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Aleve knee pain: Medication That Knocks Out Knee Pain


Medication That Knocks Out Knee Pain

Prescription Medication for Knee Pain

Prescription medication is usually a more potent pain reliever than the over-the-counter variety. These include prescription-strength NSAIDs and COX-2 inhibitors (meant to decrease gastrointestinal side effects like stomach bleeding). These drugs are typically used if your pain level is considered moderate to severe. The only COX-2 inhibitor currently on the market is celecoxib (Celebrex). Rofecoxib (Vioxx) and others were removed from the market because it was discovered that they led to an increased risk of heart complications.

Bargar says that although the data wasn’t completely clear, the consensus was to remove Vioxx and valdecoxib (Bextra), both COX-2 inhibitors, from the market because of associated cardiac issues. Celebrex was not shown to have a significant increased risk of heart problems. “I don’t think [COX-2 inhibitors] work better than standard anti-inflammatories, they just don’t have the gastrointestinal side effects,” he says. “I would prescribe Celebrex for someone who isn’t tolerating conventional NSAIDs because of GI side effects.”

Bargar also advises people with knee pain who are taking large doses of ibuprofen regularly to have blood tests every four months to check for kidney toxicity and anemia.

Injectable Medication for Knee Pain

Injecting medication to reduce knee pain is usually the step between taking oral medication and replacing arthritic knee joints with surgery. Corticosteroids or viscosupplementation with hyaluronic acid can be injected when knee pain becomes severe.

  • Corticosteroids reduce inflammation and offer pain relief and are injected directly into the knee. These injections aren’t permanent solutions, and you may need to return for repeat injections every few months (though not to exceed four injections in the same joint per year).
  • Viscosupplementation is an injection of hyaluronic acid that lubricates your joint to reduce knee pain and increase mobility. A series of three to five weekly injections is necessary to complete the therapy. These injections are helpful if you have early stage arthritis and haven’t responded well to oral medication.

“The whole concept of viscosupplementation was developed by rheumatologists to get some lubrication into the joint, but I found it doesn’t work very well,” Bargar says. “It’s also expensive, but a lot of people will try it before surgery.”

If you have modest knee pain caused by a simple strain, try an over-the-counter medication. If your knee pain or injury is severe, visit your physician for a prescription medication that may improve your particular condition.

What Really Solves Knee Pain? The Answer Might Surprise You

The pill most often prescribed for knee pain – acetaminophen – may not help at all, researchers reported Monday.

The new study of what works for arthritis pain in the knee came up with some surprising results. The most common treatments often may not help much, and even a placebo injection of salt water provides more pain relief than any pill.

The findings go against what many doctors have long believed, although they didn’t surprise veteran knee surgeons, who know pain relief varies greatly from one patient to another.

“All treatments except acetaminophen showed clinically significant improvement from baseline pain.”

Dr. Raveendhara Bannuru and colleagues at Tufts Medical Center near Boston looked at thousands of studies on various treatments for knee pain, from acetaminophen – the active ingredient in Tylenol – to ibuprofen to steroid injections.

Finding the scientific truths is tricky. There’s not much incentive for drug companies to test generic, over-the-counter drugs such as naproxen, and there’s also not much reason to test an injection of a steroid against a generic treatment such as hyaluronic acid, a kind of joint lubricant.

But the team came up with 137 studies covering 33,000 people that met some high standards – they’d been blinded, meaning the doctors didn’t know which treatment a patient actually got as they evaluated pain, stiffness and range of motion.

And most compared treatment to placebo – a dummy pill or dummy injection.

The results surprised them. “All treatments except acetaminophen showed clinically significant improvement from baseline pain,” they wrote in their report, published in the Annals of Internal Medicine.

“Contrary to popular belief, our results showed that celecoxib (a prescription drug sold under the brand name Celebrex) was not superior to acetaminophen.”

And a dummy injection of salt water worked better than any pill, although not better than injecting a steroid or lubricant.

It might be due to a super placebo effect, or it could be that injecting any fluid into the knee, called viscosupplementation, provides at least temporary relief, Bannuru and colleagues said.

Either way, it’s a big issue for many people, and one that involves a whole lot of money, said Dr. Lisa Mandl of Weill Cornell Medical School in New York and Elena Losina of Brigham and Women’s Hospital in Boston.

“The global viscosupplementation market is estimated to be $2. 5 billion by 2017, and the market for glucosamine is estimated to be $12 billion by 2020,” they wrote in an editorial.

“Almost 40 percent of the U.S. population older than 45 years has some degree of knee osteoarthritis and the estimated lifetime risk for knee (arthritis) is 14 percent,” they added.

The Tufts team did not look at alternative treatments such as glucosamine and chondroitin sulfate supplements. Both the American Board of Internal Medicine and the American Academy of Orthopedic Surgeons say they don’t work.

“Regardless, patients continue to demand these therapies,” Mandl and Losina noted.

“When we inject something into the knee, patients are going to improve for at least four weeks.”

This study may explain why. It is clearly difficult to tell which treatments work best for knee pain and relief may be highly subjective.

Dr. David Jevsevar, an orthopedic surgeon at Dartmouth Medical School and a chair of the Evidence-Based Quality and Value Committee of the American Academy of Orthopaedic Surgeons (AAOS), says it’s hard to judge knee arthritis pain because it comes and goes.

“Patients with knee osteoarthritis typically don’t have pain every day,” Jevsevar, who was not involved in the research, told NBC News.

“They have good days and bad days. If you do nothing, 60 percent of patients are going to get better because of the ebb and flow of osteoarthritis. When we inject something into the knee, patients are going to improve for at least four weeks.”

One finding that Jevsevar disagrees with was the Tufts team’s assertion that hyaluronic acid provides pain relief. The AAOS specifically recommends against it.

“It’s expensive,” Jevsevar said. “It can cost $700 to $1,000 an injection. That is a lot of money for something that doesn’t give you long-term benefit.” Jevsevar believes the Tufts analysis was flawed because it set too low a bar for measuring pain relief.

