Are creaky knees a retiree’s disease? It’s true that knee problems are the most common age-related musculoskeletal problem in Singapore. If you’re over 40, you may already be feeling a twinge or two. Understand more on how the knee joint—the largest joint in your body—works, and why it hurts when it does. 

Related: Knee Arthritis: Symptoms, Types and Treatment

How the Knee Works

The knee connects the upper leg bone and the lower leg bones. Making up this joint are ligaments (for stability), tendons and muscles (for movement), with two discs of cartilage, or menisci, (for shock absorption) and many bursae, or fluid-filled sacs (which help the knee move smoothly).

Like any mechanism, the harder you work it, the more worn out it gets. Our knees don’t just face everyday wear and tear, they also get stressed when we are overweight or engage in high-impact sports. On top of degeneration, as we grow older, our knees become susceptible to inflammatory and crystal diseases.

Knee Problems That Come With Age

Knee joints degenerate with old age.

Do you experience any of these?

  • Pain
  • Swelling
  • Difficulty bending the knee (stiffness).
  • Ache or pain when weight is put on, e.g. when climbing stairs.

These are typical complaints that tend to surface in our 50s and can limit our lifestyles, especially when we enjoy being physically active. Mdm Julie, a proud owner of two lively dogs, laments that she has not been able to take them on walks like before. Fortunately, medical intervention has given her hope of being able to do so again. (You can read her story below.)

Barring injury as a cause, the following are some common reasons behind chronic knee pain:

Osteoarthritis

The most common form of arthritis, osteoarthritis is due to the progressive wearing down of cartilage over time. This limits the range of motion and triggers pain, stiffness, weakness and swelling of the knee.

Your age, weight and genes could play a part in developing osteoarthritis, as could previous injuries and infections. The World Health Organisation estimates that 40% of people aged over 70 will develop osteoarthritis.

Rheumatoid Arthritis

This is an autoimmune disease that causes the tissue around the joint to become inflamed and thickened. In the long term, this could damage and reduce the knee cartilage.

Bursitis

That sac of fluid over your kneecap can get irritated if you have to bend or kneel repeatedly. That’s why this condition, with pain and swelling, is also known as “housemaid’s knee”!

Related: 11 Ways To Relieve Leg Pains

Gout

Crystal deposits within the joint cause pain, swelling and inflammation (with redness and heat). Again, age, genetics and obesity predispose you to gout. Additionally, excessive alcohol intake and kidney disease are risk factors.

Patellar Mistracking

When the kneecap slides out of position, pain and swelling result. This could be due to weak thigh muscles, or activities which stress the knee, especially by twisting. Being overweight, running or squatting frequently can acerbate the condition.

Related: Patellar Tendinopathy

Knee Joint Pain Prevention and Management

Stay physically active but remember to stretch before and after exercise.

In order to reduce or manage knee pain, some recommendations are to:

  1. Maintain a healthy weight
    • Your knees carry the bulk of your body weight, so any extra kilograms stress them more than necessary.
  2. Exercise
    • Strengthening exercises to strengthen the muscles around your thighs keeps your knees stable. Just starting out? Try these 7 easy exercises! Love swimming? Regular water-based exercise can reduce pain and improve osteoarthritic knees. Remember to do a mix of physical activity, especially strength, balance and flexibility exercises at least 3 days a week. 
    • Always increase the intensity of your workout gradually.
    • Stop if your knees hurt.
  3. Stretch
    • Gentle stretching helps you to maintain knee flexibility and a full range of motion.
    • Stretch before and after exercise.
  4. Wear shoes that fit well and offer enough support
  5. Check your gait
    • Your walking style may be putting your knee out of alignment and adding uneven stress on it.
  6. Use supplements
    • Glucosamine, chondroitin and MSM may help, although the benefits are not consistent. They come as both dietary supplements as well as topical treatments (creams and gels). Do not use either if you are allergic to shellfish, though.
  7. Wear knee guards or knee pads
    • Knee braces or sleeves compress and align the knee and offer some support. Arch supports may also help relieve knee pain.
    • If you kneel often, padding will help prevent bursitis.

