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Table of Contents

Anatomy of the knee 03

Home Care for Knee Pain 04

Knee Pain Diagnosis 05

Causes, Symptoms, Signs, Treatment, Prognosis, and Types of Acute Knee Pain 07

Arthritis 09

Cayenne Pepper and Arthritis Relief 11

Foods That Can Help Arthritis Sufferers 13

Osteoarthritis in the Knees: 10 Pain Relief Options 14

Seek Arthritis Relief with Apple Cider Vinegar 16

Prevention of Knee Pain 17

Common knee injuries 18

11 Knee Pain Dos and Don’ts 19

KNEE EXERCISE PROGRAM 21

DISCLAIMER: Note that the contents here are not presented from a medical practitioner, and that any and all health care planning should be
made under the guidance of your own medical and health practitioners. The content within only presents an overview based upon research for
educational purposes and does not replace medical advice from a practicing physician. Further, the information in this manual is provided "as is"
and without warranties of any kind either express or implied. Under no circumstances, including, but not limited to, negligence, shall the seller/
distributor of this information be liable for any special or consequential damages that result from the use of, or the inability to use, the
information presented here. Thank you.
Anatomy of the Knee
The knee joint's main function is to bend and straighten for
moving the body. The knee is more than just a simple hinge. It also twists
and rotates. In order to perform all of these actions and to support the
entire body while doing so, the knee relies on a number of structures,
including bones, ligaments, tendons, and cartilage.
Bones
- the knee joint involves three bones.
- the thighbone or femur comprises the top portion of the joint.
- one of the bones in the lower leg (calf area), the tibia, provides the
bottom portion of the joint.
- the kneecap or patella rides along the front of the femur.
- the remaining bone in the calf, the fibula is not directly involved in the
knee joint but is close to the outer portion of the joint (sometimes this
bone is included in the knee joint and therefore the joint will be
described as involving four bones).
Ligaments
- ligaments are fibrous bands that connect bones to each other.
- the knee includes four important ligaments, all four of which connect
the femur to the tibia:
(1) The anterior cruciate ligament (ACL) and posterior cruciate
ligament (PCL) provide front and back (anterior and posterior) and
rotational stability to the knee.
(2) The medial collateral ligament (MCL) and lateral collateral
ligament (LCL) located along the inner (medial) and outer (lateral) sides of
the knee provide medial and lateral stability to the knee.
03
Tendons
- tendons are fibrous bands similar to ligaments.
- instead of connecting bones to other bones as ligaments do, tendons
connect muscles to bones.
- the two important tendons in the knee are
(1) the quadriceps tendon connecting the quadriceps muscle,
which lies on the front of the thigh, to the patella and
(2) the patellar tendon connecting the patella to the tibia
(technically this is a ligament because it connects two bones).
- the quadriceps and patellar tendons as well as the patella itself are
sometimes called the extensor mechanism, and together with the
quadriceps muscle they facilitate leg extension (straightening).
Cartilage
- cartilaginous structures called menisci (one is a meniscus) line the top
of the tibia and lie between the tibia and the two knuckles at the
bottom of the femur (the femoral condyles).
- menisci provide both space and cushion for the knee joint.
Bursae
- bursae (singular is bursa) are fluid-filled sacs that help to cushion the
knee. The knee contains three important groups of bursae.
(1) the prepatellar bursa lies in front of the patella.
(2)the anserine bursa is located on the inner side of the knee
about 2 inches below the joint.
(3)The infrapatellar bursa is located underneath the patella.
Home Care for Knee Pain
In treating many types of knee pain, a common goal is to break
the inflammatory cycle. The inflammatory cycle starts with an injury. After
an injury, inflammation invades the knee, which causes further injury, and
further inflammation, and so on. This cycle of inflammation leads to
continued or progressive knee pain. The cycle can be broken by fighting
the inflammation (through medications or other therapies) and by
limiting further injury to tissue.
Some common home-care remedies that control inflammation and
help to break the inflammatory cycle are protection, rest, ice,
compression and elevation. This regimen is summarized by the
mnemonic PRICE.
PROTECT the knee from further trauma.
This can be done with knee padding. A pad over the kneecap, for
example, helps to control the symptoms of some knee injuries (an
example is a form of bursitis sometimes called housemaid's knee) by
preventing further repetitive injury to the prepatellar bursae.
REST the knee.
Rest reduces the repetitive strain placed on the knee by activity.
Rest both gives the knee time to heal and helps to prevent further injury.
ICE the knee.
Icing (cold application) the knee reduces swelling and can be used
for both acute and chronic knee injuries. Most authorities recommend
icing the knee two to three times a day for 20-30 minutes each time.
Use an ice bag or a bag of frozen vegetables placed on the knee.
COMPRESS the knee with a knee compression sleeve or wrap.
Compression helps accomplish two goals:
(1) compression is another way to reduce swelling.
(2) in some knee injuries, compression can be used to keep the
patella aligned and to keep joint mechanics intact.
04
ELEVATE the knee.
Elevation also helps reduce swelling. Elevation works with gravity to
help fluid that would otherwise accumulate in the knee flow back to the
central circulation.
Prop your leg up when you are sitting or use a recliner to elevate the
legs. Over-the-counter pain-control medications: Commonly used pain
relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as
naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a
role in the treatment of knee pain.
These drugs directly control pain and, at higher doses, act as anti-
inflammatory agents, helping to stop inflammation. Like all medications,
however, these drugs have potential side effects.
You should not use NSAIDs if you have a problem with bleeding
or stomach ulcers, high blood pressure, or some kidney disease.
When to Go to the Hospital for Knee Pain
If you cannot walk on your knee and you have had a traumatic injury,
you should immediately go to the hospital's emergency department or
urgent care center to be evaluated by a doctor because of the possibility of a
fracture or significant ligamentous or tendon injury.
Many fractures may require immobilization in a specific position or
surgery. Putting off seeing a doctor may hinder healing.
Other signs and symptoms that demand emergency evaluation:
- fever (which may indicate infection)
- unbearable pain
- drainage
- large wounds
- puncture wounds
- swelling, if you are on a blood thinner (warfarin or Coumadin) or have a
bleeding disorder (such as hemophilia). Swelling that is associated with
redness and the knee feeling warm
Knee Pain Diagnosis
Even in today's world of technology, physicians rely on a detailed
history and examination more than any single test.
The doctor will typically want to know the exact nature of the pain.
Where in the knee is your pain?
What does the pain feel like?
Has it happened before?
What makes it better or worse?
How long have you had pain in the knee?
The doctor will also want to know a bit about you.
Do you have any major medical problems?
How active is your lifestyle?
What are the names of the medications you are taking?
The doctor will want to know about any related symptoms.
Do you still have normal sensation in your foot and lower leg?
Have you been having fevers?
Physical examination
The doctor will likely have you disrobe to completely expose the
knee. The doctor will then inspect the knee and press around the knee to
see exactly where it is tender.
In addition, the doctor may perform a number of maneuvers to
stress the ligaments, tendons, and menisci of the knee and evaluate the
integrity of each of these. An experienced health care professional will be
able to make a preliminary diagnosis based on this examination.
These maneuvers can establish potential tendon, ligament, or
meniscus injuries.
X-rays and CT scans
Depending on your particular history and examination, the doctor
may suggest X-rays of the knee. X-rays show fractures (broken bones)
and dislocations of bones in the knee as well as arthritic changes and
abnormally large or small joint spaces.
05
Rarely, the doctor may order a CT scan (a three-dimensional X-ray)
of the knee to precisely define a fracture or deformity.
Both X-rays and CT scans are excellent for diagnosing fractures. They
both are also poor, however, at evaluating soft-tissue structures of the
knee such as ligaments, tendons, and the menisci.
MRI
Magnetic resonance imaging (MRI) uses large magnets to create a
three-dimensional image of the knee. In contrast to CT scans, MRIs do not
image bones and fractures well.
Also in contrast to CT scans, MRIs are excellent for evaluating
ligaments and tendons for injuries.
Fluid removal
The knee and all bursae of the knee are filled with fluid. If your
symptoms suggest infection, inflammation, or certain types of arthritis,
your physician may use a needle to remove fluid from the knee.
The removal of the fluid will sometimes decrease the pain you have
been experiencing and make it possible for you to bend your knee.
This fluid will then be analyzed to better clarify the diagnosis and
detect infection. Crystals, which suggest crystalline arthritis, often can be
seen under the microscope.
Arthroscopy
The orthopedic surgeon may elect to perform arthroscopy if you have
chronic knee pain. This is a surgical procedure where the doctor will place
a fiberoptic camera within the knee joint itself.
By doing so, the surgeon may be able to see small particles in the
knee or to look more closely at damaged menisci or cartilage. The doctor
may also be able to repair damage by shaving down torn cartilage or
removing particles from the knee while the camera shows the inside of
your knee.
 \