Instead, Jevsevar says his organization recommends taking things slowly and going with the cheapest and least invasive treatment first. That may mean weight loss – it really does work – and ice. Exercise can help, too, if it’s the right kind that doesn’t strain the knee. Swimming and cycling fit that bill. Physical therapy may also help.

Next come over-the-counter treatments, including acetaminophen for many people, because it is non-toxic in recommended doses and doesn’t cause stomach bleeding like other drugs, such as aspirin and ibuprofen, can. Steroid injections come next, but not unless pain pills don’t do the trick.

“We believe that pharmacologic intervention is important for patients that can tolerate it,” Jevsevar said. “We believe that surgery is a last resort.”

At least one study has found that surgery is no better than medication and physical therapy for relieving the pain and stiffness of moderate or severe arthritis.

Hyperextended knee: Cause of serious injury?

A hyperextended knee occurs when the knee is bent backward, often as a result of landing wrong after a jump. A hyperextended knee can damage ligaments, cartilage and other stabilizing structures in the knee.

Young children have softer bones because they’re still growing, so a hyperextended knee can result in a chip of bone being pulled away from the main bone when the ligaments stretch too far. In older children and adults, forceful hyperextension may tear one of the knee ligaments, particularly the anterior cruciate ligament (ACL).

If the knee injury is severe enough to cause swelling, pain or instability, see a doctor immediately. Even if the injury doesn’t need surgical repair, physical therapy may be needed to help restore leg strength and stability.

  • Glucosamine: Does it protect cartilage in osteoarthritis?

July 14, 2020

Show references

  1. Mencio GA, et al. Skeletal trauma in young athletes. In: Skeletal Trauma in Children. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed April 24, 2015.
  2. DeLee JC, et al. Knee injuries in skeletally immature athletes. In: DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed April 24, 2015.
  3. Marx JA, et al. Knee and lower leg. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Mosby Elsevier; 2014. http://www.clinicalkey.com. Accessed April 24, 2015.
  4. Brooks GP, et al. Treatment of knee injuries in the young athlete. http://www.uptodate.com/home. Accessed April 24, 2015.

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Knee Pain Treatment: Medications

Knee pain can be caused by overuse, injury, or damage to the knee joint, cartilage, or surrounding muscles as a result of an underlying condition like arthritis. It can significantly impact a person’s ability to perform everyday tasks like walking, going up and down stairs, and sitting and standing for prolonged periods of time.

Several different types of medications, both over-the-counter and prescription drugs, can be used to manage knee pain. They can be administered orally by taking a pill, topically by applying the medication to the skin, or intra-articularly by being injected directly into the knee joint.



Over-the-Counter Medications

Over-the-counter pain-relieving medications such as acetaminophen (Tylenol) and ibuprofen (Advil), or anti-inflammatory medication like naproxen sodium (Aleve), can help reduce knee pain, swelling, and inflammation in the knee joint.

Prescription Medications

If symptoms are severe enough, your doctor may prescribe a higher dosage of a nonsteroidal anti-inflammatory drug (NSAID) to help decrease your knee pain so you can sit, stand, and walk with less discomfort. 

Topical Treatments

Over-The-Counter Medicine

Over-the-counter creams and ointments, especially those that contain capsaicin, an extract derived from chili peppers, can be applied topically to the knee to help relieve pain by decreasing the intensity of pain signals sent along nerve pathways.

Prescription Creams

Prescription creams, in either gel or liquid form, that contain diclofenac can be applied topically to the knee to provide pain relief. There are varying formulations that contain either 1%, 1.5%, or 2% diclofenac depending on the strength of medication needed, which will be determined by your prescribing physician.

Topical treatment can help provide pain relief for people who cannot or do not want to take oral pain medications. Topical treatments are especially helpful for people who take other medications since oral pain relievers can interact with other drugs. Oral pain relievers can also cause stomach ulcers and bleeding, making topical pain-relieving medications more suitable for people with gastrointestinal issues.

Pain Patches

Lidocaine patches may be prescribed by your doctor to help alleviate your knee pain. Lidocaine is a local anesthetic that helps to relieve pain by blocking nerves from transmitting pain signals. The medication is delivered transdermally through the skin, which absorbs the medication on the adhesive side of the patch.

A lidocaine patch can be applied directly to the skin once a day for up to 12 hours. You can apply the patch over the area where you are having the most pain, but should avoid placing it directly on top of the knee joint. The patch should not be applied if there are any cuts or breaks in the skin. 

Prescription Pain Medications


Corticosteroids such as cortisone and prednisone may be prescribed to reduce pain, swelling, and inflammation in the body to lessen knee pain. Corticosteroids should be used with caution since prolonged corticosteroid usage can cause weakening of the muscles, tendons, and ligaments surrounding the knee, and increases the risk of developing certain conditions like osteoporosis and Cushing’s syndrome. 

Opioid Pain Relievers

Opioid medications like oxycodone, hydrocodone, morphine, and tramadol may be prescribed by your doctor to help relieve knee pain if over-the-counter or prescription NSAIDs are not effective.



Corticosteroids, or cortisone injections, are anti-inflammatory medications that can be injected into the knee joint directly to reduce pain, swelling, and inflammation. They are the most commonly used type of knee injections for treating knee pain from osteoarthritis.

According to the American College of Rheumatology and Arthritis Foundation guidelines for managing knee osteoarthritis, corticosteroid injections are recommended over any other type of injection due to improved outcomes and effectiveness in alleviating symptoms.

Corticosteroid injections are performed under local anesthesia, where you will be awake for the procedure but your knee will be numbed. A small amount of anesthesia will be injected into your knee before the corticosteroid, which usually begins to work two to three days later.

Corticosteroid injections can help relieve pain and reduce symptoms between six weeks and six months after the procedure, although the injections are not effective for everyone. You will typically not be allowed to receive more than two or three injections per year.

Corticosteroid injections may not be recommended for patients who have diabetes or other problems with blood sugar since corticosteroids can raise blood sugar levels.