When to Seek Medical Advice

A physical therapist helping a patient with a knee injury.

If you experience severe pain or swelling, are unable to walk or bend the knee, or notice a deformity, it is best to see a doctor instead of relying on home remedies. Do this too, for any pain that doesn’t go away after a few days or after rest.

Your doctor will examine your knee for flexibility, functionality and general mobility. X-rays or an MRI/CT scan can identify injuries or deformities. Occasionally blood tests may be ordered, and sometimes, a small amount of joint fluid could be drawn for testing.

Related:  Before the First Antenatal Visit (Choosing Your Doctor)

Knee Joint Pain Remedies

Physical therapy can help with knee problems.

Why knee problems trouble us so much is because they can really hurt. We suggest several ways to contain the pain and gain some ease from knee disease! Try these:

  • Compression bandage. Elastic knee bands or professionally-applied leukoplast tapes can help with swelling and knee alignment, and offer support.
  • Rest. Sometimes all you need is to put your legs up.
  • Non-steroidal anti-inflammatory drugs (NSAIDs, or painkillers), which your doctor may prescribe for pain relief. However, these may have side effects for some people, and prolonged use is not advised.
  • Apply ice. Icing the area can numb the pain and reduce swelling and inflammation.
  • Your doctor may suggest injecting corticosteroids (for arthritis and other inflammations), or a lubricant to aid movement.
  • Some people find that acupuncture helps with osteoarthritis.

As always, your doctor can advise you best.

Related: Anterior Cruciate Ligament Tear (ACL Tear)

Knee Surgeries

When the knee has degenerated badly (usually not until your late 60s), or there is knee injury, surgery may be required. Operations are usually the last resort after other pain management techniques fail to help. Knee surgery is considered very safe and effective, but it is not fool-proof. While 90%[1] are able to resume normal activities, others may still feel some pain or require revision surgery.

  • Arthroscopic knee surgery is an outpatient procedure to repair injuries or remove small pieces of bone or cartilage. A couple of tiny holes are created and the procedure is carried out using a fibreoptic camera.
  • Knee replacement surgery can be partial (where damaged portions are replaced with plastic or metal parts) or total (an artificial joint is installed). 85% of artificial knees still work after 20 years!

Related: Diabetes Complications: The Road to Recovery After Amputation

One Woman’s Experience

Mdm Julie, a 58-year-old businesswoman, attributes her knee problems to the intensive badminton sessions she played throughout her 40s. “My knees began to hurt, but I thought I was still young. Then, one by one, my friends had to give up because of similar injuries, and the group disbanded.”

Two years ago, the knee pain became severe enough for her to seek specialist help. An MRI revealed a bone spur, as well as worn-down cartilage.

Mdm Julie opted for key-hole surgery, done through two tiny incisions on either side of her right knee. However, after the effects of the anaesthesia wore off, Mdm Julie still felt pain. Cold compresses helped to suppress this, along with painkillers. Unfortunately, a lubricant injection failed to help further. Doctors told her she is among the 1% of patients who recover poorly—99% find immediate relief after surgery.

Five months on, Mdm Julie now sees more improvement and has no regrets about having had the procedure done. She is conscientious about exercise, using a stationary bike and walking twice a day despite the initial pain. “I force myself so that I can recover faster,” she smiles.

At the same time, she is preparing herself mentally in case she needs a knee replacement when she is older.

An ageing society may see more joint problems, but modern medication and surgery techniques can offer valuable, long-lasting relief. Don’t let pain bring you to your knees!

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References

  1. Greengard, S. (2015, Feb 18). Clinical Outcomes & Statistics of Knee Replacement [Healthline]. 
    Retrieved March 2016 from http://www.healthline.com/health/total-knee-replacement-surgery/outcomes-statistics-success-rate#1