A guide on how to look after your knees as you get older
As the years go by, our bodies undergo various changes, and one area that often bears the brunt of ageing is our knees. The knee joint is one of the largest joints in the body and has to sustain huge forces and pressures when we walk, run or do everyday activities like going up and down stairs. It is not surprising therefore that they are susceptible to wear and tear over time.
This article will look at the ageing process of joints and give you some tips on preventative measures to maintain healthy, happy knees as you get older.
The Aging Process of Joints
The human body is incredible, but over time, the wear and tear on our joints can begin to take its toll. The knee joint is a hinge joint, with additional complex structures such as cartilage, ligaments, and tendons, that support the joint and help us move. It is these structures that are particularly prone to age-related, arthritic changes.
A brief overview of the ageing process
Cartilage Degeneration
Within the knee joint there is a fibrous disc called the meniscus. The meniscus tissue acts as a cushion between the two bones in the knee joint, providing smooth and pain free movement. However, as we age, the meniscal cartilage may gradually start to lose its sponginess and become thinner and worn, leading to decreased shock absorption and increased friction between the bones. Eventually, this process can result in degenerative meniscal tears.
As well as the meniscus becoming thinner, the harder, hyaline cartilage that covers the end of the femur and tibia can also be affected leading to osteoarthritis (OA) of the knee.
Reduced Synovial Fluid
The knee joint contains synovial fluid, which lubricates and nourishes the cartilage. With age, the production of this fluid can decrease, resulting in less effective joint lubrication which potentially contributes to knee feeling stiff and sore.
Weakening Ligaments and Tendons
Ligaments and tendons, responsible for stabilising the knee joint, can start to lose some of their elasticity and strength over time. As this happens they become more vulnerable to injuries such as sprains or tears. Common injuries include ACL tears, or patella tendinopathy.
Bone Changes
The bones surrounding the knee also undergo changes as we age; including a decrease in bone density. This makes the bones more susceptible to fractures. Reduced bone density, if untreated, can also lead to conditions like osteoporosis.
What are the causes of knee pain as you age?
The most common cause of knee pain in older people is Osteoarthritis, however it is not the only reason that people develop knee pain. You can injure your knee having a trip or fall causing a fracture from a direct blow to the knee, or damage to the ligaments or meniscal cartilage from a nasty twisting type injury.
Some rheumatological conditions can also cause knee pain such as lupus, gout, rheumatoid arthritis.
Please note that if you’ve had a bad trip or fall, and your knee pain is not settling, it’s important to seek a phyiotherapy assessment to rule out any serious injury to the soft tissue or bones.
What are the symptoms of knee pain in old age?
People experience a whole range of symptoms in their knees as they get older. In general, one side will usually be worse than the other and symptoms may vary day to day, or week to week. They may be exacerbated by specific activities or prolonged inactivity.
Here are some of the main symptoms of knee pain caused by ageing:
- Pain – Persistent or intermittent pain in and around the knee, often described as aching or throbbing, which may worsen with activity or prolonged periods of inactivity. Pain can be worse at night if it is inflamed.
- Stiffness – Difficulty in bending or straightening the knee, particularly after sitting for extended periods or first thing in the morning.
- Swelling – Swelling around the knee joint, which can be due to inflammation or fluid buildup.
- Reduced Range of Movement – Unable to fully bend or extend the knee, affecting daily activities such as walking, climbing stairs, or getting up from a chair.
- Grinding or Crunching Sensation – Feeling or hearing a grinding, clicking, or popping sound in the knee during movement.
- Weakness or Instability – A feeling of the knee giving way or buckling, which can result from weakened muscles or damaged ligaments.
- Tenderness – Sensitivity to touch around the knee joint, particularly along the joint line or where ligaments attach.
- Redness and Warmth – Signs of inflammation, such as redness and warmth around the knee, which can accompany swelling and pain.
Who is most at risk for developing knee pain in old age?
There are a number of risk factors that make you more susceptible to developing knee problems as you age including:
Obesity – Excess body weight puts additional stress on the knee joints, increasing the risk of osteoarthritis and other knee-related issues.
Previous Knee Injuries – Past injuries such as ligament tears, meniscal injuries, or fractures can make the knee more susceptible to pain and degenerative changes over time.
Poor Physical Activity – Having a sedentary lifestyle can weaken the muscles around the knee, reducing joint stability and increasing the likelihood of pain and injury.