Hyaluronic Acid

Viscosupplementation, sometimes called gel injections, involves injecting hyaluronic acid into the knee to decrease pain and improve joint movement. Hyaluronic acid used for injections is derived from the combs of chickens.

Hyaluronic acid is a gel-like substance that occurs naturally in the synovial fluid within each joint capsule that surrounds all joints. Hyaluronic acid serves as a lubricant that allows bones to move smoothly within a joint and provides shock absorption to decrease pressure and friction within joints. Over time, hyaluronic acid levels in the joints decrease, especially as the joints wear down with osteoarthritis.

You may receive between one and five injections if you choose to undergo this treatment. If there is excess swelling and fluid buildup in the knee joint, your doctor will use a needle to aspirate, or remove, the fluid before injecting the hyaluronic acid. You should avoid prolonged standing, walking, jogging, running, or heavy lifting for the first 48 hours after receiving a hyaluronic acid injection.

It may take up to four weeks to notice any significant improvement, and the lasting effects can vary from two to six months. Hyaluronic acid injections may be repeated about once every six months.

There is no evidence, however, that suggests that hyaluronic acid injections provide significant relief for knee pain, and they are not recommended for managing knee osteoarthritis under the American College of Rheumatology and Arthritis Foundation guidelines.

Hyaluronic acid may be recommended for patients with diabetes who have knee osteoarthritis because hyaluronic acid injections do not raise blood sugar level the way corticosteroids can. 

Local Anesthetics

A local anesthetic, most commonly lidocaine, can be injected into the knee. Lidocaine has numbing and anti-inflammatory effects that can reduce the intensity of pain signals. Recent research suggests that effects can last for three months or more.

Lidocaine is also often injected into the knee before a corticosteroid injection in order to numb the area and make the injection less uncomfortable. The lidocaine may produce immediate, short-term pain relief in the knee, but often wears off a few hours after the injection since less lidocaine is used to prepare for a corticosteroid injection than the amount used for a standalone lidocaine injection.


Botulinum toxin, commonly known as Botox, is a naturally occurring toxin produced by bacteria that are commonly used to relax forehead wrinkles and decrease muscle spasticity in neurologic conditions by paralyzing nerves.

Preliminary research suggests that Botox injections can be used to treat knee osteoarthritis by paralyzing the nerves that send chronic pain signals to the brain. It may take up to four weeks for the full effect to set in, and pain relief may last up to six months.

Platelet-Rich Plasma 

Platelet-rich plasma injections are made up of your own blood plasma that contains a high concentration of platelets, also called thrombocytes, which are small blood cells that are involved in blood clotting. Platelets release substances called growth factors that stimulate healing after an injury. When injected into the knee, platelet-rich plasma has the potential to help damaged cartilage heal, but this has not yet been proven.

Your doctor will use a syringe to draw a small amount of blood from a vein in your arm and use a centrifuge to separate the plasma and platelets. Blood centrifugation takes about 15 minutes to separate the blood components. Your doctor will then inject the platelet-containing plasma directly into your knee joint. Ultrasound may be used to help guide accuracy of the injection.


Disease-modifying antirheumatic drugs (DMARDs) are specifically prescribed for rheumatoid arthritis and other rheumatic and autoimmune conditions. DMARDs decrease inflammation throughout the body by altering the immune system response.

Because DMARDs decrease your immune system response, you may be at an increased risk of infection while taking these medications. Make sure to talk with your doctor about the risks and benefits of taking DMARD medication.

Is there a “best” pain reliever for osteoarthritis?

ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. 

Osteoarthritis (OA) affects tens of millions of Americans and is a leading cause of disability and reduced quality of life across the globe. Other than joint replacement surgery, there is no known “cure” for OA, and most treatments focus on relief of symptoms such as pain. Often, the first step is non-medication-based approaches such as physical therapy, exercise, and weight loss. Most patients, however, will eventually use pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs). Other kinds of medication, such as opioids, have also been tested as treatments for OA, and there is ongoing debate about what treatments are best.

NSAIDs vs. opioids: Was there a clear winner?

A recent study compared oral NSAIDs and oral opioids for relief of osteoarthritis pain. Researchers at Harvard-affiliated Brigham and Women’s Hospital performed a meta-analysis (that is, they combined and summarized the results of numerous published studies). They included clinical trials in which patients with knee osteoarthritis (KOA) were chosen at random to receive treatment that lasted at least 2 months.

The researchers carefully chose which studies to include, and two members of the team independently reviewed each study and extracted the data. They selected studies that used a common, well-validated, and widely-accepted measure of pain (the WOMAC scale, which rates pain on a scale from 0 to 100). Data from over 5,500 patients were included, and the researchers found that, on average, oral NSAID treatment reduced pain by around 18 points on the WOMAC scale. Treatment with less potent oral opioids (such as tramadol) also reduced pain by around 18 points, and potent oral opioids (such as oxycodone) reduced pain by around 19 points on the WOMAC scale. Since, on average, patients started out with pain ratings of around 50-60 out of 100, each of these medications achieved around a 30% reduction in patients’ pain.

In short, each of these medications helped reduce pain, and their effects were about identical. The finding of a roughly 30% reduction in pain is very consistent with studies of many treatments for chronic pain. While we are fairly good at acute pain management, many chronic pain conditions such as OA, low back pain, and others are harder to treat effectively. Many researchers in the field believe that a multidisciplinary team (which includes health care providers with different backgrounds) working together to use a number of different approaches to manage pain offers the most effective way of managing chronic pain. And there is good evidence for the effectiveness of these kinds of treatments. For example, a patient with severe KOA might: be treated with NSAIDs prescribed by her primary care physician; see a physical therapist to work on strengthening and conditioning the leg muscles; receive occasional steroid shots in the knee to alleviate inflammation and pain in the joint; and see a nutritionist to help with diet and weight loss, which relieves pressure on the joint and can significantly reduce knee pain.