Patellar
surface
of femur • •
Anterior Medial
cruciform femoral
ligament condyle
Transverse liga­
ment of knee Posterior
cruciform ligament
Lateral
meniscus Medial
meniscus
Lateral
collateral Medial
ligament collateral ligament
Anterior
ligament of Patellar ligament
fibular head

Patella

Fibula
Causes, Symptoms, Signs, Treatment, Prognosis, and Types
of Acute Knee Pain
The nerves that provide sensation to the knee come from the
lower back and also provide hip, leg, and ankle sensation. Pain from a
deeper injury (called referred pain) can be passed along the nerve to be
felt on the surface. Knee pain, therefore, can arise from the knee itself or
be referred from conditions of the hip, ankle, or lower back. All of the
following sources of knee pain arise from the knee joint itself.
In general, knee pain is either immediate (acute) or long-term
(chronic). Acute knee pains can be caused by an acute injury or
infection. Chronic knee pains are often from injuries or inflammation
(such as arthritis) but can also be caused by infection.
Fractures (broken bones)
Description: Fractures of any of the bones of the knee are traumatic
injuries typically caused by moderate to high forces (such as car
accidents or contact sports).
Symptoms and signs: Fractures may be accompanied by swelling or
bruising but are almost always extremely painful and tender. The pain is
typically so severe that people are unable to walk or even put weight on
the knee.
Evaluation: Fractures are an emergency and should be checked by
a doctor. This evaluation will generally include an X-ray and other
relevant studies. A delay in evaluation can result in fracture fragments
being moved and associated injuries.
Sprained and torn collateral ligaments
Description: The medial collateral ligament (MCL) is the most
commonly injured ligament in the knee. Like all ligaments, this ligament
may be sprained or torn. A sprained ligament may be partially ruptured.
A torn ligament is completely ruptured.
Symptoms and signs: Severe MCL sprains or tears often produce a
tearing or ripping sensation along the inner joint line of the knee. You
may also notice knee instability and swelling.
A force from the outer (lateral) knee to the inner (medial) knee is
typically responsible for this injury in contrast to the more rarely injured
LCL, which is typically a result of an inner to outer force. In general,
bruises occur at the point of impact. Sprained and torn ligaments occur
opposite the point of impact. Both MCL and LCL injuries are common in
contact sports but can also result from twisting the knee with a planted
foot such as in skiing. Injured medial and lateral collateral ligaments are
typically tender at the inner and outer knee respectively.
Evaluation: After a history and physical examination, conservative
treatment with rest, application of cold packs, and elevation of the
involved extremity is often recommended. With persisting symptoms,
the doctor may suggest an MRI scan or arthroscopy to further evaluate
an injured ligament.
Sprained and torn cruciate ligaments
Description: An anterior cruciate ligament (ACL) injury is a
common sports injury generally caused by a hard stop or a violent
twisting of the knee. The posterior cruciate ligament (PCL) is stronger
than the ACL and much less commonly torn. The PCL requires strong
forces, such as those produced when the dashboard strikes the knee in
a car accident, to tear. Due to these severe forces, PCL injury is often
associated with other ligament and bone injuries.
Symptoms and signs: If you tear your ACL, you may hear a pop.
You will also notice your knee give way or become unstable and feel
pain.. This will, almost always, be followed by marked knee swelling over
the next couple of hours because the ACL bleeds briskly when torn.
Treatment: Surgical repair is recommended for athletes who
require return to competition. Conservative treatment and knee braces
may prove sufficient for those who do not demand quite so much from
their knees.
07
 Tendon ruptures
Description: Both the quadriceps and patellar tendons may rupture
partially or completely. Quadriceps tendon rupture typically occurs in
recreational athletes older than 40 years (this is the injury President
Clinton suffered while jogging), and patellar tendon rupture typically
occurs in younger people who have had previous tendonitis or steroid
injections to the knee.
Symptoms and signs: Rupture of either the quadriceps or patellar
tendon causes pain (especially when trying to kick or extend the knee).
Those people with complete ruptures are unable to extend the knee. The
patella is also often out of place either upward (with patellar tendon
rupture) or downward (with quadriceps tendon rupture). The patient can
usually notice a difference in appearance when comparing his/her knees.
Treatment: Tendon ruptures should be evaluated urgently. Tendon
ruptures generally require surgical repair. A partial rupture may be
treated with splinting alone.
Meniscal injuries
Description: Injuries to the meniscus are typically traumatic injuries
but can also be due to overuse. Often, a piece of the meniscus will tear
off and float in the knee joint.
Symptoms and signs: Meniscal injuries may cause the knee to lock
in a particular position or either click or grind through its range of
motion. Meniscal injuries may also cause the knee to give way. Swelling
typically accompanies these symptoms although the swelling is much
less severe than with an ACL injury.
Treatment: Meniscal injuries often require arthroscopic surgical
repair. A locking knee or a knee that "gives" should be evaluated for
arthroscopic repair.
Knee dislocation
Description: Dislocation of the knee is a true limb-threatening
