Knee hurts after exercise

Got Knee Pain? Maybe The Answer Is More Exercise

“We’re going to get you running again,” she said. (I loved her use of the first-person plural.)

A Slippery Slope To Knee Replacement?

Quinn wrote a prescription for two months of physical therapy. That worked. No more Achilles pain. So with the coming of spring, I was all set to get out there again — carefully, this time.

And then the knee pains started. Suddenly, going up and down stairs hurt. So did the simple act of sitting down and standing up.

Serious bummer. Hard not to think, “Is this the beginning of old age? A slide down the slope toward knee replacement?”

Not necessarily, Quinn says.

An exercise prescribed to Richard Knox: Lying on a table with a straight leg, lift the affected leg to strengthen the quadricep muscle using ankle weights. For more information, see the Nicholas Institute of Sports Medicine and Athletic Trauma. NISMAT hide caption

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“One thing about your history that’s very telling,” Quinn says, “is this all started after a period of inactivity. Your tissues, when you’re not active, get tight and weak. And this can predispose you to this condition, called chondromalacia of the patella.”

Basically, it means irritation of the cartilage lining the kneecap. My kneecaps weren’t tracking in their grooves the way they’re supposed to.

Quinn says it’s the most common knee problem she sees. It can result from either overuse or underuse. In my case, it’s clearly the latter.

“The good news is you don’t need surgery for this,” Quinn says. “This is something you can help manage.”

A Prescription For ‘Aggressive Flexibility’

Once again, she prescribes physical therapy. It will focus not on the knee itself but on the hip, the abdomen, the back, the glutes and the quadriceps muscles. All are important in getting the kneecap to track properly.

Flexibility is key, she says. I’ll need what she calls a “really aggressive flexibility program” to loosen up my leg muscles.

And the prognosis? “I would suspect that in the next six to eight weeks, you’re going to be back on a good running program,” Quinn predicts.

This is great news. I never thought I’d be able to run again.

Next stop is a physical therapy clinic and an appointment with a peppy, can-do therapist named Popi Gianakouras. When I met her, she was working with a 45-year-old bank employee named Bob Rothaker.

Like many of Gianakouras’ patients, Rothaker spends hours at his desk, staring at a computer screen. His terrible posture, she says, was causing him a lot of problems.

“By the afternoon, it was really painful,” Rothaker says. “From the upper back it would migrate to the chest area and then the shoulder area.” He had tension headaches, too.

Making Over The Muscles

Gianakouras examines me and agrees with Quinn that my problem is not just in my knees.

“It’s actually the mechanics of the entire lower extremities, from your core all the way down to your feet,” she pronounces. “And you have to address all of those things in order to correct the problem.”

“Major makeover?” I say. “Major makeover,” she affirms.

She prescribes a program of exercises designed to stretch and strengthen half the muscles in my body, it seems.

It’s actually not as bad as it sounds. The routine takes about an hour a day — not necessarily all at once. But I’ve got to be faithful about it, and so far, I have been. In only a week, it’s making a difference. Going downstairs doesn’t hurt so much.

Gianakouras says a lot of her patients are like me. We’re pretty sedentary in our everyday lives, but nevertheless expect to stay active.

As my knees can tell you, that doesn’t work.

Patellofemoral Pain Syndrome (Runner’s Knee)

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What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFP syndrome) is pain in and around the kneecap (patella). PFP syndrome is also called “runner’s knee.”

Rest and exercises that stretch and strengthen the hips and legs can help PFP syndrome get better.

What Causes PFP Syndrome?

Patellofemoral (pronounced: peh-tel-oh-FEM-er-ul) pain syndrome is an overuse disorder. These happen when someone does the same movements that stress the knee over and over again.

In PFP syndrome, repeated bending and straightening the knee stresses the kneecap. It’s most common in athletes.

Some people with PFP syndrome have a kneecap that is out of line with the thighbone (femur). The kneecap can get out of line, or wiggle as it moves along the thighbone, because of muscle weakness, trauma, or another problem. If this happens, the kneecap doesn’t glide smoothly over the thighbone when the knee bends and straightens. The kneecap gets injured and this causes the pain of PFP syndrome.

Who Gets PFP Syndrome?

