From the Guidelines
Knee pain can be effectively managed with a combination of self-management programs, strengthening, low-impact aerobic exercise, and neuromuscular education, as well as pharmacologic therapies including oral or topical nonsteroidal anti-inflammatory drugs or acetaminophen. The most recent and highest quality study, published in 2022 1, recommends sustained weight loss for overweight and obese patients with knee osteoarthritis, as it has been shown to benefit pain and function.
Key Recommendations
- Participate in self-management programs, strengthening, low-impact aerobic exercise, and neuromuscular education to manage knee pain, as recommended by the 2014 study 1 and supported by the 2021 study 1.
- Use oral or topical nonsteroidal anti-inflammatory drugs or acetaminophen for pain relief, as recommended by the 2021 study 1 and the 2022 study 1.
- Consider physical therapy as part of a comprehensive management plan, as suggested by the 2021 study 1.
- Avoid using opioids, including tramadol, for pain management due to the high risk of adverse effects, as recommended by the 2021 study 1 and the 2022 study 1.
Additional Considerations
- Weight management is crucial, as each extra pound adds 3-4 pounds of pressure on the knees, as noted in the example answer.
- Gentle exercises like straight leg raises, hamstring stretches, and quadriceps sets can strengthen the muscles supporting the knee, as mentioned in the example answer.
- A knee brace or compression sleeve may provide stability for persistent pain, as suggested in the example answer.
- If pain persists beyond 1-2 weeks despite these measures, or if you experience severe swelling, inability to bear weight, or fever, consult a healthcare provider for further evaluation and treatment, as recommended in the example answer.
From the FDA Drug Label
PRECAUTIONS General Ibuprofen tablets cannot be expected to substitute for corticosteroids or to treat corticosteroid insufficiency. The pharmacological activity of ibuprofen tablets in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting complications of presumed noninfectious, painful conditions.
The FDA drug label does not answer the question about knee pain treatment.
From the Research
Causes of Knee Pain
- Osteoarthritis (OA) is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness 2
- Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25% 2
- Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma or as a degenerative condition present in patients with knee OA who are aged 40 years or older 2
Diagnosis of Knee Pain
- The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain 2
- The McMurray test and joint line tenderness assist diagnosis of meniscal tears, with 61% sensitivity and 84% specificity for the McMurray test, and 83% sensitivity and 83% specificity for joint line tenderness 2
Treatment of Knee Pain
- First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition 2
- Conservative management, including exercise therapy, is also appropriate for most meniscal tears, with surgery only considered for severe traumatic tears or end-stage OA 2, 3, 4, 5
- A combined conservative therapy, including weight loss, aerobic and strengthening training, and pharmacological treatment, is recommended for the treatment of knee osteoarthritis 4
- Topical and oral pain medication, and intraarticular application of hyaluronic acid or platelet-rich plasma, can also be used in the conservative treatment of knee osteoarthritis 5, 6