Nonsurgical Treatment Options for Knee Pain

If you suffer from chronic knee pain, you may feel like you’re unable to enjoy the things you love doing. While a knee replacement surgery is one option to help relieve joint pain, you may feel like you’re either too young or not ready for a knee replacement surgery.

Many nonsurgical treatment options exist to help relieve knee pain, increase mobility and improve your quality of life.

Alan Heincker, DO, an orthopedic surgeon at Phelps Health, discusses ways to treat chronic knee pain without surgery.

Modify Your Activity

One recommendation your orthopedic surgeon may have for treating knee pain is modifying your activities.

“When you have arthritic knees, you should try to stay active and continue to exercise, but if you can avoid certain activities, it will help reduce your pain,” Dr. Heincker said. “For instance, it is much better to ride a bike or use an elliptical machine rather than walking or running, since the latter two [activities] cause pounding to the knee joints and pain.”

Dr. Heincker noted that staying active can help limit weight gain, or even help with weight loss, which can reduce pain in arthritic knees.

Activity modifications, like avoiding lots of stairs and squatting, can help reduce the amount of pain from arthritis in the knees.

Knee Braces

Some people also find joint pain relief with braces, Dr. Heincker said. While arthritis itself doesn’t usually cause the knee to become unstable, the inflammation caused by arthritis can give a feeling of the knee giving out or being unstable.

“Sometimes wearing a simple compression sleeve or brace improves this feeling by putting pressure on the knee,” Dr. Heincker said.

Larger braces can offer more support. An offloading brace forces you to put more weight on the part of your knee that doesn’t have arthritis.

Dr. Heincker noted that some patients use braces daily and say they are helpful, while others may find braces to be hot, rub on their skin too much or feel uncomfortable.

Medications

In addition, certain oral medications and topical creams (either over-the-counter or prescription medicines) can be used to treat arthritis.

NSAIDs, or nonsteroidal anti-inflammatory drugs, work with your body to help reduce the inflammation from the arthritis. 

“These medicines work best if they are taken regularly, which usually means daily because your arthritis is causing inflammation daily, and these pills have to be in your system constantly to work the best,” Dr. Heincker said.

Common over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve).  Common NSAIDS that require a prescription include meloxicam (Mobic), celecoxib (Celebrex) and diclofenac (Voltaren).

These pills should be taken with food as they can upset your stomach. NSAIDs are not recommended for people who have decreased kidney function or taking blood thinners. You should let your primary care physician/provider and orthopedic surgeon know if you are on these medicines long-term, so they can be monitored.

Tylenol is another oral medicine that may help reduce arthritis pain. Tylenol is safe for patients with kidney issues or people on blood thinners.

Physical Therapy/Exercises

Another nonsurgical treatment for knee pain is physical therapy.

Weight-bearing exercises, such as biking, walking and using an elliptical, are some of the best exercises to maintain healthy cartilage and strengthen the muscles around your knees and legs.

Exercises that strengthen the legs and core muscles of the abdomen and back, such as pushups and straight leg raises, can help stabilize the joints and reduce arthritis pain.

Even if exercising causes your arthritic joints to hurt, doing exercises does not make your arthritis worse and may actually minimize your pain and maintain the good cartilage you have, according to Dr. Heincker.

You can do these exercises on your own, or you can get a prescription to do formal physical therapy if you want someone to show you these exercises.

Joint Injections

Joint injections are another common treatment for knee pain and arthritis. Joint injections fall into three categories: steroid or cortisone shots, gel shots and stem cell injections.

Steroid or cortisone shots

Steroid shots, which can be safely given every 3 months, help reduce knee pain from arthritis by reducing the inflammation, which is the cause of the pain. These types of shots usually work quickly, and you can feel relief by the time you’re leaving the office.

“The shot usually takes only a few seconds to give. [A steroid shot is] given with a thin needle and hurts less than most people think,” Dr. Heincker said.

While steroid shots can raise your blood sugar level minimally for a few days before returning to normal again, these types of shots are safe for patients with diabetes.

Gel shots (viscosupplementation, hyaluronic acid injections, rooster comb and chicken shots)

Gel injections, which generally aren’t as effective at relieving pain, contain a thicker fluid and may hurt slightly more than a steroid injection.

Gel shots work by placing more fluid, or lubrication, into the knee joint to provide more cushion between the bones and help the knee glide more smoothly with motion.

Patients usually don’t get immediate relief with these injections, and gel shots can make your knee feel slightly stiffer or tight for a short period of time.

Some brands of gel injections require a single shot, while others require an injection once a week for 3 weeks (three shots total) or 5 weeks (five shots total). These shots have to be approved by your insurance company before they can be given. Gel shots have to be given at least 6 months apart.

Stem cell injections (platelet-rich plasma, or PRP)

Many different types of stem cell injections exist, but the most common one is platelet-rich plasma (PRP). These shots work by injecting cells that allow the body to grow new healthy cartilage.

PRP injections are done by drawing a patient’s blood in the office and using a special machine to spin the blood to separate out the stem cells, which are then injected into the patient’s knee the same day.

Stem cell injections also can use blood collected from a patient’s bone marrow or donated cells.

Studies show that these shots usually don’t actually regrow cartilage but can sometimes help reduce pain.

Stem cell or PRP injections are not covered by insurance because they haven’t been shown to be beneficial for most patients.  These injections can cost between a few hundred dollars and several thousand dollars per injection. The Phelps Health Orthopedics Clinic offers PRP injections for tendon or soft tissue injuries, but they are not recommended for arthritis.

Stem cell injections can be given as often as a patient is willing to pay for them but usually should be done at least 3-6 months apart.

For all three types of joint injections, the number of injections you can have in a lifetime is not limited as long as you wait the appropriate time between injections.