Patellofemoral pain syndrome usually happens in people who do sports that involve a lot of knee bending and straightening, such as running, biking, and skiing. It also can happen to people, particularly young women, who do not do a lot of sports.

PFP syndrome is more common in women and happens most often to teens and young adults.

Tight or weak leg muscles or flat feet can make someone more likely to get PFP syndrome.

What Are the Signs & Symptoms of PFP Syndrome?

Patellofemoral pain syndrome causes pain under and around the knee. The pain often gets worse with walking, kneeling, squatting, going up or down stairs, or running. It may also hurt after sitting with a bent knee for a long time, such as in a long car ride or in a movie theater.

Some people with PFP syndrome feel a “popping” or creaking after getting up from sitting or when going up or down stairs.

How Is PFP Syndrome Diagnosed?

To diagnose patellofemoral pain syndrome, health care providers:

  • ask about physical activities
  • do an exam

Usually no testing is needed. Sometimes the health care provider orders an X-ray or other imaging study to check for other knee problems.

How Is PFP Syndrome Treated?

Someone with patellofemoral pain syndrome needs to limit or completely avoid activities that cause pain. Sometimes a change in training is all that’s needed. For example, someone who usually runs hills to train can try running on a flat, soft surface instead.

A person who has severe pain or pain that interferes with activity (for example, if it causes a limp) needs to rest the knee until the pain is better.

For pain:

  • Put ice or a cold pack on the knee every 1–2 hours for 15 minutes at a time. Put a thin towel between the ice and your skin to protect it from the cold.
  • You can take ibuprofen (Advil, Motrin, or store brand) or naproxen (Aleve, Naprosyn, or store brand). Follow the directions that come with the medicine for how much to take and how often. Do not take this medicine for longer than about 2–3 weeks.

An important part of the treatment for PFP syndrome is improving the strength and flexibility of the legs, hips, and core muscles. Health care providers usually recommend going to a physical therapist to make an exercise plan that will help. The plan may include stretching, squats, planks, lunges, and other exercises that improve strength and flexibility of the legs and hips.

The health care provider might also recommend:

  • a knee brace
  • taping of the knee
  • special shoe inserts

It doesn’t happen very often, but sometimes surgery is needed for PFP syndrome.

Can Someone With PFP Syndrome Play Sports?

Most people with PFP syndrome need to cut back or stop sports for some time. Follow the health care provider’s instructions on when it’s safe for you to go back to sports. This usually is when:

  • Hip, leg, and core strength is near normal.
  • Flexibility, especially in the hamstring muscle, has improved.
  • There’s no pain with everyday activities, such as walking and going up/down stairs.
  • Any pain with activity is very mild and goes away within a few minutes of starting the activity.

Looking Ahead

It can take months to years for the symptoms from PFP syndrome to get better. Following an exercise plan given by the health care provider or physical therapist can help the knee heal.

To lower the stress on their knees after healing, athletes should:

  • Warm up and stretch before running or other sports.
  • Keep a healthy weight.
  • Wear supportive running shoes and replace them often.
  • Run on soft, flat surfaces (such as grass, dirt, or a synthetic track with a softer surface).
  • Increase the intensity of workouts slowly.
  • Use shoe inserts or a knee brace, if the health care provider recommends it.

Reviewed by: Alvin Su, MD Date reviewed: January 2019

Exercises to Reduce Knee Pain

Knee-strengthening exercises are one of the best ways to avoid injuries and to treat knee pain. “We’re living in a world where we do more and more, so we’re seeing both younger and older patients with knee pain,” says Robert Gotlin, DO, director of orthopedic and sports rehabilitation in the department of orthopedic surgery at Beth Israel Medical Center in New York City. “Knee problems are catching up and maybe even exceeding lower back problems. Knees are now on top of the list as the No. 1 physical injury.”

Exercising Pain Out of Your Knees

The most proactive step you can take in dealing with knee pain and preventing further damage is to exercise. By building strong muscles, you can reduce knee pain and stress and help your knee joint better absorb shock. Strengthening exercises involve developing stronger muscles in your quadriceps (front of the thigh) as well as the hamstring (back of the thigh). Having strong muscles in place can take some of the pressure off your knees.