Working toward a personalized approach to pain management

This meta-analysis cannot tell us which of these types of medication (if any) should be prescribed for a particular patient. No study can. The person-to-person variation in the effectiveness of any KOA treatment is huge. One patient may get near-total pain relief while another is not helped at all. These findings do give clinicians a benchmark for the “typical” amount of pain relief that might be expected from these medications, and suggest that, since they work about equally well, the choice of which one to use will be influenced by considerations other than effectiveness. Providers and those suffering with chronic pain also need to weigh potential side effects. Treatment (especially long-term treatment) with oral NSAIDs can result in stomach problems like bleeding, ulcer, and stomach upset, as well as high blood pressure and kidney problems. Opioids can have side effects such as constipation, nausea, and drowsiness. As you are also likely aware, opioids are also associated with a risk of serious overdose and addiction.

Many of us in the field of pain management are hopeful that eventually we will be able to more effectively “personalize” pain treatment on the basis of an individual’s characteristics, and his or her likely responses to a particular treatment. It is worth noting that non-medication treatments such as exercise, weight loss, and improvements in diet generally have few or no side effects, and have benefits that extend beyond relief of knee pain (for example, improvements in heart health). For most people, these treatments should be included as a part of their multidisciplinary pain management program, regardless of the medication options being considered.

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Please note the date of last review or update on all articles. No content on this site, regardless of date,
should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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What Is the Best Treatment for Knee Osteoarthritis?

July 21, 2018

There is good news if you are living with the constant pain of knee osteoarthritis. A new research study shows that an inexpensive, over-the-counter medication is best for relieving the pain of knee osteoarthritis.

A new study in the Journal of American Academy of Orthopaedic Surgeons published in May 2018 examined a variety of pain treatments for knee osteoarthritis (KOA). It found that the over-the-counter medicine, naproxen, sold as Aleve, Naprosyn, and other brands was the best treatment for pain and a good choice for improving function. [1]

KOA Is Often Constant

Individuals with KOA already know how extremely painful this condition can be and how it limits your ability to get through daily activities. There is currently no cure, but there are lots of ways to treat the pain, including over-the-counter and prescription drugs, injections, and in some cases, total knee replacement surgery.

Study Compared Oral and Injection Treatments for KOA

In their study, the researchers analyzed data from 56 previously conducted studies that compared two or more treatments, including oral medications and intra-articular injections such as hyaluronic acid, corticosteroids, and platelet-rich plasma.

  • The oral medications included:
  • Acetaminophen (Tylenol)
  • Diclofenac (Cambria, Voltaren, and others)
  • Ibuprofen (Advil, Midol, and others)
  • Naproxen (Aleve, Naprosyn, Motrin, and others)
  • Celecoxib (Celebrex)
  • Combination drugs (Advil PM, Aleve PM, Combunox, Vicoprofen, and others)
  • A placebo drug

Naproxen Determined Best Treatment for KOA Pain and Function

After combining all the data from the studies and analyzing the results, the researchers concluded that naproxen ranked first for improving both pain and function, followed by corticosteroid injection, plasma injection, celecoxib, and ibuprofen.

When researchers looked at pain and function separately, they found that naproxen was best for improving function followed by diclofenac, celecoxib, ibuprofen, and plasma injection. For pain alone, corticosteroid injection was ranked first followed by ibuprofen, plasma, naproxen, and celecoxib.

During this comparison study, the analysis also found the hyaluronic acid injection was no better than placebo for pain and function. Acetaminophen also did not score well for either pain relief or improved function.

In an interview, lead author David Jevsevar, MD, department chair of orthopedics at Dartmouth-Hitchcock Medical Center, New Hampshire, spoke about how the Arthritis Foundation can help patients use the information from the study.

“There are multiple treatments out there for management of knee OA,” Dr. Jevsevar said. “Some work better than others. Some work well for pain, and some work well for function. Our study showed that naproxen works best for both pain and function, and it is one of the least expensive, non-steroidal anti-inflammatory drugs.” [2]

Side Effects and Diet and Exercise Not Considered

While the study did not consider side effects of drugs like naproxen, including the well-known effects on the heart, vascular, and intestinal systems, Dr. Jevsevar noted that naproxen has the lowest risk of cardiac events compared to similar drugs.

The study also did not include weight loss and exercise, which a 2005 study in Arthritis & Rheumatism found to be two of the most effective ways to manage KOA. [3]

The good news is that for many people with KOA, taking naproxen to ease the pain enough to allow you to participate in an exercise and weight loss program could be the best way to achieve long-term relief from your knee osteoarthritis.

It should be noted that Dr. Jevsevar receives research support from DePuy Synthes, a maker of joint reconstruction products, a subsidiary of Johnson & Johnson, the makers of naproxen.

At Healthcare Associates of Texas, we specialize in finding the optimal treatment for you. Our osteoarthritis specialists will help you manage your pain and find the best long-term therapy for your KOA.  Call our Appointment Line at (972) 258-7499 or contact us by email.

[1] Journal of American Academy of Orthopaedic Surgeons, May 1, 2018 – Volume 26 – Issue 9

[2] Osteoarthritis blog of the Arthritis Foundation, <http://blog.arthritis.org/osteoarthritis/treatments-ranked-knee-oa>

[3] Arthritis & Rheumatology, Volume 52, Issue7, July 2005, pages 2026-2032

Home Treatments to Decrease Knee Osteoarthritis Symptoms

Many home or over-the-counter remedies can effectively treat knee arthritis pain, making day-to-day living easier and more comfortable. Some home therapies are one-time treatments that provide fast, short-term relief. Other remedies involve changing daily habits.

Home treatments for arthritis pain relief include:

A Warm or Cold Compress

Heat or cold treatment may provide immediate, short-term pain relief from knee arthritis.

Heat therapy may reduce pain and improve circulation in and around the knee joint. Applying a warm compress to the knee can also relieve muscle and joint stiffness and help warm up the knee before activity.

See When and Why to Apply Heat to an Arthritic Joint

Heating can be achieved by using hot water bottles, heated packs/ wraps, hot towels, and electric heating pads.


