you absolutely need to do. Not for walking across dangerous parking lots. If you have arthritis, you only have X number of steps left in that knee, and when your last molecule of cartilage is gone, it’s time for an operation.
  • Spend time in water. Weightlessness is good. If you have access to a pool, a lake or a pond, just go float in the water for as long as you possibly can. Like until your skin gets all wrinkly and waterlogged. You don’t have to swim. Just get a little kick board or a noodle and float around, leisurely contemplating cloud shapes. You can kick a little or move your legs as if you were peddling a bicycle under the water. So, this is not necessarily a recommendation for water aerobics, which sometimes turns into a program of leaping off the bottom of the pool and doing underwater squats. Nothing wrong with nice, gentle water aerobics, but I’m specifically recommending a period of just weightless floating. Your aging body will thank you!
  • Bend and straighten your knees before you get up from a chair, especially if you’ve been sitting for a while. Believe it or not, your knees would like nothing better than for you to stay in bed or seated for the rest of your days. But it’s not time yet. If you’ve been sitting a while, your knees get stiff, and little rough bits of cartilage get a tad wonky in your knee. Then when you stand, a tremendous amount of pressure is put on the knee, and you feel it as you straighten that knee against gravity. Pain getting out of a chair is a common complaint, and often the earliest complaint in patients with arthritis. So just gently bend and straighten them a few times before you get out of bed in the morning and before you stand up from sitting. You will feel a difference. I promise.
  • Square up your movements. This is a term I use. It’s not a medical term. There is not acronym for it, so I’m making one up now. SUM. When you get up from a chair, get up straight in front of yourself. Don’t twist your body or legs. Stand up straight and THEN make your move across the room. Swing your legs around as you get out of your car. Then stand up. I often see patients who recall that their pain started when they just lightly twisted their knee getting out of a chair.
  • Don’t wear backless shoes, like flip flops and sandals without a strap around the heel. Your legs have to work overtime to hold them on. They’re more likely to slip and cause accidents, and your weakened knees are not as capable of compensating for this hobbled state as they were when you were young, and unafflicted! Ha! How’s that for a term for our aging state?
  • Get a simple knee sleeve and wear it when you’re doing a lot of walking, like when you’re on a vacation or something. Don’t wear it all day. Wear it only when you’re walking a lot. It influences a part of your brain that subconsciously controls all your muscles, and then that part of the brain sends a little extra umph back down to the muscles surrounding your painful knee. It doesn’t have to have copper or fancy hinges on it to work. Frankly, a piece of duct tape down the front of your knee would probably work just as well, but then say good-bye to hair and the top layer of skin.
  • Get a pair of hiking sticks and use them when you’re walking long distances. It will improve the quality of your exercise and will diminish the stresses to your knees. It has the extra benefit of improving your balance as well, so you’ll be less likely to fall down! I prefer hiking sticks over canes. And they look a little sporty.
  • Slow down! That’s right! Don’t be in such a hurry. I’ve posted something on this already, and I feel strongly about this. Being in a hurry can result in injury, but it can also just overwork your aching joints.
  • Sit Like A Man (S.L.A.M.™)
  • Raise the seats you sit on (toilets, couches and chairs). Get a comfort height toilet. Put cushions under worn out couches and chairs. Get them reupholstered if you can’t part with them. Add pieces of wood under the legs.
  1. Judy Miller

    My trainer at the gym still loves squats. Should I just tell her NO More? I think I will after reading this article. You’ve said no squats over and over for years.
    Thanks for the advice. I was surprised about the walking. Hmm.

  2. Carol tisdale

    Dr. Bergen, i have great appreciation for the personal time you take to speak to us about how to prolong our quality of life through proper care of our joints, etc. You dispel heresay and offer the most common sense approaches. Now that I am 68 – life is beginning to take its toll on my knees and back. I remember the first visit i had with you , you told me to think of surgery as the very last resort. I did the injections you recomended on my knees – that was about 5 years ago and my knees give me very little problem. Thanks for all the simple suggestions you give….I without guilt avoid stairs when i can, use knee wraps when we travel abroad and do so much walking, I am stretching before getting out of bed….I just know you have benefitted me immensely and I hope you will continue these “articles”. Your deep concern for the humanity of your patients is evident – I hate to say but that seems to be disappearing from much of the medical community. Wishing you the best!

    1. Barbara

      Thank you for checking out my blog, and saying such nice things about it. I do hope you derive benefits from my posts!