People need to remember that the body is all connected, including the bones, Dr. Gotlin says. “One should never think about strengthening just the knee — start with the hip muscles, because they control the knee.”

It’s also important to do some gentle stretching after a workout. This will eliminate soreness and keep your muscles flexible. When you work to build strong leg muscles to prevent injury and reduce pain, the muscles can react by tightening. And if your muscles are tight, you’re more likely to have an injury or experience knee pain.

The American Academy of Orthopaedic Surgeons suggests the following tips to stay safe and avoid further injury:

  • Begin slowly, because establishing new muscle strength is a gradual process.
  • Expect some discomfort when exercising, but you shouldn’t be in major pain. If you’re in serious pain after a workout, to the point that it’s difficult to even move, it’s because you’ve overdone your exercises.
  • Ask for advice about an exercise routine from your doctor or physical therapist.

Reduce Knee Pain With Exercise

Here are some exercises that can be done at home or in the gym to reduce knee pain. Gotlin advises doing three sets of 10 repetitions each. You should increase those numbers only after you can perform them easily, without pain or difficulty.

  • Hamstring curls (backs of the thighs). Face and hold onto the back of a chair. Lift your right foot and move it up toward your backside, but don’t go further than a 90-degree angle (your legs will be in the shape of the number four). Hold for three to five seconds, lower the leg, repeat, and switch sides. Be sure to keep your knees close together.
  • Straight-leg lifts (front of the thighs). While lying on your back, keep one leg bent and the other one straight. Lift the straight leg a few inches off the floor while tightening your thigh muscles. Hold for about five seconds in the air, lower it slowly, and then repeat on the other side. Try to avoid jerky motions, and don’t arch your back.
  • Wall squats (front of the thighs). Stand up straight with your back to a wall and your feet parallel, about two feet away from the wall, spread hip-width. Slide down the wall slowly until you are just about in a sitting position. Hold that position for up to 10 seconds and then slowly slide back up. Don’t allow your knees to overextend in front of your toes.
  • Single-leg dips (thighs, hips, and buttocks). Hold the backs of two chairs on either side of you while lifting one leg slightly in front. Then, bend your supporting knee, lowering yourself a few inches. Make sure to push your weight on the heel of the supporting leg. Hold the move for about five seconds, straighten up, and switch sides.
  • Step-ups (thighs, hips, and buttocks). Use a sturdy platform, stair-step, or stool that’s about six inches off the ground. Put one foot on the platform and let your other foot hang off loosely — hold the move for about five seconds. Lower the hanging foot slowly to the floor to repeat and then switch sides.

After you’ve mastered a routine like this to help reduce knee pain, you can consider adding weights to increase the impact of your exercises and to improve overall knee strength.

The most common cause of knee pain can hit you at any age — your 30s or 40s as easily as your 60s and 70s. Orthopaedic surgeon Robert Nickodem, Jr., MD says osteoarthritis, or “wear-and-tear arthritis,” is the most common cause of knee pain. It includes more than 100 types of arthritis or joint inflammation.

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“Osteoarthritis is like a rusty hinge,” says Dr. Nickodem. “The knee still works, but it creaks.”

To help alleviate the “creaking” and soothe the discomfort, Dr. Nickodem recommends:

  • Anti-inflammatory medications. Try aspirin or ibuprofen. Acetaminophen is a good pain reliever but does not reduce inflammation.
  • RICE therapy. Rest, Ice, Compression and Elevation can help reduce swelling and pain.
  • Physical therapy. Exercise that strengthens your quads and hamstrings may help relieve the pressure on your knees.
  • Knee braces. They can take pressure off the arthritic area.
  • Cortisone injections. An occasional injection of this steroid may lessen the swelling and achy pain.
  • Lubricant injections. Viscosupplementation, or lubricant injections, can help the knee move more smoothly. “It can help three out of four people if the arthritis isn’t too severe,” Dr. Nickodem says.

More about ‘wear and tear’ arthritis

How can you tell if you have osteoarthritis?

“If you have pain inside your knee, under your kneecap, especially when kneeling, squatting or going up and down steps, it’s usually wear-and-tear arthritis,” says Dr. Nickodem.

Cartilage, the cushioning between bones, deteriorates throughout life. It can erode more quickly in some people due to injury or genetics. As cartilage thins, your bones begin to rub together, causing pain, swelling and stiffness.