emergency. This is also a rare injury. Dislocation of the knee is caused by
a particularly powerful blow to the knee. The lower leg becomes
completely displaced with relation to the upper leg.
This displacement stretches and frequently tears not only the ligaments
of the knee but also arteries and nerves. Untreated arterial injuries leave
the lower leg without a blood supply. In this case, amputation may be
required. Nerve injuries, on the other hand, may leave the lower leg
viable but without strength or sensation.
This injury can be due to a motor vehicle accident where the
patient's knee or leg hits the dashboard.
Symptoms and signs: Knee dislocations are severely painful and
produce an obvious deformity of the knee. Many dislocations are
reduced or put back into anatomic alignment spontaneously. As this
occurs, many will report feeling a dull clunk.
Treatment: If the knee dislocation has not been put back into place
(reduced), the doctor will immediately reduce the dislocation. Medical
treatment, however, does not stop here. Whether a dislocation reduces
by itself or is put back into place in the hospital, it requires further
evaluation and care. After reduction, people with these injuries are
observed in the hospital, where they usually do a number of tests to
ensure that no arterial or nerve injury has occurred. If such an injury is
found, it must be repaired immediately in the operating room.
Dislocated kneecap (patella)
Description: A common injury caused by direct trauma or forceful
straightening of the leg, such as an injury that happens when serving in
volleyball or tennis. Patellar dislocation is more common in women, the
obese, knock-kneed people, and in those with high-riding kneecaps.
Symptoms and signs: If you have this injury, you will notice the
patella being out of place and may have difficulty flexing or extending
your knee.
Treatment: The doctor will pop the patella back into place (reduce
the dislocation). Even if the patella goes back into place by itself,
however, it needs to be X-rayed for a fracture.
08
Arthritis
Crystalline arthritis (gout and pseudogout)
Arthritis of the knee is an inflammatory disorder of the knee joint that is
Description: These severely painful forms of arthritis are caused
often painful. Arthritis has many causes:
by crystals that form in the knee and other joints. These crystals can
Osteoarthritis
form as a result of defects in the absorption or metabolism of various
Description: Osteoarthritis is caused by degeneration of cartilage
natural substances such as uric acid (which produces gout) and calcium
in the knee. In its extreme form, the menisci (cartilage) will be completely
pyrophosphate (pseudogout).
eroded, and the femur will rub on the tibia, bone on bone.
Symptoms and signs: Gout and pseudogout cause a rapid-onset,
Symptoms and signs: Osteoarthritis (OA) causes a chronically
markedly inflamed knee joint. The knee can be exquisitely painful,
painful knee that is often more painful with activity. It can be stiff with
swollen, and warm with loss of range of motion.
prolonged sitting and may become enlarged from new bone formation
Treatment: Treatment is aimed at controlling inflammation with
at the edge of the degenerated cartilage.
anti-inflammatory medications and at aiding the metabolism of the
Treatment: Treatment is aimed at pain control with over-the-
various chemicals that may lead to crystal formation. Alcohol should be
counter pain relievers. Anti-inflammatory medications, either over the
avoided and gout-specific dietary changes can be successful in avoiding
counter, or by your doctor's prescription, are also quite helpful. Knee
flare-ups.
bracing can be beneficial for more mobile patients.
Bursitis
Description: As a result of trauma, infection, or crystalline deposits,
Rheumatoid arthritis
the various bursae of the knee may become inflamed.
Description: Rheumatoid arthritis (RA) is a disease of the whole
Symptoms and signs: Acute or chronic trauma causes a painful and
body that affects many joints, often including the knee. People who have
often swollen knee from the inflammation of the bursae. A particularly
this disease often have family members who suffer from it as well.
common bursitis is prepatellar bursitis. This type of bursitis occurs in
Symptoms and signs: In addition to knee pain, rheumatoid
people who work on their knees. It is often referred to as housemaid's
arthritis may produce morning stiffness and pain in other joints. The
knee or carpet layer's knee. Another type of bursitis is anserine bursitis.
knee can be warm to the touch and swollen.
The anserine bursa is located about 2 inches below the knee along the
Treatment: Treatment includes pain medications, anti-
medial side of the knee. Though it occurs more commonly in the
inflammatory medications, and prescription drugs. (These drugs either
overweight and in women, it also affects athletes and others. Anserine
try to slow the progression of the disease or try to suppress the immune
bursitis often causes pain in the region of the bursa and is often worse
system or decrease inflammation.) Your health care professional will
with bending the knee or at night with sleep.
need to evaluate which one of these medications is best suited for you.
Treatment: Treatment will usually include home care with PRICE
Prognosis: It is essential that patients with rheumatoid arthritis be
therapy and NSAIDs. Severe forms, however, can be treated with
evaluated and treated aggressively early for best outcomes. This
periodic steroid injections to the bursae.
generally will include a thorough evaluation by a rheumatologist.
Prognosis: With optimal treatment and management, patients
09
generally do very well.
 Common types of Arthritis

