The medical name for knee pain is Patellofemeral pain, or PFP. And knee pain is really common as people get older. It can have a variety of causes, but only one third of people over the age of 50 who struggle with knee pain will go and see their GP.
Why people don’t seek medical help is unclear. Perhaps it is because they are worried they will be told it is their own fault – there is a common (often mistaken) belief that you get knee pain because you are overweight, and the doctor will just tell you to lose weight. Patellofemeral pain is far more complex than simply “you’re fat”, though.
There can be many causes for knee pain. Obesity is one, but so is meniscus damage and repeated injury (ex-footballers are more likely to suffer knee pain than people of the same age and gender who didn’t play football). There’s also arthritis, but interestingly, the steroid injection that is often touted as a cure-all may not be as good as we think – a study in the New England Journal of Medicine (April 2020) found that after 12 months, people who had physical therapy were in less pain than people who had an injection of glucocorticoids into the knee.
One of the major problems with knee pain is that people don’t really understand what is happening. For most people, the crunchy knee crepitus that many people have is nothing to worry about – until there is pain. Dr Google steps in and before you know it, people are worrying about “bone on bone” knee movement, and becoming too scared to move for fear of pain. This in itself causes a problem – because keeping moving is one of the best things you can do when faced with knee pain. As this study in the BMJ shows, “A home based, self managed programme of simple knee strengthening exercises over a two year period can significantly reduce knee pain and improve knee function in overweight and obese people with knee pain.” Interestingly, losing weight (also part of the study) reduced people’s depression (most people feel happier about themselves if they lose a little weight) but was “without apparent influence on pain or function” – or in other words, the exercise helped the knee pain but losing weight seemed to have no effect.
Another study looked at how people understand their knee pain, and compared the pain levels of people who were given exercises against the pain levels of people who had education about their knee pain given to them by a health professional. You would think this would be obvious – exercise would beat simple explanations hands down….but you’d be wrong. Health professional delivered education about knee pain produced similar functional and clinical outcomes as education and exercise. But the study showed that the education only worked if it was delivered by a health professional. Simply giving someone some leaflets had the worst outcomes – worse than even just exercise by itself.
So what does this tell us about the best way to manage knee pain? Sitting at home isn’t going to fix it, even if you think you’re just “resting” your knee. When you seek help, just getting a leaflet or information to try and understand yourself isn’t going to help much, but having someone explain to you what is happening will be great – and have a really positive outcome. If that is tied in with exercises, even simple knee strengthening exercises, you’re likely to see an improvement in function and reduction in pain too. If you’re offered a steroid injection, see if you can have manual therapy instead – the results are better at 12 months than the injection.