Cold therapy reduces inflammation, pain, and swelling. It also decreases nerve conduction, potentially slowing down pain signals to the brain. A cold compress may be applied to an arthritic joint periodically and/or after physical activity.

See When and Why to Apply Cold to an Arthritic Joint

A cold wrap, gel pack, a bag of ice, or a bag of frozen vegetables (such as peas) may be used as a cold compress.

Important precautions: To avoid skin and/or nerve damage, do not to use cold and/or heat therapy for longer than 15 to 20 minutes at a time. In addition, compresses should not be used in combination with topical medications, as there is a risk of injuring the skin and/or altering the medications effectiveness. Special caution should be exercised in the setting of diabetes or other conditions that may cause decreased skin sensitivity.

See Applying Heat vs. Cold to an Arthritic Joint

Resting the Knee

A painful arthritic knee can ‘flare up’ following an increase in physical activity or intensive exercise. Sometimes such a flare is best treated with a brief period of rest, for a couple of hours or even a day. (In general, it is advised to consult with a doctor if undiagnosed knee pain is severe or lasts for more than a couple of weeks.)

In This Article:

Electrical Stimulation Therapy

Research suggests1,2,3 that electrical stimulation devices, sometimes called e-stimulation or e-stim devices, can reduce knee arthritis pain using electrical pulses. These devices are sometimes used by physical therapists and are available to buy online and in stores without a doctor’s prescription.

The strength of electrical pulses can usually be adjusted, ranging from mild to strong. For most people e-stim treatment is painless, but for some people it is uncomfortable.

Most e-stim devices fall into one of two categories: Transcutaneous electrical nerve stimulation (TENS) or Pulsed electromagnetic field therapy (PEMF).2 E-stim does not work for everyone. It is typically used in combination with other knee arthritis treatments, such as an anti-inflammatory diet.

See An Anti-Inflammatory Diet for Arthritis

Over-the-Counter Pain Medications

Oral pain relievers, such as ibuprofen (Advil) and naproxen (Aleve) may temporarily relieve knee arthritis pain. These medications carry side effects and are not recommended for long-term daily use. In particular, NSAIDs can cause stomach upset, and regular use can lead to a bleeding ulcer, which can be potentially life-threatening. Acetaminophen may also be used to relieve arthritis pain and may have fewer side effects when used appropriately (health professionals typically recommend less than 3,000 mg per day). People older than age 72 are advised to consult with their health care providers, as a lower dose of medication may be appropriate.

See Pain Medications for Arthritis Pain Relief

Topical pain relievers. Topical creams, gels, and patches can be applied directly onto the skin over the knee. They can provide fast, localized pain relief and are less likely to carry serious risks and cause side effects.

See Topical Pain Relief for Arthritis

Doctor and patient should discuss medication in the context of the patient’s lifestyle, existing medications, severity of pain, and medical history.



Some people find taking a daily supplement reduces chronic knee arthritis pain. The onset of pain reduction may take weeks to months. The pain reduction is usually not dramatic, but it may be helpful, especially when combined with exercise and an anti-inflammatory diet.

The most commonly used supplements to treat knee arthritis include:

  • Chondroitin sulfate is found in cartilage. It helps cartilage retain water, keeping joints healthy. Limited research suggests that, on average, chondroitin supplements reduced pain by 8 points on a 100-point scale.4
  • Glucosamine, like chondroitin sulfate, is a natural component of cartilage. While popular, researchers have been unable to conclude whether or not glucosamine helps reduce knee arthritis symptoms.5,6 Some evidence suggests it may improve knee function when combined with chondroitin. These supplements should be avoided by anyone allergic to shellfish.

    See Glucosamine and Chondroitin Sulfate Supplements for Osteoarthritis

  • Turmeric and/or curcumin. Found in the spice turmeric, curcumin has antioxidant properties that can potentially decrease inflammation and inhibit arthritis pain.7,8,9

    See Turmeric and Curcumin for Arthritis

Supplements tend to be controversial in the medical field. They are not subject to approval by the FDA and do not fall under the same rigorous and strict standards that traditional medications do. Patients may ask their healthcare providers and pharmacists for suggestions on which brands they believe have the highest quality products.

See Dietary Supplements for Treating Arthritis

Coping Techniques

Relaxation techniques, such as meditation, visual imagery, biofeedback, or hypnosis can be used to lessen knee pain. While these techniques may provide short-term pain relief, they are typically most effective when practiced regularly.


  • 1.Newberry SJ, FitzGerald J, SooHoo NF, et al. Treatment of Osteoarthritis of the Knee: An Update Review. Comparative Effectiveness Review No. 190. AHRQ Publication No.17-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm. DOI: https://doi.org/10.23970/AHRQEPCCER190.
  • 2.Bagnato GL, Miceli G, Marino N, Sciortino D, Bagnato GF. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial. Rheumatology (Oxford). 2016;55(4):755–762. doi:10.1093/rheumatology/kev426
  • 3.Cherian JJ, Harrison PE, Benjamin SA, Bhave A, Harwin SF, Mont MA. Do the Effects of Transcutaneous Electrical Nerve Stimulation on Knee Osteoarthritis Pain and Function Last?. J Knee Surg. 2016 Aug;29(6):497-501. doi: 10.1055/s-0035-1566735. Epub 2015 Nov 5. PubMed PMID: 26540652.
  • 4.Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane Database Syst Rev. 2015;1:CD005614. Published 2015 Jan 28. doi:10.1002/14651858.CD005614.pub2
  • 5.Harrison-Muñoz S, Rojas-Briones V, Irarrázaval S. Is glucosamine effective for osteoarthritis?. Medwave. 2017 Mar 15;17(Suppl1):e6867. doi: 10.5867/medwave.2017.6867. Review. PubMed PMID: 28306711.
  • 6.Runhaar J, Rozendaal RM, van Middelkoop M, Bijlsma HJW, Doherty M, Dziedzic KS, Lohmander LS, McAlindon T, Zhang W, Bierma Zeinstra S. Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis.2017 Nov;76(11):1862-1869. doi: 10.1136/annrheumdis-2017-211149. Epub 2017 Jul 28. Review. PubMed PMID: 28754801.
  • 7.Funk JL, Oyarzo JN, Frye JB, Chen G, Lantz RC, Jolad SD, Sólyom AM, Timmermann BN. Turmeric extracts containing curcuminoids prevent experimental rheumatoid arthritis. J Nat Prod. 2006 Mar;69(3):351-5. PubMed PMID: 16562833; PubMed Central PMCID: PMC2533857.
  • 8.Nakagawa Y, Mukai S, Yamada S, Matsuoka M, Tarumi E, Hashimoto T, Tamura C, Imaizumi A, Nishihira J, Nakamura T. Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. J Orthop Sci. 2014 Nov;19(6):933-9. doi: 10.1007/s00776-014-0633-0. Epub 2014 Oct 13. PubMed PMID: 25308211; PubMed Central PMCID: PMC4244558.
  • 9.Huang G, Xu Z, Huang Y, et al. Curcumin protects against collagen-induced arthritis via suppression of BAFF production. J. Clin. Immunol., 33 (3) (2013), pp. 550–557

