Arguably the most debilitating sports and fitness injury is a knee injury. Knee injuries are second only to lower back pain in terms of prevalence. According to the Institute of Medicine, 61 million Americans suffer from knee pain, which is almost 20% of all US adults. Of those 61 million, 6.6 million visited an emergency room between 1999 and 2008. Knee injuries are serious business.


The knee injury is particularly daunting because it can leave you sidelined for weeks, if not months. Many other injuries can be worked around. For example, I took up road cycling when I injured my rotator cuff, swimming when I injured my low back, and trail running when I injured my wrist. However, it’s hard to work around the limiting and painful factors of a knee injury.


The subsequent inactivity due to a knee injury can leave you feeling hopeless. This is why taking a step back to consider your options is critical. Doing too much too soon can delay your healing, but pushing through the pain is never a good option. Here are options to consider when it comes to your achy knees and how to treat them right.


Get New Shoes

Heel height and shoe flexibility are important considerations for addressing knee pain. Elevated loads may also progress the severity of osteoarthritis in the knee. Gait problems like overpronation are also linked to knee pain. While more research is needed, when it comes to sport and fitness, the most important piece of equipment you buy are your shoes. Further, it’s not only the right type of shoes that is vital, but also the duration of wear and tear on your shoes. Like the tread on your tires, running shoes tend to have a max shelf life (about six months for running shoes). Whether you’re a runner, gym rat, or just a weekend hiker, shoes are a critical component of keeping your knees healthy.


Drop Some Weight

With more than two thirds of Americans overweight or obese, the prevalence of related knee pain is on the rise. Carrying around those extra pounds puts pressure on your knee joints. Obesity is a major cause of osteoarthritis, but even a little extra weight puts considerable pressure on your joints. For each pound of weight lost, you reduce knee joint load by 4 pounds. For example, losing 20 pounds is the equivalent of 80 less pounds per step that your knee has to bear. If you are overweight and have knee issues, address the weight first.


Don’t Mask the Problem

As anyone who has ever been injured knows, pain sucks. It’s tempting to pop pills in an effort to alleviate the pain. And why not if doing so helps you sleep better, exercise more, and feel pain free? The problem is psychological. Studies show that while some drugs are effective in regulating pain and providing temporary relief, nonsteroidal anti-inflammatory drugs (NSAIDS) may actually inhibit the healing process. NSAIDS are linked to the weakening of collagen and bone formation, which are essential elements in the healing process.


heavy backsquat

Take proper care of your recovery process and you'll be squatting heavy in no time. [Photo credit: CrossFit Empirical]


Get a Second Opinion

Before jumping into surgery, get a second opinion and try physical therapy. A recent study found that exercise therapy is as effective as surgery for middle-aged patients with a meniscal (MCL) tear. Surgery is not only invasive, it will cost you, literally. ACL surgery (with insurance) is estimated at $800-$3000. If you don’t have insurance, it’s a staggering $20,000-$50,000.


Second, surgery may or may not work. Many famous athletes have undergone knee surgeries only to have their careers cushort or never seem the same post op. Still, surgery is a widely accepted option for alleviating acute or chronic knee pain and/or instability. Bottom line – do your due diligence before electing for surgery.


Consider Injections as a Treatment Option

A recent study in the Annals of Internal Medicine concluded that, for treatment of osteoarthritis of the knee (OA), corticosteroid and hyaluronic acid injections were the most effective options. Injured tissues can be stimulated to repair by a treatment of injecting growth factors called PRP, made from your own peripheral blood platelets. While the cost isn’t cheap, it’s worth considering injections as a treatment option.


Skip the “Rest” Part of RICE

The most basic injury treatment starts with rest, ice, compression, and elevation (RICE). But there is a growing body of evidence that suggests that the rest portion of RICE isn’t necessarily optimal. While knee injuries are indeed limiting, instead of total rest, practice ‘relative’ rest. Work around your injury with pool exercises, supine weight lifting, pilates, yoga, or an upper body ergometer. Exercise is important to continue as it stimulates the natural endorphins, adrenaline, testosterone, and pheromones that promote healing.


Optimize Neuromuscular Training (NMT)

Neuromuscular training includes agility specific drills, plyometrics, deceleration techniques, strengthening, and proximal control training. According to a recent study in the British Journal of Sports Medicine, effective adaptations of NMT can reduce injury prevalence in female athletes by 17.2-17.7%. The more variations in your training the better, and a dosage of NMT is recommended at a minimum of 20 minutes for a minimum frequency of twice a week. The study also found that participants who started younger (ACL injury is particularly pronounced in teenage female athletes) helped reduce injury. Lastly, NMT is particularly operative when accompanied by effective verbal cues such as “Watch for your knees caving inward.” The moral of the story – hire an effective coach/therapist to guide you through your NMT and knee rehab/prehab. 


Stay Positive

There is an interesting study that suggests that a positive attitude can help you feel better and be more active. In fact, the study concluded that among respondents of knee pain, those with high positive affect walked significantly more steps than those with low positive affect. It’s no secret that pain can de depressing and unmotivating. The importance isn’t in avoiding pain, but in controlling your attitude to help override and counteract your mind’s tendency to depress with injury. There are many factors out of your control with rehabbing injury. Attitude is one of the factors you can control. Keeping positive can only help.


Address the Root Cause

As someone who has suffered knee injuries and endured knee surgery, I can attest to the challenges that accompany knee pain. I can also attest to the opportunities that present themselves through injury if we’re open and willing to listen. Every injury I’ve suffered has come with the experience of learning more about my body, trying new approaches, sports, and ways of training. If you’re weak in the knees, addressing the root causes and strengthening your weaknesses will ultimately help you stand tall.


Here’s a primer on working out with knee pain:

4 Safe and Effective Ways to Work Out with a Cranky Knee