When to call your doctor

If your pain and swelling are getting worse and you can no longer put weight on your knee, see your doctor. A simple X-ray can show if there is osteoarthritis and, if needed, an MRI scan can check for meniscal tears or loose chips of cartilage.

Arthroscopic surgery can sometimes remove loose cartilage. Partial or total knee replacements are other surgical options, especially for those who can no longer stay as active as they’d like.

“Surgery is a last resort, though,” says Dr. Nickodem. “It’s something to consider when nonoperative treatments aren’t helping.”

Knee Osteoarthritis Symptoms

In most but not all cases, the symptoms of knee osteoarthritis come and go, becoming worse and more frequent over months or years. It is easy to dismiss early knee arthritis symptoms, but symptoms may worsen if left untreated.

Knee Pain

The most commonly reported symptom of knee osteoarthritis is knee pain. The description of the pain will depend on the person’s condition and situation. For example, the pain may come and go or there may be a chronic low level of pain with intermittent flare-ups of more intense pain. The pain may be experienced as dull and aching or as sharp and intense.

See Knee Pain and Arthritis

Knee arthritis pain usually gets worse with certain activities that place additional strain on the joint, such as when squatting or walking up stairs. Typically, the knee pain can be lessened with rest and an ice compress.

See When and Why to Apply Cold to an Arthritic Joint

Exactly how knee osteoarthritis causes pain is unknown and seems to vary from person to person.1

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Other Symptoms of Knee Osteoarthritis

In addition to knee pain, people with knee arthritis often report one or more of the following symptoms:

Swelling
When knee cartilage wears away, the femur and tibia (and sometimes patella) bones can rub together, resulting in irritation. Sometimes this irritation leads to the production of excess joint fluid, resulting in knee swelling.

See What Causes a Swollen Knee (Water on the Knee)?

Stiffness
Bone-on-bone friction and knee joint swelling makes the knee feel stiff. Some people may only experience knee stiffness for about 30 minutes in the morning or after sitting for a long period. Stiffness may or may not be accompanied by visible swelling or a reduced range of motion.

See How to Care for a Swollen Knee

Redness and warmth
The skin over the knee may become red and warm. These signs could also indicate an infection, which requires immediate medical attention. People who are uncertain of the underlying cause of knee redness and warmth, particularly when accompanied by swelling, are advised to seek immediate medical attention.

See How Infection Can Lead to Severe Knee Pain

In This Article:

  • What Is Knee Osteoarthritis?
  • Knee Osteoarthritis Symptoms
  • Knee Osteoarthritis Causes
  • Knee Osteoarthritis Diagnosis
  • Knee Osteoarthritis Treatment
  • Knee Osteoarthritis Video

Reduced range of motion
The knee’s range of motion may become limited, making it less flexible. For example, moderate to advanced knee osteoarthritis may make it difficult to completely bend or straighten the knee.

Worsening symptoms with inactivity
Knees can become stiff after sleeping or sitting for a long period of time. People with knee osteoarthritis often find stiffness and pain are most noticeable when they try to get out of bed in the morning or out of a chair after a long period of sitting.

Popping or crunching
Feeling or hearing crunching or popping when bending the knee, such as when bending down into a squat, are signs of knee joint friction. The medical term for this symptom is crepitus. (Crepitus by itself without other symptoms is not a cause for concern.)

See Crepitus in the Knee

Buckling or locking up
Moderate to advanced knee osteoarthritis can cause the sensation of a knee giving way or buckling. This sensation can occur if uneven grooves or flaps in the degenerated cartilage catch or if a piece of cartilage breaks off and becomes lodged in the joint. Knee locking or buckling is also typical in people who have a ligament injury or meniscus tear.

Watch: Knee Meniscus Tear Video

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The symptoms and signs of knee osteoarthritis most often come on gradually. Sudden knee pain is more likely to be caused by trauma or another condition, such as pseudogout. Knee osteoarthritis may be dormant (i.e. a person may be unaware they have it) and only become symptomatic following a traumatic event or excessive physical activity.

Early recognition of knee osteoarthritis symptoms and signs, and appropriate treatment, can dramatically slow or eliminate the progression of osteoarthritis symptoms.

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