Knee pain therapy

Thanks for joining us for our live chat on coping with knee pain with Dr. Paul Christo of Johns Hopkins. As more people are getting active during the spring warm-up, now is a good time to address the latest treatments and therapies. Below is a transcript of the discussion.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine.

Note: Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

Learn about other pain topics in Pain: Time to Take Charge.

 Health chat: Knee pain(04/06/2011) 
Baltimore Sun Health: 
Hi, Dr. Christo will be joining us at noon, but feel free to add your questions now.
Wednesday April 6, 2011 11:28 Baltimore Sun Health
Baltimore Sun Health: 
Welcome, everyone, to our live health chat. Dr. Paul Christo of Johns Hopkins is back with us to discuss knee pain. We'll get to as many of your questions as we can within the hour, so let's get started.
Wednesday April 6, 2011 11:58 Baltimore Sun Health
dr. christo: 
Welcome to the health chat.
Wednesday April 6, 2011 11:59 dr. christo
[Comment From SandraSandra: ] 
I have pain in my knees only at night. It keeps me awake, but responds to acetaminophen to some extent. If it is really bad, I have to take a naproxen. I have always had difficulty rising from a kneeling position, but otherwise, my knees don't hurt during the day. My X-rays show normal knee joints with some minor roughness of both patellae. Could my knee pain be due to the patellar roughening? If so, what would help? Would physical therapy or knee exercises help? I already do leg lifts with mild weights.
Wednesday April 6, 2011 11:59 Sandra
dr. christo: 
You may have some prepatellar bursitis which usually presents with knee swelling and pain on the top of the knee. It's commonly caused by trauma or direct pressure from repeititve kneeling. Treatment that can be helpful consists of draining the swelling, ice, anti-inflammatories (naproxen or motrin, etc). avoidance of squatting or flexing the knee more than 90 degrees. If it persists, then steroid can be injected.
Wednesday April 6, 2011 12:05 dr. christo
[Comment From NeilNeil: ] 
located below the fibular head is a nonunion fracture, with constant pain, at times very little and at other times, quite substantial pain. Is rotates and the knee gives way 2-4 times a month. What kind of surgery should I consider. I control the pain with medicines and acupuncture but they are not a cure. I need some sort of surgery to mend the non-union fracture, and perhaps tighten ligaments on the outer left side of the knee (to the femor ¿ thigh bone) for more security and firmness. Help from one doctor to another!!!
Wednesday April 6, 2011 12:07 Neil
Baltimore Sun Health: 
Just a note. When asking questions, it can be helpful to add your age since pain affects young adults, middle age and seniors differently.
Wednesday April 6, 2011 12:09 Baltimore Sun Health
dr. christo: 
I would see an orthopedist for guidance. You may have developed some arthritis in the area of the non-union which is causing the pain. For instance, you may have developed osteophytes or cysts in the area of the non-union. Consider imaging the knee with x-ray first, then MRI. Physical therapy, braces, and strenghthening the quadricepts often helps.
Wednesday April 6, 2011 12:13 dr. christo
[Comment From SheilaSheila: ] 
I was diagnosed with chondromalacia and tilted knee caps about 20 years ago. Every now and again the dull pain behind my knee caps flares up. I use heat, advil, and yoga stretches to try to alleviate it. Usually it works pretty well. But I find I have to be really vigilant. If I do certain physical activities, the pain flares up. I am quite physically active. As a p/t college instructor, I carry a heavy bookbag as part of my job and I walk all over campus and up and down stairs every day. What can I do - in addition to the things I mentioned above - to ensure good knee health. I'm going to be 57 years old in June - I teach yoga part-time - I want/need to be in good physical health. I feel like I'm going to need surgery at some point - like it's going to be inevitable. What is the best way to treat my kind of knee pain?
Wednesday April 6, 2011 12:14 Sheila
Baltimore Sun Health: 
So everyone knows ... Chondromalacia, also known as runner's knee, in which the cartilage under the kneecap is damaged.
Wednesday April 6, 2011 12:17 Baltimore Sun Health
dr. christo: 
Chrondromalacia usually results from direct trauma, overuse, or repetitive irritation from misaslignment. Most patients complain of knee pain that increases after long periods of sitting. Ice and elevating the knee can help and avoid aggravating factors such as squatting and kneeling. Straight leg raising with the leg externally rotated to improve strength of the vastus medialis (one of the muscles of the thigh) can help. Steroid injections every 6 weeks or so may be useful. Ultimately, surgical intervention such as a lateral retinacular release may be considered.
Wednesday April 6, 2011 12:21 dr. christo
[Comment From Duane HendersonDuane Henderson: ] 
Hello. I shredded my ACL and cartlidge back in 2001 playing football. SInce I had cartlidge scope in 2002, and complete ACL reconstruction in 2005. SInce I have never completely recovered. My joints are week and experiance alot of pain going up and down steps. I am currently involved with PT for my back and hamstring, and I take glucosomine chondrotin, and MSM daily with no relief. Pain in R knee seems to radiate at time after excessive bending. Any exercise advice
Wednesday April 6, 2011 12:24 Duane Henderson
[Comment From Duane HendersonDuane Henderson: ] 
Forgot to enter my age. 34 but feel like 50.
Wednesday April 6, 2011 12:24 Duane Henderson
Baltimore Sun Health: 
Here are some general websites about knee pain:
Wednesday April 6, 2011 12:29 Baltimore Sun Health
dr. christo: 
Patients usually report a "pop" at the time of injuring the ACL (anterior cruciate ligament). You may need to refrain from significant weight bearing activities. You can elevate the leg as well. Quadricepts and hamstring strenghtening will help increase stability of the knee joint. Otherwise, medicines like anti inflammatories (motrin, naproxen), and even tramadol by mouth could be considered. There are anti-inflammatory topical agents that you can apply to the knee (pennsaid or diclofenac gel) that are approved for arthritis which may also help ease the pain.