Gender – Women are more likely to develop knee problems than men.
Occupation – Jobs that require repetitive knee bending, kneeling or heavy lifting, can lead to increased stress on the knees and higher risk of pain and injury.
Muscle Weakness or Imbalance – Weak or imbalanced muscles around the knee can lead to problems with the joint mechanics, increasing the risk of pain and injury.
Joint Malalignment or Deformity – Conditions such as flat feet, high arches, uneven leg lengths or knock knees can put uneven stress on the knee joints, contributing to pain and degenerative changes.
How do I prevent knee pain as I get older?
While the ageing process is inevitable, there are a number of proactive and preventative steps that you can take to promote your knee health and reduce the risk of sustaining knee injuries and flare ups of knee osteoarthritis.
1. Maintain a Healthy Weight
Carrying excess weight puts additional stress on the knee joints, accelerating the wear and tear of the cartilage and adding strain on your soft tissues. By maintaining a healthy weight, you can reduce the pressure on your knee joints and decrease the risk of developing injuries or osteoarthritis.
2. Stay Active
Regular exercise, and staying active is really important for maintaining good joint health and managing knee OA. Increased activity will also help with improving cardiovascular fitness and maintaining a healthy BMI (Body Mass Index). There is considerable research that links an increased BMI with aggravated symptoms of OA, especially in your load bearing joints like the knees.
The government guidelines suggest that adults should aim to do 150 minutes of moderate exercise every week, ideally split over 4-5 days.
Low-impact activities such as walking, swimming, and cycling are particularly beneficial. These activities minimise joint stress while promoting cardiovascular health and muscle endurance.
Chemelo. E. et al. BCMJ 2024.
Walking – Is a simple, effective way to stay active. To start with, choose flat, even surfaces to reduce stress and impact on the knee. You can challenge yourself to some hill walking as you get stronger and fitter.
Swimming – Water supports your body weight and reduces the pressure on joints while allowing for a full range of motion. You can combine doing some exercises in the water as well as lengths, to increase your cardiovascular fitness too. Often pools run water based fitness classes which are a great way to keep in shape!
Cycling – Is a great low-impact exercise that helps strengthen the muscles around the knee without excessive stress. You could start by using a static bike at home or local gym, try a spin class or even join a local cycling group.
3. Strength Training
Incorporating more specific, strength training exercises into your routine can help build and maintain muscle mass. Strong muscles support and protect the knee joint, reducing the load on the joint itself and minimising the risk of injuries and the impact of joint degeneration.
Knee Strengthening Exercises
Here is a comprehensive exercise program for knee strength:
- Squats
- Action: Stand with feet shoulder-width apart. Lower your body by bending your knees and hips as if you are sitting back into a chair. Keep your chest up and knees aligned. Return to standing.
- Repetitions: 3 sets of 10-15 reps.
- Lunges
- Action: Step forward with one foot and lower your body by bending your knees until both knees are bent at about 90 degrees. Push back up to the starting position. Your weight should predominantly be on your front leg.
- Repetitions: 3 sets of 10 reps per leg.
- Wall Sits
- Action: Stand with your back against a wall, slide down into a sitting position (as if sitting on an invisible chair), and hold for 30-40 seconds (or as long as comfortable).
- Repetitions: 3 sets
- Step-Ups
- Action: Stand in front of a step or bench. Step up with one foot and bring the other foot up to meet it, then step down.
- Repetitions: 3 sets of 10 reps per leg.
- Hamstring Curls
- Action: Stand and hold the back of a chair. Use a resistance band around your ankle and curl your heel towards your bum while keeping your knee pointing to the floor.
- Repetitions: 3 sets of 15 reps per leg.
- Calf Raises
- Action: Stand on a step with your heels slightly off the edge. Raise your heels by pushing through the balls of your feet, then lower back down to just below the step.
- Repetitions: 3 sets of 15-20 reps.
Building up both specific muscle strength around your knee, and also your functional strength (ability to get out of a chair or go up and down stairs) will provide you with better joint support and enhance your overall mobility, enabling you to carry out daily activities more easily and pain free.
4. Flexibility and Stretching
Flexibility exercises and stretching routines can improve your mobility and reduce muscle and joint stiffness. Focus on exercises that target the muscles around the knee, such as the quadriceps, hamstrings and calves, to maintain a good range of movement.
