Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
One of the most common physical complaints, especially for older adults, is a knee that swells or aches. Some people live with constant knee pain, while others experience occasional flare-ups. A “bum” knee can have a myriad of causes, but in almost all cases, inflammation is involved. So whatever the cause, understanding how to treat knee inflammation may bring you relief.
If you haven’t suffered an obvious traumatic injury to your knee, you may approach your doctor complaining of pain in the joint without knowing its source. In such a case, your doctor will likely start with a physical examination to see how much mobility you have, how much pain you’re experiencing, how much knee swelling there is, and whether there appears to be damage to the knee’s mechanical structures.
The examination may be followed up with an x-Ray, MRI, CT scan, or ultrasound. These imaging tests will help the doctor understand the source of the problem, which could include a fracture, a dislocated kneecap, osteoarthritis, rheumatoid arthritis, gout, bursitis, infection, torn meniscus (cartilage), ruptured ligaments, a “loose body” (meaning a bit of broken off bone or cartilage floating in the joint space), or inflammation of the tendons in the knee.
To confirm some of these diagnoses, including bursitis and gout, the doctor may order or perform a procedure called arthrocentesis, in which a needle is inserted into the knee area to draw out synovial fluid to be analyzed by a lab for bacteria and for markers of inflammation. Withdrawing fluid from the knee also has the potential benefit of reducing swelling.
Because of the great variety of causes of knee pain, there is also a considerable variety of treatment options, some of which are entirely non-invasive and may be performed at home, and others of which require teams of doctors.
Rest…Mild sprains and occasional inflammatory flare-ups may require nothing more than some deliberate inactivity. Refraining from vigorous exercise…or even from your normal daily activities…can allow healing to occur without aggravating the swollen knee or introducing new injury.
Ice…Cooling the joint not only reduces swelling but also brings down the level of pain, perhaps by numbing the nerves. Rather than applying ice directly onto bare skin, wrap your ice pack in a thin towel or washcloth. Because knees are big, awkward joints, you might try a bag of frozen vegetables, which you can drape or wrap around your knee to hit the crucial spots. Don’t ice the joint for more than 20 minutes at a time.
Heat…It seems strange that opposite ends of the temperature spectrum would have similar effects, but it’s true. A heat compress can reduce pain just as much as ice can. Some people like to alternate between ice and heat. Obviously, never apply so much heat that you’re in danger of burning your skin.
Elevation…While you’re resting the knee, while you’re applying heat or ice, or simply while you’re sleeping or watching TV, keep the joint elevated with pillows or cushions. This keeps the joint from swelling, presumably because it slightly restricts blood flow and thus reduces the amount of inflammatory substances delivered to the knee.
Compression bandages and braces…Wrapping the knee firmly keeps it nicely aligned to reduce further injury and stops fluid from building up in the tissue. Be sure you’re not cutting off your circulation, and remove the wrap periodically to let your skin breathe and to relax the joint.
Over-the-counter pain medications…Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium (Aleve) can lower inflammation and reduce pain. However, they should be used sparingly. If you’re suffering from an acute injury, take NSAIDs just long enough to get you through the worst of the first few days. Research has shown that people who rely too heavily on NSAIDs after injury fare worse in the long haul than those who don’t use them, because disrupting inflammation amounts to blocking the healing cascade. And if you suffer constantly from knee joint pain, you could experience negative side effects by using NSAIDs too often. Talk to your doctor about what more permanent solutions you might try.
Creams and gels…Some people with knee pain find relief through rubbing the joint and surrounding area with products containing lidocaine or capsaicin. These substances numb the tissue.
Acupuncture…This ancient Chinese healing technique, in which tiny needles are inserted into the body, has been shown to bring relief to people with knee pain stemming from a host of problems.
Physical therapy…Often, a contributing factor to knee pain is an imbalance in the stabilizing muscles that surround the knee. A physical therapist can guide you in exercises to strengthen those muscles and balance out the mechanics of the knee. Once the strain is taken off a portion of the knee that was previously overburdened, the pain diminishes.
Injections…Doctors sometimes inject medications directly into the knee. These include corticosteroids, platelet-rich plasma, and hyaluronic acid. Such injections may promote healing, reduce inflammation, soothe pain, or lubricate the joint, although their effectiveness is mixed.
Surgery…Sometimes no amount of rest, therapy, acupuncture, or medications is sufficient to correct the source of the knee pain. For example, you may need to have a “loose” body removed, repair cartilage, or reconstruct a ligament. In such cases, surgery is the best option. Knee surgeries are often done arthroscopically, meaning through a narrow incision near the surgery site in which a tiny camera and tools are inserted. However, if the damage to the joint is excessive, you may need to have a partial or total knee replacement, in which damaged bone and cartilage are discarded and replaced by metal and plastic parts. Knee replacements require considerable recovery time, so the decision about whether to undergo one should not be taken lightly.
Finally, a type of surgery called osteotomy is sometimes performed on patients with osteoarthritis in the knee. The surgeon realigns the knee by removing bone tissue from above and below it in the thigh and shin. An osteotomy is sometimes offered as a way to delay or forego knee replacement.
