What can I do to relieve knee pain from a potential sprain, considering I have a history of arthritis?

Managing Acute Knee Pain After Snow Shoveling with Underlying Arthritis

For your acute knee pain following a potential sprain, begin strengthening exercises immediately as tolerated, combined with acetaminophen for pain relief, while avoiding prolonged rest that can worsen your underlying arthritis.

Immediate Pain Management

Start with acetaminophen (paracetamol) as your first-line medication for both the acute injury and arthritis pain 1, 2. Take 2 caplets every 8 hours with water (maximum 6 caplets in 24 hours), which temporarily relieves minor aches and pains due to muscular aches and minor arthritis pain 2.

• If acetaminophen provides insufficient relief, topical NSAIDs are the next safest option before considering oral NSAIDs, especially given your age 1
• Oral NSAIDs can be considered but require careful assessment of gastrointestinal, liver, and cardiorenal risk factors at age 69 1

Exercise: The Core Treatment You Should Start Now

Strengthening exercises are strongly recommended and should begin as soon as you can tolerate movement - avoiding prolonged rest is critical for both acute injury recovery and arthritis management 1.

Specific Exercise Protocol

Perform quadriceps strengthening and lower limb strength training at least 2 days per week 1, 3, 4:

• Use moderate to vigorous intensity (60-80% of your maximum effort) for 8-12 repetitions 1, 3, 4
• Dynamic exercises (with movement) are more effective than static holds 1
• Both specific quadriceps exercises and general lower limb strengthening reduce pain (effect size 0.29-0.53) and improve function (effect size 0.24-0.58) 1, 3

Supervised vs. Home Exercise

Ideally, obtain 12 or more supervised sessions initially for optimal outcomes 1, 4:

• Supervised sessions are significantly more effective than unsupervised exercise for pain reduction (effect size 0.46 vs 0.28) and function (effect size 0.45 vs 0.23) 1
• After learning proper technique, you can transition to home-based exercise 4
• Consider physical therapy referral for initial instruction 1

Additional Beneficial Exercises

Tai chi is strongly recommended for knee arthritis and can be started once acute pain subsides 1:

• Combines gentle movements with balance training
• Effect sizes for pain reduction range from 0.28 to 1.67 1
• Yoga is also conditionally recommended for knee arthritis 1

Adjunctive Measures

Assistive Devices

Consider using a cane if pain significantly impacts your walking 1:

• Strongly recommended when disease causes sufficient impact on ambulation or stability 1
• Tibiofemoral knee braces are also strongly recommended if pain warrants assistive device use 1

Footwear

Wear appropriate footwear with shock-absorbing insoles 1, 3:

• Shock-absorbing insoles for 1 month reduced pain and improved function in knee arthritis 1
• Proper footwear acts as shock absorbers and helps control foot mechanics 1

Ice Application

While ice (cryotherapy) is commonly used for acute injuries, the evidence for its effectiveness is surprisingly weak 5, 6:

• May provide short-term pain relief but insufficient evidence exists for specific protocols 5, 6
• If using ice, apply intermittently rather than continuously 5, 7
• Do not let ice application delay starting therapeutic exercise 7

Weight Management (If Applicable)

If you are overweight, weight loss programs significantly improve knee arthritis outcomes 1:

• Weight loss programs show significant effects on pain (effect size 0.20) and function (effect size 0.23) 1
• Programs with explicit weight-loss goals and regular follow-up are most effective 1
• Mean weight loss of 6.1 kg provides meaningful symptom improvement 1

Critical Pitfalls to Avoid

Do not rest excessively or immobilize the knee - this is the most common mistake:

• Prolonged rest leads to loss of proprioception and formation of inelastic scar tissue 8
• Immobilization should be reserved for fractures and severe (grade III) sprains, not minor injuries 8
• Early therapeutic exercise facilitates faster recovery 7

Do not delay exercise waiting for pain to completely resolve:

• Exercise should begin as soon as tolerable, even with some discomfort 1
• The analgesic effect of ice can facilitate earlier exercise 7

When to Seek Further Evaluation

Seek urgent medical attention if you develop 1:

• High level of pain or rapid onset of severe swelling
• Coldness or numbness in the foot
• Inability to bear any weight
• No improvement after 3-5 days of conservative management

Consider intra-articular corticosteroid injection if pain is moderate to severe and not responding to the above measures 1.