Healthy Joint Osteoarthritis Rheumatoid Arthritis

Cayenne Pepper and Arthritis Relief
Most arthritis sufferers turn to their medicine cabinet to seek relief.
A medical professional typically offers this suggestion. If you suffer from
arthritis, your physician does have your best interest at heart. They truly
believe over-the-counter or prescribed pain medication is best for you. It
may be, but many natural remedies relieve pain too. One of them is
cayenne pepper, also know simply as red chili pepper.
As great as it is to know that some individuals are able to seek
arthritis pain relief from red chili peppers, you likely have many questions.
What type of red pepper? What format should I opt for? How much
should I consume? Do I eat it or apply it to the skin and how often? If
you have these questions, please continue reading on for answers.
Cayenne pepper is available in many different formats, including
capsules, oil, creams, and pepper. Where you purchase yours will depend
on the remedy selected. For example, if you wish to try a topical cream,
head to the drug store. If you wish to increase your cayenne pepper
intake naturally, head to your local supermarket or organic food store.
Cayenne Pepper Remedy (1)
Mix a small amount of red pepper with a small amount of Castor
oil. Use a paper towel or cloth to soak in the mixture. Apply the damp
paper towel or cloth to the painful area. Some recommend applying and
leaving on overnight. Castor oil has many health benefits, although it is
not right for everyone. Try this home remedy for a couple of hours
during the day first. If you notice a decrease in pain with no reactions,
aim for overnight relief.
Cayenne Pepper Remedy #2
Purchase the cayenne pepper spice. This is the dry mixture. Add
to your food. If you have digestive problems, you may notice a few
complications at first. For many, their body needs to adjust to the
11
pepper, as it can be difficult to digest.
Start slow, like with 1/8 tablespoon. Overtime, work your way to
two teaspoons a day. You can scatter this dosage out over different
meals. Red pepper can be added to most foods.
Cayenne Pepper Remedy (3)
Purchase hot sauce that is made from cayenne pepper. The hot
sauce label should state the main ingredient is “aged cayennes.” Apply to
the painful areas of your body at least two times a day. Many report this
home remedy does work, but there is the possibility of stained clothes.
Cayenne Pepper Remedy #4
Purchase an over-the-counter topical cream with capsaicin as the
main ingredient. This is an alternative to using the above mentioned hot
sauce. Many creams use capsaicin, which is derived from cayenne
pepper. If on a budget, try the above mentioned hot sauce remedy first.
If it does not work, try this alternative.
As with any natural and home remedy, it is important to consider
the risk and speak with a trusted medical professional. The active
ingredient in cayenne pepper is capsaicin. It can interact with a number
of drugs, including acid reducers, aspirin, blood thinners, and ACE
inhibitors. If taking these medications, hold off. First, speak to your
primary care physician or a pharmacist. He or she can inform you of the
dangers or the risks of mixing with your current medications.
With all natural and home remedies, it is important to
remember variance. Our bodies process food differently.
Cayenne pepper may
provide relief from some,
but not others. It is best to
experiment to find the
best pepper
remedy and dosage.
Consider more natural ways to seek relief
from Arthritis
Foods That Can Help Arthritis Sufferers
Do you suffer from arthritis? So, what should you do? Consider
more natural ways to seek relief. In fact, start in your kitchen. Although
there are no guarantees, many arthritis patients see success by
incorporating certain foods into their diets.
What type of foods may help those, like you, suffering from
arthritis?
Pineapple. Pineapple is recommended for arthritis because it contains a
chemical called Bromelain. Many claims this helps to prevent
inflammation. In fact, some athletic trainers recommend its consumption
to keep joints pain free and flexible. As with any other health foods, it is
best to consume fresh instead of canned or frozen.
Oily fish. Those suffering from rheumatoid arthritis are often encouraged
to avoid meats. Meat has fat that is known to produce inflammation
agents in the body. The only exception to this is with fish. Oily fish, such
as mackerel and salmon, are rich in omeg-3 fatty acids. These acids have
many health benefits. They inhibit the release of joint destroying
chemicals and compounds. Supplements are found in most retail stores,
but it is best to get these oils directly from the source.
Celery. The celery plant contains many different anti-inflammatory
agents. These can lessen the suffering of arthritis pain and discomfort. It
is best to eat the celery seeds. Most recommend placing up to one
teaspoon of celery seeds into a cup with warm, but not boiling water. Let
stand for a few minutes and drink. This can provide almost instant relief
during an attack. The celery plant as a whole contains anti-inflammatory
agents; so eating fresh celery regularly has benefits too.
Red chili pepper. Red pepper, also known as cayenne pepper, can help
relieve the joint pain associated with most types of arthritis. As for how,
you may be amazed. Many claim it causes the release of natural
endorphins. Essentially, your body itself stops the pain.
Not only should patients consume red chili pepper, but a topical mixture
works too. Many recommend mixing up to one quart of rubbing alcohol
with once ounce of cayenne pepper. It is important to note, this mixture is
to be applied to the skin during bouts of pain. Under no circumstances