Knee Mobility and Muscle Stretching Exercises
- Quad Stretch
- Action: Stand on one leg, lift your other heel toward your bum, and hold your ankle. Keep your knees close together and push your hips forward slightly. You should feel a stretch along the front of your thigh.
- Hold: 30 seconds per leg. Repeat twice
- Hamstring Stretch
- Action: Lie on a mat and raise one leg into the air keeping it straight. Hold that leg with your hands around your knee and feel a stretch at the back of your leg.
- Hold: 30 seconds per leg. Repeat twice
- Calf Stretch
- Action: Stand facing a wall, place your hands on the wall and step one foot back, keeping it straight and pressing the heel into the ground. You will feel the stretch in the lower part of your leg over your calf muscle.
- Hold: 30 seconds per leg. Repeat twice
- Hip Flexor Stretch
- Action: Kneel on one knee with the other foot in front. Push your hips forward until you feel a stretch in the front of your hip.
- Hold: 30 seconds per side. Repeat twice
- Butterfly Stretch
- Action: Sit on the floor with your knees bent and with the soles of your feet together and your knees bent out to the sides. Gently push your knees towards the ground.
- Hold: 30 seconds. Repeat twice
Tips for Exercising
- Warm-Up: Start with a 5-10 minute warm-up such as a brisk walk or short cycle.
- Progression: Gradually increase the repetitions of your exercises as your strength and flexibility improve. You can also add weights or exercise bands to add some more resistance.
- Consistency: Aim to perform these exercises 3 times per week if you can. Little and often is the key.
- Listen to Your Body: If you experience pain during any of these exercises, stop immediately and if pain persists then consult a physio or healthcare professional for guidance.
5. Happy Feet
Wearing appropriate footwear is often overlooked but can have a significant impact on your knee (and other) Joints.
For individuals with knee OA, the best type of footwear is one that provides good support, cushioning, and stability to help reduce joint stress. Shoes with soft, shock-absorbing soles can help minimise the impact on the knees during walking or other activities.
Additionally, footwear that has a low heel and firm arch support helps to maintain proper alignment of the leg and knee, ensuring better weight distribution and reducing strain on the knee joint. Avoid wearing heels as these will add significant stress to the knee joint.
Custom orthotic inserts that are tailored to support the individual’s foot structure can offer additional relief. It’s also a good idea to choose shoes with a wide toe box to accommodate any swelling and prevent additional pressure on the feet.
It’s also important to address any foot issues that you have, and bear in mind that in some cases your knee pain may well be caused or exacerbated by a problem with your foot and lower limb biomechanics (your movement patterns).
At Complete Physio we have a team of highly experienced podiatrists who have undertaken extensive training to provide a ‘one stop clinic’ for all your foot care needs.
Our expert team of positarists assess and treat both structural and/or functional factors that can contribute to knee pain.
6. Balanced Diet
A healthy, and well balanced diet is very important for your overall health, including joint health. Make sure that your diet includes nutrients such as vitamin D, calcium, and omega-3 fatty acids, which can support bone and cartilage health.
7. Pace Yourself
While staying active is great, it’s equally important to listen to your body. As you get older, you should try to avoid high-impact activities that may put excess strain on the knees, especially if you are not used to doing this type of activity. Allow for adequate rest and recovery between activities and workouts so that your muscles and tissues have time to repair.
8. Protective Measures
If you do engage in activities with a higher risk of knee injury, such as high impact sports or manual labour, then it’s a good idea to consider using protective gear such as knee braces or supports. These can provide additional stability and also reduce the impact on the joints and potential injury.
9. Book an appointment with a Physio
If you do engage in activities with a higher risk of knee injury, such as high impact sports or manual labour, then it’s a good idea to consider using protective gear such as knee braces or supports. These can provide additional stability and also reduce the impact on the joints and potential injury.
What do I do if my knee pain flares up?
Despite your best efforts, knee flare-ups can occur. Here’s what to do when your knee flares up:
Rest and Protect – Limit activities that aggravate the pain and use assistive devices to offload stress from the knee.
Ice – Apply an ice pack to the affected area for 15-20 minutes several times a day to reduce pain, inflammation and swelling.
Compression – Use a knee brace or neoprene support to give your knee some stability and offload the joint. It can also help to reduce swelling.
