The short version
The worst thing you can do with a bad knee is to stop using it. Inactivity is the number 1 mistake that makes a bad knee worse. This is true for someone who has knee pain for more than a week and rest has not fully fixed it.
What are the signs you need to rest vs exercise your knee?
Initial swelling, redness, bruising means that rest for a few days with elevation and gentle muscle contractions should be rested. If there was never a traumatic injury that you can specifically pinpoint, then resting your knee is likely not going to help.
Most knee pain happens because your knee is overworking or compensating for another area. Life doesn’t stop simply because your knee hurts, so you find a way to keep going. Same thing if your hip or your ankle hurts, right? When we do this we compensate. Over time the area that picked up the additional workload is now feeling overwhelmed.
When knee pain happens from a “day of doing too much” then a day of rest is ok. After that single day, you need to move. Even if it hurts a little, that’s ok. You need exercise.
What do you do when exercise hurts your knee?
Ok, ok I get it. You hurt. So why would you exercise? And then what do you actually do to make it not hurt?
I’m not saying go load the barbell and squat. That is usually not the type of exercise your body needs when you have a bad knee or have knee pain.
When your knee hurts with an exercise you need to change a variable of the exercise. This means you need to change up the intensity, the range of motion, the type of muscle contraction, the length of time under tension or how long you’re holding a stretch.
You can also change the type of stretch. We have static stretching, the standard hold a stretch for 30 seconds that we are all familiar with. We have dynamic stretching, which involves moving the muscle through a range of motion or movement while putting the muscle in a lengthened position for it. There is contract-relax stretching where you are contracting the opposing muscle and then once you relax you are lengthening in to stretch the muscle you’re targeting.
There are even more types of stretching that can be done. I happened to write a 65 page literature review on stretching and exercise in graduate school. I will save you the time and effort of figuring all the ins-and-outs of stretching.
Simply put, you need to put the muscle in a position that calms down the nervous systems guarding response. This guarding response is what will hold the tension, tightness, and sometimes signal pain when your knee hurts.
But, what if your knee pain isn’t from a muscle and is from bone?
Muscles and tendons are what causes your bones to move. A tendon is the connector between the muscle and the bone. Most of what we feel is truly tendon and bone related.
Perhaps you have been told you have “bone on bone” knees. Or “the worse knee MRI I have ever seen” or “the knees of a 65 year old” and you are only in your 20s.
If I had a nickel for every time I hear an orthopedic doctor told someone that.
I wouldn’t be writing blogs and would be on the beach in front of my house off Lanikai beach in Hawaii.
Truly. I know it’s hard to hear, but those are the classic phrases repeated over and over, and each and every knee cannot be that different. It is a fear-inducing phrase. One that is meant to grab your attention and get you to do exactly as they recommend.
But you know what? Imaging is a static picture. You’re holding still. Not moving. Our bodies move. Our bodies have cells that regenerate every minute of every day. You’re not a car part that wears out. There is no “wear and tear.” Ok…I’ll avoid my soap box.
Back to my original question, what does bone pain feel like?
Bone pain is truly constant. Think like a toothache. It sticks around non-stop while you are at rest and when you are moving. It is a dull aching and throbbing type pain.
Now, truly constant pain is something to be cautious about and to seek an evaluation from a healthcare provider. There are some major health issues that can present as orthopedic pains but if they are truly constant and nothing provokes it or makes it better…you need to see your primary care physician at the least to rule out anything sinister.
How do I stay active when my knee hurts to walk?
Trying to stay active, trying to exercise and trying to be healthy all while having knee pain is possible. Even if your knee hurts to walk, you can do light exercises and movements within your body’s capacity to be active. The more you move, the less you will hurt. If you are choosing the right exercises and methods that is. There is a saying physical therapists love “motion is lotion.”
As you move a knee the joint allows synovial fluid to move in and out. Synovial fluid is the fluid around joints that helps reduce friction. Movement increases circulation. Movement also moves lymph in and out like a pump. Lymphatic massage or lymphatic drainage is very popular right now which you see with many of the vibration plates. Vibration plates are not necessary, small movements will do the same exact thing. Lymphatic massage is incredibly easy to learn and can help the “heavy leg” feeling that we sometimes get after a lot of exercise.
What 3 exercises should you do for a bad knee?
As a physical therapist, board certified in orthopedics, my favorite 3 exercises for a bad knee are a calf stretch, a figure 4 hip stretch in sitting and a side leg lift lying down.
Why these?
Ankle dorsiflexion, the ability to move weight forward over the foot is often limited after a long history of rolling your ankle. This stiffness that develops in the ankle means that motion has to come from somewhere else. The most common compensation for a stiff ankle is to put stress on the knee.
The figure 4 hip stretch in sitting is a great exercise for the deep hip rotators. Anyone who sits a lot, hello my fellow Americans, will have tightness in the hips. A tight hip changes the angle of your leg bone (femur) when you are standing which put uneven stress onto the knee.
For someone who has knee pain when standing for a long time, check how you stand. Are your toes pointed forward, in or outward. I bet for many of you toes point outward and that you have knee pain on the inside part of your knee. It is all biomechanics.
How you stand matters. How you move matters.
The side leg lift laying down helps to strengthen the deep hip rotators. For those born before 1990, you know all about Jane Fonda and leg lifts. It was an era. Go back to some of those old school exercises and your knee will thank you.