90,000 Knee pain: causes, treatment, why knees hurt, what to do, which doctor to go to

Movement is life. But on straight legs you will not go far. One in three people on the planet face pain in the knee, regardless of age. Medical statistics are disappointing:

  • the number of causes of knee discomfort exceeds 200;
  • 80% of people over 50 have problems with the musculoskeletal system;
  • The percentage of patients with arthritis in Russia is increasing by 1% per year.

The knee is a complex mechanism. Thanks to him, a person makes dozens of different movements. We walk, we run, we go downstairs, we go to the gym. At the same time, the knees are under stress. With age, the cartilaginous surface of the joint wears out, inflammation and pain occurs. If you gain extra pounds, move a little, do not drink enough clean water, overcool, then accelerate the natural process of wear and tear. Injuries with increased physical exertion and chronic pathologies of the musculoskeletal system are additional risk factors.

Knee pain is very uncomfortable. It is difficult to walk, painful to bend the leg. Joints crunch and swell, discomfort does not allow sleep, anesthetics do not help. These symptoms poison life, make a person suffer, and interfere with normal movement and sports.

If you suffer from knee pains that you are tired of putting up with, contact the Innovative Medical Center – our doctors will restore the mobility of the knee joint and help you return to your usual physical activity, to movement without pain!

Why contact the Medical Innovation Center?

The principle of the Center’s work is an integrated approach to diagnosis and treatment, which is as follows:

The decision on treatment is made not by one highly specialized doctor, but by a team: traumatologist, neurologist, surgeon, osteopath, chiropractor.They develop a comprehensive patient recovery program and jointly monitor the patient’s recovery dynamics.

A unique method of treatment combines kinesitherapy with physiotherapy, osteopathy, manual and shock wave therapy, acupuncture. How does this technique work?

Our doctors find the cause, block pain and remove edema. For this, the clinic uses: the blockade method, the introduction of hyaluronic acids and platelet-rich plasma into the shoulder joint, as well as the unique apparatus Khivamat-200.It acts on the source of inflammation by an electrostatic field, improves lymph flow, stimulates tissue nutrition, and has an anti-inflammatory effect.

One of the stages of knee joint recovery is training in the Center’s hall, with an area of ​​250 m2, which is equipped with modern decompression machines. All classes are supervised by a physician-kinesitherapist and experienced instructors.

The result of this approach to treatment is a positive effect after the first procedures, quick recovery and return to life without surgery.

Employees of the Center

The main advantage of the clinic is a team of highly qualified specialists:

Bogdanov Vadim Yurievich Chief physician, traumatologist-orthopedist
Experience 15 years

More details Ronami Valery Guseinovich Neurologist Professor, Doctor of Medicine
Experience 35 years

More details

Patient reviews confirm the quality of the work of the Center’s team – read and watch reviews.

Our treatments for knee pain

What diseases do we treat?

Pain in the knee joint can cause the following diseases:

  • Arthritis
  • Gonarthrosis
  • Bursitis
  • Periarthritis of the tendons of the knee
  • Pathologies in which pain penetrates into the knee area, and the source is in another part of the body: coxarthrosis of the hip joint, sciatic nerve neuropathy, fibromyalgia
  • Post-traumatic recovery

You should not engage in self-diagnosis by comparing symptoms on the Internet with those you have.This approach will complicate the treatment process and lengthen the recovery time for your joints. In our Medical Center, you can immediately start treatment correctly using the most modern techniques.

How is the treatment process going?

1. At the initial appointment, on the basis of examination, questions to you, medical history, as well as data from existing examinations (ultrasound, MRI, X-ray), the doctor makes a diagnosis, and, if necessary, prescribes additional examinations. They can be done the same day in our center on a modern ultrasound machine, which allows you to diagnose various knee pathologies (meniscus injuries, ligament ruptures, etc.)).

2. Having established the exact cause of knee pain, the doctors of our Center jointly develop an individual recovery program depending on your diagnosis.

3. The first stage focuses on techniques aimed at relieving pain and reducing inflammation. According to reviews, most of our patients feel that the pain is receding after the first procedures.

4. Then efforts are concentrated on restoring the mobility of the knee joint. At this stage, our Center uses: kinesitherapy – treatment with movement on decompression simulators, as well as methods of physiotherapy, osteopathy, manual and shock wave therapy.

5. The course of treatment is analyzed at the daily morning meeting with the Chief Physician: the attending physician outlines the current situation for each patient and, together with colleagues, analyzes the dynamics of recovery. If necessary, the treatment program is adjusted.

6. At the end of the course of treatment, the patient must be given personal recommendations and a set of exercises that he can perform at home or in our gym under the supervision of a doctor and instructors.

Every day patients come to the clinic for rehabilitation treatment after injuries, with chronic diseases of the knee joints, professional athletes, to whom we have returned the joy of movement without pain.