should you drink the mixture due to the rubbing alcohol.
Sesame seeds. The Chinese have long believed and used sesame seeds
to combat the inflammation caused by arthritis. As with oil, sesame seeds
contain healthy fatty acids. For the best results, eat sesame seeds straight.
If you dislike taste or texture, opt for incorporating them into your meals.
Eat sesame seed rolls and use them when preparing dinner at home. They
can be added to most foods.
Ginger. Ginger is well-known and widely used to fight inflammation.
Most commonly used as a cooking spice, it has many health benefits. In
addition to reducing inflammation, it assists in treating diarrhea and
nausea. Available in a spice format, it can and should be sprinkled atop
cooked vegetables and other foods. As with omeg-3 fatty oils, it is best to
go directly to the source. Fresh ginger is easy to peel and cook. Wrapped
in a towel, bag, and freeze for months. It is also found in the non-
carbonated ginger ale drink.
Raw cabbage. Although not as well-known and as popular as the above
mentioned foods, many also claim raw cabbage assists with arthritis relief.
Some recommend the regular consumption of raw cabbage or cabbage
juice. They claim this relieves both joint paint and swelling.
The above mentioned foods may assist those suffering from
arthritis. Unfortunately, there are no guarantees. Our bodies each process
food in different ways. For example, celery can work to reduce joint pain
for one individual, but it may actually trigger additional pain with another.
In fact, some forms of rheumatoid arthritis are trigged by certain foods.
For that reason, be prepared to experiment. Trial and error can help you
13 determine which foods are the best at relieving your own, unique pain.
Osteoarthritis in the Knees: 10 Pain Relief Options
Do you suffer from osteoarthritis in the knees? If so, you know pain
and you know it well. Luckily, your suffering does not have to be constant
or last for long. There are many ways to seek relief. In fact, just ten of your
options are outlined below. These particular options were selected due to
ease and practicality; just about anyone can seek relief with these methods.
(1) Over-the-Counter Pain Relievers
For osteoarthritis, most professionals recommend Tylenol or
acetaminophen. With that said, there are many over-the-counter pain
relievers available. Choose a brand that you can afford and one that
provides you with relief. For example, if Aleve has worked to stop
headache pain, try it for arthritis relief. You already know the formula
works.
(2) Topical Arthritis Creams
For instant arthritis pain relief, it is best to go directly to the source.
Topical arthritis creams enable you to do so. You apply the cream directly
to the hurtful joints. At first, you may notice a slight tingle or sting, but
then comes the relief. This relief usually lasts as long as over-the-counter
pain relief pills.
When examining the active ingredients in over-the-counter arthritis
creams, you are likely to find capsaicin. This ingredient is also found in
cayenne pepper. Many not only recommend a capsaicin cream, but
adding the pepper spice to foods for flavor and the health benefits.
(3) Prescribed Medication
Many times, physicians only write prescriptions for severe pain. This
is pain that cannot be treated with over-the-counter products. Opioids are
prescription pain relievers, but there is a risk of addiction or problems from
improper use. If your doctor deems you a responsible and low-risk taker,
codeine, hydrocodone, or oxycodone may be prescribed.
14
(4) Heat
For most, heat provides pain relief. So, give it a try. Draw a warm bath, use
a warm washcloth, or purchase a heating pad. As always, caution is advised
to prevent burns. Although most individuals benefit from heat, some do
better with cold. Some medical professionals, according to Arthritis Today,
recommended alternating between the two.
(5) Exercise
To reduce joint pain, strong muscle strength is needed. With strong
muscles, you are able to rely on them and use them more. This puts less
pressure on achy knees. In fact, strong muscles give the joints extra
protection and cushion. Therefore, exercise is advised. If it is painful to
exercise, start out slow with low-impact exercises. For some, stretching and
light walking is enough. If still too painful, consider low-impact water
exercises.
(6) Physical Therapy
As previously stated, some osteoarthritis patients may find it too painful to
exercise. Your goal is to avoid and prevent pain, so why do something that
causes it? Exercise has long-term health benefits. Not only does it
promote an overall healthy body, but it does provide the joints protection
through increased muscle strength. You can exercise at home, but physical
therapy is good. In some cases, this gives you easy access to water
exercises. You can also learn safe low-impact exercises to do at home.
(7) Weight Loss
Not all patients suffering from osteoarthritis are overweight, but those who
are increase the risk of pain. The more weight one carries around, the more
pressure there is applied to the knees. If you can lose weight without
compromising your health, do so. The best way to lose weight is to
combine exercise with healthy eating.
(8) Knee Braces
Those who suffer from osteoarthritis in the knees are more likely to
experience walking troubles. It can be painful to walk from one room to
another, let alone leave the house. A knee compression sleeve can
provide support and stability. A proper fitting knee compression sleeve
not only makes it easier to walk, but less painful too! Knee braces are
available for sale at most health and drugstores, but talk to your physician
first.

