Knee pain: Too much or too little activity can both cause damage

Every time you climb stairs, get out of bed, or make even the smallest movement, your knees absorb the impact. It is why the knee is the second most common site of chronic pain after the lower back. Over time, the joint gradually wears down, and if there is existing damage, symptoms can range from mild discomfort to pain severe enough to interfere with daily life.

The New York Times reported Wednesday that knee pain does not automatically mean surgery is needed, and that treatment should vary depending on the underlying cause.

"Chronic pain creates not only physical suffering but also financial and psychological burdens," said Dr. Matthew Abdel, an orthopedic surgeon at the Mayo Clinic. "Even if people don't say out loud that their knee hurts terribly, they are constantly aware of the pain in the back of their mind."

The most common cause of chronic knee pain in adults over 55 is osteoarthritis, a degenerative condition in which the cartilage protecting the joint wears away, reducing its ability to absorb shock and triggering inflammation. The result is swelling and pain that tends to worsen over time.

"There will be days without pain, but generally the pain intensifies as time goes on," said Dr. Nicholas Scarcella, an orthopedic surgeon at the Cleveland Clinic.

The pain typically appears on the inner or outer side of the knee, or beneath the kneecap, and is often described as a dull ache or a sharp, stabbing sensation. A characteristic sign is morning stiffness that gradually eases once movement begins.

Overuse injuries are common among people who exercise heavily, and are especially likely when training intensity, distance, or duration is increased too quickly. Two typical examples are iliotibial band syndrome — outer knee pain caused by repetitive running — and patellofemoral pain syndrome, which tends to develop when thigh muscles are weak or knee alignment is poor.

When pain comes on gradually, physical therapy is a better first step than a doctor's visit. A physical therapist can identify root causes such as weak hip muscles or a walking pattern in which the foot rolls inward. A medical consultation is recommended only when necessary.

For chronic pain, strengthening the muscles around the knee is the most effective approach. Building up the glutes, hip flexors, quadriceps, hamstrings, and calf and ankle muscles together is key. Exercise can also reduce osteoarthritis pain — some research has found it to be as effective as common pain relievers. For those who find running too demanding, low-impact activities such as cycling or swimming are recommended.

If lifestyle changes and medication provide no relief, steroid injections are an option to consider. However, the effects often last only a few weeks, so repeated use is not advised.

For pain caused by a sudden injury, the approach is different. The first step is to stop exercising and apply ice not just to the inner knee but around the entire joint. Anti-inflammatory pain relievers such as ibuprofen and topical analgesics can also help.

While some risk factors such as age and genetics cannot be avoided, weight management is one of the most effective preventive measures. With every step, the knee bears a load two to three times a person's body weight.

Many people assume that exercise wears out the knees faster, but experts say the opposite is true: when muscles weaken from inactivity, the long-term risk of osteoarthritis can actually increase.