Come to the Innovative Medical Center. We will help you!

Pain in hips and knees

Move with ease, relieving hip and knee pain

Answers to your questions about hip and knee pain

Hip pain and knee pain can seriously affect your life, especially if you are dealing with both.

Do you feel pain in your knees or even a feeling that they might suddenly bend under you? Is it difficult to get up in the morning, move around during the day, and lie back down at night due to acute pain in the hip?

Whether you’re experiencing hip or knee pain, physical therapy can help you find the root of your problem safely and comfortably, without the use of harmful drugs or surgery.

Make an appointment with Sobe Innovative Rehabilitation to completely relieve hip and knee pain without the need for potentially dangerous medications or surgery.

How can physiotherapy help me cope with hip / knee pain?

Physiotherapy treatments at Sobe Innovative Rehabilitation can help significantly reduce hip and knee pain. Our physiotherapists in Hallandale Beach will examine your hip and / or knee for signs of displacement or structural damage, and examine your stance, posture, gait, and range of motion.

In many cases, our physiotherapist can completely relieve your pain, eliminating the need for potentially harmful medications or surgery.

After completing your physical examination, our physiotherapist will assign you a physical therapy plan to relieve unnatural stress and tension. They will also focus on normalizing your joint function so you can return to a comfortable life.

You will be offered targeted exercises designed to relieve joint pain and stabilize a weak hip and / or knee. Exercise may vary depending on your condition; For example, studies have shown that people with patella pain (kneecap pain) tend to respond better to exercises that strengthen both the hips and knees, rather than just the knees.

You may also be offered exercises designed to strengthen your core, including muscle groups in the lower back, muscle groups in the lower abdomen, or pelvic muscles. The main exercises are aimed at straightening posture and equalizing the weight load on both sides of the body.

At the discretion of our physiotherapists, additional specialized treatments may be added, such as mobilization to improve joint mobility or other soft tissue treatments to relieve pain and promote healing of injured thighs and / or knees.

What Should I Know About Hip and Knee Pain?

Often the hips and knees suffer from the same diseases, disorders and injuries. For example, overuse injuries such as tendonitis and chronic muscle sprains are common in both the hips and knees as both joints are constantly used. They are also both prone to acute injuries such as sprains, strains, and dislocations.

Pain in the hip and knee can also be caused by reflected pain from pinching of the sciatic nerve as the nerve travels through both areas.An imbalance in stance or gait can cause abnormal stresses and premature wear on the hips and knees, resulting in painful arthritis symptoms .

Some painful conditions may be specific to one or the other joint. Damage to cartilage, known as labial ruptures , is characteristic of hip pain, while inflammation of the bursae , known as bursitis , is a specific disease affecting the knee joint.

However, painful injuries that cause hip instability can also affect the knees. Narrow hip flexors and weak gluteus medius muscles can cause the hip to rotate inward, which you might not even know. This can cause painful problems such as iliotibial friction syndrome brace or patellofemoral stress syndrome because the load is placed on the knee or patella.

So what is causing my hip / knee pain?

Hip and knee pain can be experienced together or separately, but it is important to note that, as the old adage goes, your knee bone is connected to the thigh bone, so what happens to one affects the other.

The hip is a ball-and-socket joint that supports the weight of the upper body by drawing on several muscles and tissues to maintain mobility and stability so that it can move correctly.

Your knee is a hinge joint limited to forward and backward motion. Individually, your knees can support more weight than your hips, which is 6 times your body weight when doing squats. Correct movement of your hips and knees allows you to perform complex movements, giving you the ability to stand, walk, run and dance without falling.

Pain felt in the hips and / or knees can occur in the joints themselves, but can also be the result of an underlying condition elsewhere in the body.

For example, your hips and knees are part of the same kinetic chain, meaning they are a combination of weight-bearing joints that must function together in harmony for your body and posture to function properly.

Thus, a knee problem can transmit abnormal forces to the hips and vice versa. If one part of the kinetic chain is out of balance, stress and deterioration can be transferred to another.

Get Rid of Hip and Knee Pain Today

Make an appointment with Sobe Innovative Rehabilitation today to meet with one of our dedicated Hallandale Beach physiotherapists.

It’s time to confront your hip and knee pain – start your journey to lasting pain relief today! Your hips and knees will be glad to see you!

90,000 Everything You Need To Know About Internal Knee Pain

Any pain in different parts of the body interferes with your daily activities. Internal knee pain is a common problem that affects approximately 19% of the population. The knee is one of the most difficult and important joints in your body, so it is normal to be prone to injury.When it comes to internal knee pain or medial knee pain, it means pain in the inner area of ​​the knee closest to your opposite knee. Many reasons can provoke this problem at any age, regardless of gender. This pain is accompanied by various symptoms that distinguish it from other knee pains. Do you want to know what these symptoms are and what causes them? All this and even ways to prevent and treat medial knee pain can be found in this article.

What Does Internal Knee Pain Mean?

It may be important for you to know which parts of the knee are most prone to medial knee pain.Therefore, to make this clear, you first need to know where the medial side of the knee is. The medial sides of your knee point to the right side of your left knee, and the left side of your right knee points to the middle of your body. Thus, you will feel pain in these areas, which usually affects your daily activities. To better understand, it is best to have an overview of the anatomy of the inner parts of the knee.

  • The quadriceps tendon connects the quadriceps to the patella
  • Medial collateral ligament (MCL)
  • The medial meniscus is a thick, elastic, crescent-shaped cartilaginous band attached to the tibia.
  • Plica is a crease in fine tissue that forms the joint of your knee.
  • Between your bones and tendons Bursa acts as a cushion and reduces friction.

These areas are among the most susceptible and vulnerable areas where internal knee pain is usually caused by injury or complications in one of these areas. Accidents, sometimes a little carelessness and poor lifestyle choices, can easily damage your knee health.Who do you think is most likely to experience medial knee pain?