(9) Walking Aids

Those with mild osteoarthritis in the knees can benefit from a cane. Those
with severe osteoarthritis in the knees may need crutches. As previously
stated, walking is difficult with arthritis in the knees. It is painful and there
is an increased risk of falls, due to instability. Cane or crutches can
provide support.

(10) A Strong Support System

Many arthritis patients believe they reach the point of no return. This is
when the pain is so unbearable it seem as if nothing will work. Those
individuals are more likely to suffer in silence than seek treatment. If you
are one of those individuals or if you just need a push to lose weight or
exercise, a strong support system is vital. For many, talking about their
pain helps to ease it. Ensure you have someone at home to discuss your
arthritis with or find local support groups.

15
Seek Arthritis Relief with Apple Cider Vinegar
Do suffer from arthritis? Are you tired of the aches, pains, difficulty
moving, and trouble sleeping? Your physician will recommend pain reliever
and exercise. Yes, these do help, but you may want to try something new.
If and when you reach that point, turn to apple cider vinegar. For many
years, arthritis patients, just like you, have claimed it relieved their pain and
discomfort.
As nice as it is to know that apple cider vinegar can give you arthritis
relief, you may be looking for more information on this natural remedy.
What type of apple cider vinegar? How much? Do I drink it?
Apple cider vinegar is made from apple must and cider. The apples
are crushed and the liquid is squeezed out. Yeast and sugar are later
added. This starts the fermentation process. The alcohol is later converted
into vinegar. Your best bet is to purchase from a health and nutrition or
organic food store. With that said, apple cider vinegar is available for sale
at many retail stores, both on and off-line.
When buying apple cider vinegar to relieve the pain and discomfort
associated with arthritis, opt for the fresh kind. It is found in most health
and nutrition stores. When looking at the package, you should see
sediments at the bottom. This is natural apple cider. Yes, the kind sold at
the grocery store does look more enticing, but it has been altered and
strained, losing some of its helpful properties.
Apple Cider Vinegar Remedy #1
Combine up to three tablespoons of the vinegar in a cup with large
water. If you cannot stomach the taste, as a few drops of honey. You can
do this anytime through the day, but most recommend before bed. Some
recommended drinking the mixture two to three times a day.
16
Apple Cider Vinegar Remedy #2
Combine ¼ cup of apple cider with one to two cups of warm water.
Place the combination in a bowl and soak the achy joints. For example, if it
is your fingers or toes that hurt, soak them. Do so for at least ten minutes.
Apple Cider Vinegar Remedy #3
Combine ¼ cup of apple cider vinegar with one to two cups of warm
water. This is a continuation of remedy two. If your achy joints are too
large to soak, put a cloth in the bowl. Let it soak up the mixture, wring to
prevent dripping, and apply to the achy area. Keep the wrap on for at least
ten minutes.
Apple cider vinegar is full of acid. For that reason, never drink
straight. Always mix with water. This should not be a problem, as most are
unable to stomach the sour taste anyways. As with most natural
supplements, it is available in capsules form. You can take these, but it is
best to opt for the real thing. You receive added health benefits and get a
better value for your money.
Now that you have three different apple cider vinegar remedies, you
may wonder exactly what they will do for you. As previously stated, results
will vary. With that said, most noticed a decrease or elimination in pain.
Users also noticed increased mobility. So, not only was it less painful to
move around, but easier too!
Prevention of Knee Pain
Knee pain has a host of causes. Many types of pain are difficult to
Protect the knee
prevent, but you can do some general things to reduce the likelihood of
Wearing proper protection for the activity at hand can help avoid
sustaining a knee injury.
knee injuries. When playing volleyball or when laying carpet, protecting
Stay slim
your knees may include knee pads.
Staying slim reduces the forces placed on the knee during both
When driving, knee protection may include wearing a seat belt to
athletics and everyday walking and, according to some medical research,
avoid the knee-versus-dashboard injuries as well as injuries to other
may reduce osteoarthritis.
parts of your body.
Keeping your weight down may also reduce the number of ligament
and tendon injuries for similar reasons.
Keep limber, keep fit
Many knee problems are due to tight or imbalanced musculature.
Stretching and strengthening, therefore, also help to prevent knee pain.
Stretching keeps your knee from being too tight and aids in
preventing both patellofemoral syndrome and iliotibial band syndrome.
Strengthening exercises particularly of the quadriceps (straight leg raises
and leg extensions are two excellent exercises, but please see a book on
exercise and training for more) can help prevent knee injury.
Exercise wisely
If you have chronic knee pain, consider swimming or water exercises.
In water, the force of buoyancy supports some of our weight so our knees
do not have to. If you don't have access to a pool or do not enjoy water
activities, at least try to limit hard pounding and twisting activities such as
basketball, tennis, or jogging.
You may find that your aching knees will act up if you play
basketball or tennis every day but will not if you limit your pounding
sports to twice a week. Whatever you do, respect and listen to your body.
If it hurts, change what you are doing. If you are fatigued, consider
stopping; many injuries occur when people are tired.

17
Common knee injuries
The knee is one of the joints most prone to injury. Its structure
and many components put it at risk of many types of injuries, which can
result in knee pain or loss of function.
Sometimes a knee injury happens suddenly as a result of the knee
being hit, fallen on, twisted or moved beyond its intended range of
motion. Sudden knee injuries are common among athletes and may
result in tears to one of three major ligaments of the knee – the
anterior cruciate ligament (ACL), medial collateral ligament (MCL) or
posterior cruciate ligament (PCL) – or the menisci, crescent-shaped
wedges of cartilage within the knee designed to distribute your body
weight across the joint.
At other times, knee injuries happen slowly. For example, a
problem such as a leg-length discrepancy or arthritis in the hip that
causes you to walk awkwardly can throw off the alignment of the knee,
leading to damage. Constant stress to the knee – from sports or jobs
that require bending and lifting, for example – can cause joint cartilage
to wear down over time.
The following are some of the more common knee injuries:
Meniscal Injuries. Menisci can be torn when the knee is bent and
then twisted, such as turning to hit a tennis ball. If the outside of the
knee is hit, during contact sports, for example, the ligaments can be torn
as well. Meniscal injuries that are not repaired increase the risk of
developing osteoarthritis years later.
Anterior Cruciate Ligament and Posterior Cruciate Ligament
Injuries. A sudden twisting motion or change in direction can lead to
injury of the anterior cruciate ligament, whereas the posterior cruciate
ligament is more likely to be damaged from direct impact, such as being
tackled in football. Medial cruciate ligament injuries are often the result
of a direct blow to the outside of the knee. The anterior cruciate
ligament is the ligament most commonly injured.
18
Tendon Injuries. Ranging from inflammation (tendinitis) to ruptures,
tendon injuries can result if you overwork or over-stretch your tendon.
Activities that can injure tendons include running, jumping, dancing and
squatting, especially to lift heavy items.
Bursitis. Some injuries to the knee can lead to inflammation of the
bursae, small fluid-filled sacs that normally cushion the knee and reduce
friction between the joint and surrounding ligaments and tendons.
Injury to bursa can lead to swelling, warmth, pain and stiffness.
Loose bodies. Sometimes an injury to the knee can cause a piece or
pieces of bone or joint cartilage to break off into the joint space. These
loose bodies may interfere with joint movement and cause pain.
Osgood-Schlatter disease. Usually affecting preteen and young
teenage boys, this condition is caused by repetitive stress on the upper
area of the tibia, where the bone is growing. In children with this
condition, the patellar tendon (which connects the knee cap and tibia)
becomes inflamed and may even tear away from the tibia.
Dislocated kneecap. This occurs when an injury causes the patella, or
kneecap, to move out of position. The movement of the kneecap is
always visible and, often, intensely painful.
Iliotibial band syndrome. This syndrome occurs when a band of tissue
rubs against the outer portion of your femur (thigh bone), causing
sharp, burning pain on the outer side of the knee. Although this can
result from a direct injury to the knee, often the cause is the stress of
long-term use, such as long-distance running.
Plica syndrome. This condition occurs when bands of synovial tissue,
called plica, are irritated by overuse or injury. Symptoms may include
knee pain, swelling, locking and weakness.
11 Knee Pain Dos and Don’ts