  3. Anne Davies

    I totally agree with you-keep away from the knife and from twisting.Use your quads rather than an arm Push-up to get into standing.
    I need advice to try to reduce pelvic rim pain seemingly caused by degenerative disc syndrome in most of my spine.This has caused my rib cage to rub along my pelvic rim and the highly acute pain is excruciating.10% Voltaren helps but does not have a lasting effect.I also wear a lumbo-sacral spinal brace when I’m doing activities.My diagnosis is Psoriatic Arthritis.I am very independent,living in my home.Much to my surprise,reciprocal walking up and down stairs reduces the pain.I am 81yrs.old and I’ve lost 51/2″ in height(very little disc in situ). Any suggestions will be gratefully received.

    1. Barbara

      Anne, you have a complicated problem, and it’s hard to give very individualized recommendations. We all start losing disc space as well as vertebral body height as we age. That’s party why our tummies seem to get bigger. It’s like squishing a marshmallow. Not sure why stair climbing helps. Can’t argue against your experience. Spend more time in water if you have access. Weightlessness is a good thing, as mentioned in my post.

  4. Nancy McKay

    Thank you, Dr. Barbara-~

    Would you be able to do a similar recommendation to address hip bursitis? Feeling like mine may become permanent and would like suggestions to deal with it. Love your “no nonsense” explanations!


    1. Barbara

      Yes! Read my posts on “Hip Bursitis” and “Sit Like A Man.” Some of the arthritis tips will help your hip as well. But read those other two posts. Thanks for following my blog!

  5. Maureen Firle

    Great advice! I also followed your advise for Sit Like A Man and along with massage therapy specific to both hips, my hip bursitis Is resolved. Now, when I feel my hip starting to tighten up…back to massage therapy and uncross those legs!

  6. Joyce

    I just want to thank you for making me laugh! You have a way of talking that is so refreshing!
    I have arthritis and bursitis of the hip and just had a cortisone injection. I pray it works. Sooo much pain.
    I will follow your instructions on how to help myself through this which is most helpful but I really do appreciate the humor!

    1. Barbara

      I’m glad you enjoy my posts, and find them useful. I love to laugh, and find that laughter makes a visit with the doctor feel better. It’s rare that I have a visit with any patient, when we don’t have a little giggle, laugh or even a belly laugh together. So I like to share that with my readers as well. It makes the read a little easier, I think.
      I too, hope your injection works. Remember, it just decreases inflammation. You must stop the mechanical forces contributing to your pain. So yes…keep slamming! And of course, getting your bursitis to hurt less, will not help that hip arthritis. Be certain, before ever considering a total hip replacement, that your pain is indeed coming from the hip. Lateral hip pain is usually bursitis pain, and hip arthritis usually causes groin pain. I hate it when I see patients who had total hip replacements as treatment for lateral hip pain, and the pain is not gone after replacing the hip. Sometimes they feel as if they shouldn’t have had the surgery.

  7. Tracey

    Love love your articles. I have hip pain coming from the groin. Can be very painful especially when I lay down, have trouble knowing where to put my legs to ease it. Can you suggest if there is any particular exercise that may help. Think I have been doing Slam for years as my weight has stopped me from crossing my legs for years now.
    Will be sharing your blog with others, so keep the info coming.

    1. Barbara

      Thank you Tracey. I’m glad you get something out of my posts. We grossly place “hip” pain into three groups: buttock, lateral hip pain and groin pain. In general, groin pain comes from the hip joint itself, but it can also come from the hip flexor tendon. If it is indeed arthritis of the hip, no exercise will reverse this. In fact, it will get worse over time. Buttock pain, usually comes from the nerve roots, and is associated with the back and sciatica. McKenzie exercises can help, and of course, NSAIDS, injections, etc., can help. Last, and most commonly, at least in my practice, comes lateral hip pain. This is usually associated with bursitis.

  8. Brigitte

    Since I have time now to read and search knee advice treatment options and advice for a possible meniscal tear I am thrilled to have discovered your blog and a wealth of incredible good information. I am a 64 year old woman, still up to last week working in the ER as an R.N. I picked up my filled suitcase to put on the bed, instantly felt a pop in my right knee. My ultrasound showed a possible torn meniscus of the posterior horn. I have an MRI scheduled January 30, I have a physio assessment today. I am devastated and fearful. I have been doing gentle exercises wearing a brace and lots of RICE. I hope to get advice and instructions from physio today, We were to leave for Florida for a 6 week vacation last weekend. Generally I am fairly fit, not overweight and active. I go to the gym 2x weekly. No more squats for sure. Do you have any comments? I appreciate your valuable input!

    1. Barbara

      Sorry to hear you might have a tear, which as you know, is just the beginning of having arthritis. Please try not to be fearful. You are in good shape, and you’re 64 years old, which means, if everything fails, you CAN have a total knee replacement, and you will have pain relief and be able to return to activities you enjoy. But, also don’t give up. Conservative treatment might also work well for you. I saw two patients today, with similar history who are both doing well after cortisone injections. You should try it, especially before going to Florida.