Wednesday April 6, 2011 12:30 dr. christo
[Comment From Mary EllenMary Ellen: ] 
I tore several things in my knee in 1079, no surgery done. I had arthroscopy in 1998 with removal of debris, but no repair possible. Xrays show moderately severe arthritis medially in both knees, and at age 50 I am told knee replacement is next for my left knee. I am recovering from 4 years of bilateral plantar fasciitis post deliviery of twins, and am actually able to bike and walk. But I have legy knee pain every day, sometimes that breath-taking "pinch" 8-10 times a day. So, my question is: is there a surgery short of the traditional total knee replacement that I might have when I am really ready? I am an outdoor athlete, and carrying 30 extra pounds, and plan on much more reconditioning before I would even consider surgery. Thank you for any advice you may have, Dr. Christo. Be Well, Mary Ellen C.
Wednesday April 6, 2011 12:32 Mary Ellen
Baltimore Sun Health: 
Just a reminder, we have a collection of articles done by health journalists across Tribune on pain topics. You'll also find an archive of all our pain chats there:,0,7737765.storygallery
Wednesday April 6, 2011 12:37 Baltimore Sun Health
Baltimore Sun Health: 
Some osteoarthritis resources:
Wednesday April 6, 2011 12:41 Baltimore Sun Health
dr. christo: 
Mary Ellen,
The pain of arthritis of the knee can be reduced with anti-inflammatories by mouth, or topical anti-inflammatory medicines like the ones I described for Duane. You can reduce pressure on the medial part of the knee by using heel wedges or a knee-unloading brace. Measures to decrease joint impact like shock-absorbing insoles can also be effective. An injection of steroid into the joint can be helpful, or an injection of something called hyaluronidase (synvisc) into the joint to reduce the pain has some evidence of effectiveness as well. Arthroscopy can be used to irrigate the joint and remove loose pieces of cartilage before considering a knee replacement. Knee replacement if generally reserved for people over 60 years of age because younger, more active folks like you may put exessive stress on the prosthesis. Tramadol is a medicine that is like an opioid (narcotic), but much weaker and not a controlled substance by the DEA. The risk of abuse or addiction is rare and it can be helpful if other measures just don't seem to provide the benefit you need.
Wednesday April 6, 2011 12:43 dr. christo
[Comment From GuestGuest: ] 
25 years old. I played volleyball since I was little (in college, I subluxed my patella) and now run regularly, both outside and on treadmill). My knees click loudly walking up stairs, when I squat and pop harshly sometimes when I walk and run. The clicking isn't always painful, but my knees are always tight and ache regularly inside the knee, behind the patella. Swelling occurs occasionally, usually after prolonged running.
Wednesday April 6, 2011 12:45 Guest
Baltimore Sun Health: 
Here are some images of knee anatomy bones and ligaments:
Wednesday April 6, 2011 12:47 Baltimore Sun Health
dr. christo: 
Patellar subluxation occurs in adolescent girls and young women most commonly. There is a feeling of "giving out" with the knee that is reported. Rehabilitation by strengthening the quadricepts, especially the vastus medialis is important. A neoprene patellar stabilization brace may be beneficial during any sporting activities. If functional problems continue, then you may want to consider surgery. Occasional use of anti-inflammatories (motrin, naproxen) can help too.
Wednesday April 6, 2011 12:50 dr. christo
Baltimore Sun Health: 
More on subluxation:
Wednesday April 6, 2011 12:51 Baltimore Sun Health
[Comment From MarcMarc: ] 
I'm 35 and have a torn PCL in my right knee. I have movement at 90 degree, but am solid at other times. I can run on it well but the next day I have tightness and brusing behind my knee. Its very harrd to stay in good shape as it takes me 4 or 5 days to recover. I've been told there is not much they currently do for a PCL tear - is there anything new?
Wednesday April 6, 2011 12:51 Marc
dr. christo: 
PCL tears often result from a direct blow to the front of the knee while the knee is bent. People often complain of instability and giving out of the knee as well as stiffness and some swelling. Arthroscopy can directly view the damage. Avoiding heavy, weight bearing on the joint is something to bear in mind. You may need to consider swimming and other activities that place less force on your knee. Rehabilitation with strengthening exercises an knee bracing can allow return to activity. Surgery is recommended if the supporting structures of the knee in addition to the PCL are damaged which may be why you were told there isn't much to do surgically.
Wednesday April 6, 2011 12:57 dr. christo
[Comment From CarolynCarolyn: ] 
I had a total knee replacement on Oct. 11, 2010. Should I be pain free?
Wednesday April 6, 2011 12:59 Carolyn
dr. christo: 
The pain from total knee replacement can take several months to control, sometimes 9 months or more. Occasional use of anti-inflammatory medicines by mouth can help after talking to your doctor.
Wednesday April 6, 2011 1:02 dr. christo
Baltimore Sun Health: 
That's all the time we have for today. Thanks again for your questions.
Wednesday April 6, 2011 1:02 Baltimore Sun Health
dr. christo: 
Thank you. I hope it was helpful.
Wednesday April 6, 2011 1:02 dr. christo
dr. christo: 
For those who may be interested in gaining more helpful information on pain and pain relief, I host a new radio show on WBAL Radio in Baltimore, called Aches and Gains. It typically airs every Saturday from 8 pm to 8:30 pm. Please go to or for show archives. The next show airs April 16 and features Naomi Judd discussing Holistic Approaches for Pain Relief.
Wednesday April 6, 2011 1:12 dr. christo