There are many things you can do to help knee pain, whether it's
due to a recent injury or arthritis you've had for years.
Follow these 11 dos and don’ts to help your knees feel their best.
(8) Don't let your shoes make matters worse. Cushioned insoles can
reduce stress on your knees. For knee osteoarthritis, doctors often
recommend special insoles that you put in your shoe. To find the

(1) Don’t rest too much. Too much rest can weaken your muscles, which appropriate insole, speak with your doctor or a physical therapist.

can worsen joint pain. Find an exercise program that is safe for your (9) Do play with temperature. For the first 48 to 72 hours after a knee

knees and stick with it. If you're not sure which motions are safe or how injury, use a cold pack to ease swelling and numb the pain. A plastic

much you can do, talk with your doctor or a physical therapist. bag of ice or frozen peas works well. Use it for 15 to 20 minutes three
(2) Do exercise. Cardio exercises strengthen the muscles that support or four times a day. Wrap your ice pack in a towel to be kind to your
your knee and increase flexibility. Weight training and stretching do, too. skin. After that, you can heat things up with a warm bath, heating pad,
For cardio, some good choices include walking, swimming and water or warm towel for 15 to 20 minutes, three or four times a day.
aerobics, stationary cycling and elliptical machines. Tai chi may also help (10) Don’t jar your joint(s). High-impact exercises can further injure
ease stiffness and improve balance. painful knees. Avoid jarring exercises such as running, jumping, and
(3) Don’t risk a fall. A painful or unstable knee can make a fall more likely, kickboxing. Also avoid doing exercises such as lunges and deep squats
which can cause further knee damage. Curb your risk of falling by making that put a lot of stress on your knees. These can worsen pain and, if not
sure your home is well lit, using handrails on staircases, and using a done correctly, cause injury.
sturdy ladder or foot stool if you need to reach something from a high (11) Do get expert advice. If your knee pain is new, get a doctor to
shelf. check it out. It's best to know what you're dealing with ASAP, so you
(4)Do use "RICE." Rest, ice, compression, and elevation (RICE) is good for can prevent any further damage.
knee pain caused by a minor injury or an arthritis flare. Give your knee
some rest, apply ice to reduce swelling, wear a compressive bandage, and
keep your knee elevated.
(5) Don't overlook your weight. If you're overweight, losing weight
reduces the stress on your knee. You don’t even need to get to your
"ideal" weight. Smaller changes still make a difference.
(6) Don't be shy about using a walking aid. A crutch or cane can take the
stress off your knee. Knee splints and braces can also help you stay stable.
(7) Do consider acupuncture. This form of traditional Chinese medicine,
which involves inserting fine needles at certain points on the body, is
widely used to relieve many types of pain and may be useful for knee
pain. 19
KNEE EXERCISE PROGRAM
(1) ANKLE ABC’s: Using the big toe as an imaginary pencil, write the letters of the alphabet moving only the ankle and foot. Try
to make the letters as large as possible. Repeat as often as possible throughout the day.

(2) PATELLA MOBILIZATION: With leg straight and muscles relaxed, place two fingers on either side of the kneecap and gently
move kneecap side-to-side for 1 - 2 minutes. Repeat, moving the kneecap up and down for 1 - 2 minutes. Repeat as often as
possible

(3) HEEL SLIDES: While sitting on a smooth surface, pull heel of injured leg toward buttocks, flexing knee as much as tolerable.
Hold and straighten leg by sliding heel downward. Use hands to put pressure on leg above kneecap, trying to make the knee as
straight as possible. Repeat 30 times, 2 - 3 times
daily.

(4) PASSIVE KNEE FLEXION: While seated in chair or table, gently push involved foot back as far as tolerable with opposite leg.
Hold for 5 seconds and slowly relax. Repeat 30 times, 2 - 3 times daily.

(5) QUAD SETS: With leg as straight as possible, tighten thigh muscles, trying to pull kneecap toward hip. Hold for 10 seconds
contracting the muscles as tight as possible. Relax and rest 2 seconds. Repeat as often as possible.

(6) HAMSTRING STRETCH: While seated with legs straight and heels resting on a book or rolled up towel, slowly lean over
involved leg touching toes with hands and nose to knee. Hold for 10 - 30 seconds and slowly return to start position. DO NOT
BOUNCE! Repeat as often as possible.

(7) PROGRESSIVE RESISTANCE EXERCISE (PRE): Begin all PRE’s doing 3 sets of 10 repetitions. Upon completion of 3x10 with
little difficulty, progress to 3x15 for the next session, then 3x20. When 3x20 can be completed with little difficulty, add 1 - 2 lbs. of
resistance and return to 3x10. Work back up to 3x20
add another 1 - 2 lbs, and repeat cycle.