  9. Rawan khaled

    I am only 17 years old i’ve been training basketball since i was 13,i’ve been lately diagnosed with arthritis in the right knee but i can’t stay away of the court what do i have to do to reduce the pain and strenghten my knee.
    Thanks in advance

    1. Barbara

      This is most unfortunate. You’re very young to have arthritis in your knee, but my assumption is that you injured it when you were very young. It doesn’t take too long to develop “post-traumatic arthritis” after a serious injury. And we’re seeing them more and more, because of the huge number of students playing sports. I’m not so sure we’re helping ourselves stay pain-free for the long haul. I wish you would “stay away from the court.” It’s the only way you’re going to have a better chance of avoiding further injury. Your arthritis will only get worse, even if you don’t have another injury. It no longer can sustain the heavy wear and tear from participating in sports. If you insist on playing basketball, then there’s really nothing else that will help your knee. If you’ve read any of my other blog posts, you know I hate squats, and they would be terrible for an already arthritic knee. Perhaps just participating in your sport will keep your knees strong enough. I can’t think of any exercises I could recommend to you, that would suffice to strengthen your legs. Anything I could offer would be insufficient to really strengthen your quads and hamstrings. Sure, you can ride a stationary bike, run, lift weights, but all of these will aggravate your knee. You should question your orthopedic surgeon. Only they know the real condition of your knee. Since I have not seen you as a patient, I really can’t give you specific advice. I can only tell you what I would not recommend, as I did above! Best to you.

  10. John (Jack) Odom

    Thanks, this is very good advice. Ok, I’ll retire my flip-flops for trekking to the mall or your office. One of the exercise classes my club has is Zumba-Gold and I have avoided it because of the pressure on my knees when spreading my legs during the dance steps. I also will avoid lunges and squats in the future when they are included in our Silver-Sneakers classes. We live in a 3 story house so the stairs are hard to avoid although I will work to be wise about how many times I trek up and down. I love to garden and have already quit kneeling although I do bend a lot when weeding, planting, fertilizing, and harvesting. I will seek help with the more strenuous work requiring my knees. My hiking canes are supposed to be delivered tomorrow and I will be looking forward to using them soon.

    1. Barbara

      Yes, yes, yes and yes! Oh, and yes…haha! Put your hand on the stair handrail and push a little. That will reduce the pressure walking up those stairs. Seek a one-story home…I could write you a prescription!

  11. Cecilia Adamson

    Dear Dr . Barbara , I came upon your website by pure happenstance . What a refreshing site .Though I personally haven’t a need at this time .Many people I come in contact could find great value in this site and I will have it in my “if/when” I may need it site . All the best Cecilia

  12. Kim

    I recently came across your blog and thoroughly enjoy reading your advice and recommendations. I’m 58 years old and suffering from chronic left knee pain. I’ve had 2 MRI’s this year, one being last week, and both show small oblique horizontal medial meniscus tear, joint effusion and Baker’s cyst. I’ve tried hyaluronic acid injections with no relief and 2 cortisone injections that provide some relief for about a week or two. My ortho has now referred me to another surgeon for a knee replacement consultation. I’m not crazy about going this route but feel my options are becoming limited. Any advice on avoiding invasive knee surgery in the near future? I value your input!

    1. Barbara

      It would be my wish that you wait as long as possible for total knee replacement. 58 is a little young, but not unreasonably early to consider TKR. It does sound like you’ve participated in a good conservative course of treatment for knee arthritis, to no avail. TKR is the next alternative. Have you modified all painful activities? You’re not running, squatting, stair climbing or doing any kind of crazy exercise program that involves all of the above activities which ensure me and all orthopedic surgeons a good living? You’re not doing jump-squats, thinking that will help you lose weight? Because it won’t, and it will ensure that you have a knee replacement in short shrift. Ride a stationary bike, or do water aerobics. Do gentle stretches. Don’t even walk too much for exercise. Lose weight if that’s indicated. And don’t use exercise to facilitate weight loss. You must “diet.” Oh, and did I say, “NO SQUATS!” Well, if not, then, NO SQUATS!

  13. Sandy frank

    Dr. Bergin
    What a terrific wealth of information I have found reading your blog. Just want to tell you how much your knowledge and kindness meant to me when saw you as a patient. So very happy to have hooked up with you.

    1. Barbara

      Thanks for your kind words! It makes me so happy to know I’m helping folks through that blog…and in the office too! I’m glad you’re my patient as well!

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