Elevation – Elevate your leg above the level of your heart to also help reduce swelling.
Medications – Over-the-counter anti-inflammatory medications, like ibuprofen, can help manage pain and inflammation. You should always consult with a healthcare provider before starting any medication.
Physiotherapy – It’s important to seek advice from a qualified and experienced physiotherapist who can give you support and guidance on exercises to strengthen your knees and reduce the frequency of ongoing issues and flare ups.
What are the benefits of Physiotherapy for knee health as you age?
“Knee osteoarthritis (OA) is a prevalent condition that significantly impacts the quality of life due to pain and functional limitations. Physiotherapy plays a crucial role in the management of knee OA, offering non-invasive treatment options that aim to reduce pain, improve function, and enhance the overall quality of life.”
Barber, T. and Jahanbani, S., 2024
Caring for your knees as you age involves a combination of lifestyle choices, exercise, and awareness of your body’s changing needs.
Physiotherapy provides fitness with clinical precision! Tailored exercises and manual therapy techniques help maintain strength, flexibility, and overall fitness.
Specific physiotherapy lead exercise programmes that include exercises such as quadriceps and hamstring strengthening, balance training, and flexibility exercises, will help to maintain and develop knee joint stability and function. Additionally, manual techniques like joint mobilisations and soft tissue massage can alleviate muscle tightness or stiffness and enhance mobility.
A study that explored the relationship between physical activity and physical function in older adults suffering from knee osteoarthritis (OA), found that higher levels of physical activity are associated with better physical function in older adults with knee OA and engaging in regular physical activity helps reduce pain, enhance joint flexibility, and improve muscle strength.
It also highlighted that participants who maintained an active lifestyle demonstrated significant improvements in functional tasks such as walking speed, balance, and lower body strength compared to their less active counterparts.
Chemelo. E. et al. BCMJ 2024.
The benefits of Physiotherapy for Knee OA is further documented in a qualitative study published in the BCMJ which found that many patients reported significant improvements in pain management, mobility, and overall function as a result of physiotherapy.
A strong therapeutic relationship was highlighted as a critical factor in the success of physiotherapy. Patients appreciated physiotherapists who were empathetic, communicative, and supportive, and they valued having personalised care and tailored exercise programs that were designed to meet their specific needs.
Tao. P.L. et al 2024.
At Complete Physio we have exceptional team members who specialise in treating patients with knee conditions such as osteoarthritis. We use evidence based assessment tools and treatment techniques to ensure that our patients receive the best possible care to keep them doing the activities they love.
Beyond traditional physiotherapy, Complete Physio integrates a whole body approach to treatment. We offer services such as podiatry, pilates and strength and conditioning coaching to ensure that our patients don’t just recover, but become stronger and fitter than before, and remain injury free in the long term.
Ultrasound Guided Knee Joint Injections
Complete has a unique team of clinicians who have undertaken extensive training to be qualified to do ultrasound guided joint injections.
Ultrasound-guided injections have become a valuable tool in the management of knee osteoarthritis (OA). This advanced technique uses real-time imaging to precisely deliver an injection of therapeutic drugs such as corticosteroids, hyaluronic acid, or platelet-rich plasma directly into the affected knee joint. The use of ultrasound guidance ensures accurate needle placement, which improves the efficacy of the injection and reduces the risk of complications. This precision not only maximises the therapeutic benefits, such as reducing inflammation, alleviating pain, and improving joint mobility, but also minimises discomfort during the procedure.
For patients with knee OA, ultrasound-guided injections offer a targeted, minimally invasive treatment option that can provide significant relief and improve quality of life.
Conclusion
Physiotherapy treatments and exercises are highly effective in managing knee pain caused by osteoarthritis. By staying active with appropriate exercises, pacing yourself, and maintaining functional strength and fitness, you can significantly improve your symptoms and quality of life. Remember to listen to your body, seek professional advice when needed, and take proactive steps to manage flare-ups effectively. With the right approach, living with knee osteoarthritis can become more manageable, allowing you to continue to live life to the full!
If you have any questions or would like to book an appointment, please don’t hesitate to get in touch. Call us on 020 3479 4051 or email info@complete-physio.co.uk
References
Barber, T. and Jahanbani, S., 2024. Physiotherapy and knee osteoarthritis. BCMJ, 66(5), pp.165-170.
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