(8) STRAIGHT LEG RAISES (SLR) — SUPINE: While lying on back or sitting with hips flexed less than 90 degrees, flex ankle to 90
degrees. Tighten thigh muscles and raise leg upward, keeping knee straight. Lift leg 12” - 18” off of floor and hold 1 second.
Slowly lower leg to floor. Repeat and progress as
detailed under PRE (#7). 21
(9) STRAIGHT LEG RAISES — ABDUCTION: Repeat process used for Supine SLR while lying on uninvolved side and raise
injured leg 10 - 18” off floor. Repeat and progress as detailed under PRE(#7).

(10) STRAIGHT LEG RAISES — ADDUCTION: Repeat process used for Supine SLR while lying on involved side and raise
injured leg 6 - 12” off floor. Repeat and progress as detailed under PRE(#7).

(11) STRAIGHT LEG RAISES — PRONE: Repeat process used for Supine SLR while lying on stomach and raise injured leg 6
-12” off floor. Repeat and progress as detailed under PRE(#7).

(12) PRONE FLEXION: Lay on stomach and flex knee, bringing heel toward buttocks. Hold and slowly lower leg. Repeat and
progress as detailed under PRE (#7).

(13) STANDING FLEXION: Standing, using an object for balance, flex knee, bringing heel up to buttocks. Keep thighs
parallel. Hold and slowly lower leg. Repeat and progress as detailed under PRE (#7).

(14) SEATED EXTENSION: In sitting position, slowly extend lower leg until straight. Hold, contracting thigh muscles as tight
as possible, and slowly lower. Repeat and progress as detailed in PRE (#7).

(15) 90 - 45 DEGREE EXTENSION: In sitting position, slowly extend lower leg to a 45 degree. angle. This can be seen when
the shin is in line with the kneecap. Hold and slowly lower leg. Repeat and progress as detailed under PRE (#7).

(16) SEATED CORD EXTENSION: In sitting position with Sport Cord placed under ball of involved foot, extend knee against
cord pushing down and away, to -5 degree. of full extension. Repeat 3x10, 3x15, 3x20 then progress by increasing cord
density and returning to 3x10.

(17) HIP FLEXION: Sit on edge of firm surface with feet resting on floor. Lift involved knee toward chest, while keeping knee
comfortably bent. Hold and slowly lower. Repeat and progress as detailed in PRE (#7).

(18) TERMINAL KNEE EXTENSION: Place a coffee or paint can under involved knee, allowing knee to bend about 30
degree. Slowly extend lower leg until it is straight and contract thigh muscles as tight as possible for 3 seconds. Slowly lower
heel to floor. Repeat and progress as detailed in PRE (#7)
(19) STANDING TERMINAL KNEE EXTENSION: While standing with Sport Cord placed just above the joint line on back of
involved knee. Slowly straighten knee (without locking knee) against Sport Cord. Repeat and progress as detailed in PRE (#7)

(20) PARTIAL SQUATS: Standing with feet shoulder width apart and toes pointing slight outward, bend knees and slowly
squat down. Maintain upright posture and do not allow thighs to go below parallel to floor. Hold and slowly return to start
position and repeat. Progress by increasing reps to 3x20 then begin one-leg squats.

(21) SPORT CORD SQUATS: Stand with heels on Sport Cord. Squat down and grasp Sport Cord handles stretching cord
snugly. Slowly stand erect pulling on cord. Slowly return to squat position against cord. Repeat as directed and progress as
for Seated Cord Extensions (#16).

(22) ONE LEG SQUATS: Using chair or table for balance assistance, slowly squat down on involved leg as far as possible —
not to exceed 90 degree. of knee flexion. Then slowly raise up to start position and repeat as directed.

(23) SIDE STEP UPS: Stand sideways with involved leg next to 3 - 6” step. Place involved foot on step and slowly lift body
weight with involved leg. Slowly lower body back to start position, gently touching heel on ground, then repeat by slowly
lifting body with involved leg. Repeat as by increasing repetitions for 3 x 10 to 3 x 15 to 3 x 20, increase step height 2 - 3”
begin with 3 x 10 reps, increasing to 3 x 20.

(24) FRONT STEP UPS: Stand directly behind 4 - 6” step or box. Step up on box with involved leg followed by uninvolved leg.
Step back down with involved leg followed by uninvolved leg. Repeat as directed, increasing reps and box height as directed
in Side Step Ups (#22)

(25) BALL SQUEEZE: Seated on edge of chair, place an 8 - 10” rubber ball between knees. Slowly contract inner thigh
muscles, squeezing ball as tightly as possible, hold for 5 - 10 seconds. Relax and repeat as directed.

(26) HEEL RAISES: Stand with feet shoulder width apart and toes pointed forward. Raise up on toes, lifting heels off floor as
high as possible. Hold for one second and slowly lower to start position. Progress by increasing reps, placing balls of feet on 2
- 4” board (elevated), then progressing to one-leg calf/heel raises.

23
27 CHAIR WALK: Sit on a rolling chair or stool. Reach out in front of body as far as possible with involved heel. Slowly pull
body and chair toward heel and repeat with opposite leg. Fully extend leg on each cycle and DO NOT EXCEED 90 DEGREES
OF KNEE FLEXION. Repeat as directed.

28 SLIDE BOARD: Begin at one end of slide board with knees bent and one foot pressed against block. Maintaining a
squatting position, use outside leg to push body sideways across board, sliding to opposite side. Bring both feet together
when opposite block is reached and repeat.

29 STATIONARY BICYCLING: Adjust seat height so that legs are almost straight at the bottom pedal position. Tension
should provide low to moderate resistance. Ride for 10 - 20 minutes. Progress by lowering seat height as tolerable and
increasing resistance and time.

30 SWIMMING/RUNNING/STAIRCLIMBER: These activities may be beneficial to your knee rehabilitation. Please consult
your therapist or doctor to determine if these forms of exercise are recommended for your condition.

31 ICE: Apply ice to the involved area before and after exercise to reduce swelling, pain, and reduce the chances of
aggravating the condition. Ice massage is preferable if there are no open wounds. Massage the affected area with ice cup
until it becomes numb, this may take between 4 to 10 minutes. Ice bags may be used when placed over a wash cloth, and
the treatment time is 15 - 20 minutes.