Ashlee Williams, MD (Host): Whether it's from years of wear and tear, arthritis or injury, knee pain can get in the way of doing the things that you enjoy the most, but it doesn't have to stop you. So, how can you help to keep your knees healthy, strong, and pain-free?

Welcome to the Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm talking with Dr. Lysa Charles, a board-certified orthopedist and Sports Medicine physician at Kaiser Permanente, to share the simple tips and strategies to help you relieve knee pain and get back to doing what you love. Dr. Charles, thank you so much for being here.

Lysa Charles, MD: Thank you, Dr. Williams. It's my pleasure to be here.

Host: It's such an exciting topic. Okay. So, knee pain is probably one of the most common things that I see in my primary care clinic. Can you talk about some of the common causes?

Lysa Charles, MD: To begin with, I think what's important to realize is that there're really sort of generally two broad categories of knee issues. There are injuries, and then there's the chronic wear and tear that we all experience as we age. So, it's really important to separate those two because they really are managed very differently.

What I love about Orthopedics is that we treat patients from birth all the way up to the retiree, but they're completely different animals. So if we're talking about the soccer player who's injured their knee while playing versus a retiree who's starting to notice some aches and pains as they go up and down the stairs, that's a whole other animal. So, we really need to separate those two.

But generally speaking, in terms of causes, you can have an injury. Something can happen acutely. It can be sort of a gradual wear and tear. It could be an overuse. So, there are really a lot of categories. And last but not least, it can be an inflammatory disease or inherited disease like rheumatoid arthritis. So, there really are a host of different things that can cause knee pain and impact our function.

Host: And I have an array of patients that come in. Some, it's like, "I hurt my knee yesterday," and some that have been dealing with pain for years thinking, "Oh, I just thought it would go away on its own." Can you talk about that? Will knee pain just go away on its own? Is that possible?

Lysa Charles, MD: Depending on the age of the patient, if it's an acute injury, something that is sort of fixable, like an acute meniscus tear in a 15 or 20-year-old, yeah, we can fix that. And that can go away. But for most of us, as we age, there are just aches and pains that kind of creep into our lives. And we're talking about most commonly arthritis. You know, our population is living longer. And so, we're seeing more and more patients have gradual onset of knee pain first initially, maybe with walking up the stairs or more aggressive activities. And with time, it can just be with activities of daily living. So, that sort of knee pain, the pain that happens as we age, is not something that we can make completely go away, but there are a lot of things at our disposal to manage or control that pain.

Host: So, how do you counsel your patients on keeping their knees healthy? How do people prevent future knee pain or lessen the severity of current knee pain?

Lysa Charles, MD: Definitely, there's a lot that the individual can do. I always tailor my treatment for patients in terms of what I can do for them and what they can do for them. And you've hit the nail on the head by saying that there are things that they can do for themselves. And most certainly, what we want to do is keep our muscles strong, that supports the joints. I tell my patients that that's like wearing a brace underneath your skin. Also, never forget every step we take, we're putting weight or pressure on our joints. When we walk, we put about three to five times our body weight at that phase where we are on one leg. When we run, it's seven to eight times our body weight. So, our body weight really has an impact. So, one pound of weight loss can have three to five pounds of effect of taking pressure off the knee. So, keeping your muscles strong, keeping your weight down as low as possible or losing weight certainly can impact your knee pain. And if you're doing more aggressive activities, we don't want you to stop. But sometimes as we age, we have to move to lower impact activities, such as swimming or cycling versus running or jogging or basketball. So, under our control, besides taking medications, which is really not the first choice, I like people to modify their lives as much as possible and use medications only when really necessary. So if you can get your weight down, strengthen your muscles and move to lower impact exercise as you age or mature, a lot of times that can really relieve a lot of the knee pain.

Host: And that's a great segue into my next question. What advice do you give people to do at home for their knee pain?

Lysa Charles, MD: Definitely start with strengthening the muscles. I used to be against YouTube, but there's so many really good exercise regimens.

Host: So many great things.

Lysa Charles, MD: Right on YouTube. I would caution people to do an exercise regimen or look at something that's by a licensed physical therapist or you'll get programs where you can do Strengthening exercises for knee pain, strengthening exercises for the runner, strengthening exercises for the weightlifters. So, there are a lot of really specifically tailored programs put on there by licensed physical therapists. Another option is talking to your doctor or going to the KP website. There are a lot of, you know, knee exercises right on there that you can use. So, strengthening the muscles is one thing, just a general support sleeve that you can get at a drugstore is another option as well. But if you're looking at more elaborate braces and things like that, by the time you're at that point, I really think you should see your doctor first.

Host: And thank you for mentioning that KP.org is actually a very excellent resource for all things about different injuries or exercises that you can do at home, especially for our members. Okay. So, you've done everything at home and you're still having pain, when should you go see a doctor?

Lysa Charles, MD: I think if there's any swelling at all, at any point, you really should see a doctor. That's an indication that something's really going on. So, that's one thing. Certainly, if you've had a definite injury, you bent down or twisted, felt a pop. And 24, 48 hours later, it's just not getting any better. In that situation, I think you should see your primary care doctor who may or may not refer you to an orthopedic surgeon. Most things will settle down with conservative care, taking an anti-inflammatory agent, such as Motrin or Tylenol, icing it, resting it. And if it doesn't improve past that, then probably your doctor will refer you to a specialist for further evaluation. So in the event of an injury, or if you notice any swelling or any huge change, something more gradual, that generally is a sign of aging. But if one day you could do this and the next day you absolutely cannot, or you feel as if your knee's blocked or can't move, as if something's physically in the way, those are all reasons to seek fairly immediate medical attention.

Host: Great. Well, Dr. Charles, I really appreciate all of this great information. We learned a lot about relieving knee pain as we age. Here are the top takeaways. One, knee pain can result from repetitive overuse, injuries, and weak or tight leg muscles. It's important to differentiate between pain from injuries, which are sudden, and pain from normal aging processes, which develop gradually over time, to understand what relief options are available.

Two, while knee pain is often treatable with self-care, arthritis-related pain is chronic and must be managed long term. It may not go away completely, but symptoms can be alleviated with the right type of care.

Three, to prevent future knee pain, focus on lifestyle changes, such as maintaining a healthy weight and strengthening the muscles around your knee. The less strain on your knees, the less pain you will experience.

Four, to reduce knee pain, switch to low-impact exercises like swimming and avoid movements like squatting or kneeling, which can exacerbate the pain. And five, at home, you can manage knee pain by icing your knees, wearing knee sleeves, engaging in gentle stretching and exercise, taking anti-inflammatory medications, and using proper footwear.

For more information about orthopedics from our experts, visit kp.org/doctor, and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you. And from all of us at Kaiser Permanente, be well.