Everyone can feel knee pain throughout their life and at different ages. For some people, this is temporary and disappears after a while; for others, it becomes a lifelong problem. Athletes, adults over 60 years old are at high risk, while youth and children are at low risk in terms of injury sensitivity. Overall, the following people are more likely to experience internal knee pain:

  • Football players, skiers, rugby players.An estimated 52.2% of former footballers had knee pain, compared with 26.9% in the general population. (Reliable source)
  • People who suddenly increase their physical activity
  • Cyclists or breaststroke swimmers. because these people use knees too often
  • Elderly due to osteoporosis or falls

But do not forget that anyone, young and old, can suffer from this disease, so you should take care of your health.

Causes of Medial Knee Pain

Various factors cause medial knee pain that varies from person to person. But sports injuries, falls, and sudden increases in knee joint activity are common causes of pain. In children, the causes of medial knee pain may differ from those in adults. For example, patellar tendonitis, patellar subluxation, and Osgood-Schlatter disease are the most common causes of this pain in children. In addition, the main causes of medial internal knee pain are associated with anatomical injuries to the inside of the knee, some of which are described below.

1.Medial Collateral Ligament (MCL) Injury

This injury is generally recognized as the most important cause of medial knee pain. First of all, it is best to know what the “Medial Collateral Ligament (MCL)” is. The MCL is one of the most important ligaments in your knee that connects your tibia to your femur. This ligament keeps the knee stable and controls lateral knee movement. A sprain or tear of this ligament is one of the main causes of internal knee pain that athletes, especially rugby players, often experience more often.This results in MCL injury when the impact pushes the knee inward into the opposite knee. In addition, various factors, such as twisting the knee while skiing or falling, can damage this ligament.

MCL Trauma Symptoms

Depending on the severity of your injury, you may experience mild or severe knee pain. If the blow is strong, you will not be able to walk or even touch the affected area. According to the experience of traumatized people, you can hear a popping sound during the impact and the area swells up, which is not the same for different people.Knee blockage and medial knee pain during flexion are other common symptoms of medial collateral ligament (MCL) injury.

Possible treatments: knee brace, PRICE (protection, rest, ice, compression and lifting)

2. Rupture of the medial meniscus

What is Meniscus? The meniscus is a C-shaped fibro-cartilaginous structure that acts as a shock-absorbing structure between the femur (femur) and the tibia (tibia).Each knee has two meniscus cartilages (one meniscus on each side), and tearing is one of the common causes of medial knee pain. Knee rotation and pressure can cause this injury, especially during sports activities such as football and basketball. This gap isn’t just for athletes, and older adults can experience it when exposed to light impacts.

Symptoms of rupture of the medial meniscus

The most interesting thing about the meniscus tear is that you can hear the pop and continue walking without pain.But what about the day after the accident? You will most likely wake up with pain and swelling, and the pain will gradually get worse. Other symptoms include:

  • Hardness
  • Catch or Lock
  • Feeling of imbalance
  • Acute pain inside the knee

Possible treatments: Surgery, Exercise and PRICE

3. Osteoarthritis (OA)

Suppose you have pain without swelling inside your knee while sitting, walking, or lifting up and down.In this case, you are more likely to develop osteoarthritis. It is a degenerative disease that usually causes loss of cartilage between joints in people over 50. As a result, you may have difficulty moving your knee and numbness when you first get up less than 30 minutes in the morning. Elderly people, women, obese people, gardeners or runners are at high risk of developing osteoarthritis.

Possible treatments: Medication, acupuncture, injections and knee braces


Bursa are thin tissue sacs that contain a small amount of slippery liquid. The bursa allows tissues to move easily on both sides of the pouches. The bursa between the MCL and the three tendons in the knee is collectively called “ Pes Anserinus “. Sometimes various causes, such as osteoarthritis, obesity, and a ruptured medial meniscus, cause excessive fluid secretion and bursal inflammation called bursitis.

Symptoms of knee bursitis
  • Pain approximately 2-3 inches below the knee joint
  • Redness
  • Difficulty walking
  • Edema
  • it hurts to lie on the hip
  • thickening of bursa

Possible treatments: Corticosteroid injections, strengthening exercises, rest and ice

5.Rheumatoid arthritis (RA)

This condition is an autoimmune disease that causes joint inflammation and usually causes internal knee pain. Arthritis affects various parts of the body, but the elbow and knee joints are most affected. Severe knee pain and tightness in the morning are symptoms of arthritis that improve throughout the day.

6.Medial Plaque Syndrome

Sometimes part of the synovial membrane folds into the articular space, forming a synovial fold.This fold, also called plica, is located inside the knee and is very effective in stabilizing the knee joint. Excessive use of the knee in activities such as running, cycling, or climbing and descending can cause friction, irritation, and inflammation of the plate.

  • Symptoms of the Medial Plaque Syndrome
  • Hear a clicking sound when bending the knee
  • painful and not abrupt or feverish
  • unpleasant sitting for a long time
  • Severe pain on ascent and descent
  • catch or snap your knee when you bend your leg

Possible treatments: Anti-inflammatory drugs such as Celecoxib and Diclofenac.

All of these factors are significant causes of medial knee pain and associated symptoms. There are many other factors associated with this problem that orthopedic surgeons are looking for. Keeping your knee healthy should be very important to you because minor injuries can have a significant impact on your life. If you have one or more of the above symptoms, do not treat it arbitrarily and be sure to see your doctor. You might be wondering when is the best time to see a doctor for internal knee pain management?

When should you see a doctor?

Knee injuries are widespread and you do not need to see a doctor immediately after an accident.Try not to bend or press on your leg, and use an ice pack to reduce swelling. Rest for three days and do the following:

  • Cover the area with elastic compression bandage
  • Try walking on crutches for three days
  • Ice on the affected area three or four times a day for twenty minutes
  • Do not bend your legs while sitting or climb stairs
  • While sleeping, keep your knee slightly higher than your body
  • Take anti-inflammatory drugs such as ibuprofen or naproxen

However, if your pain persists after three days and you have one or more of the following conditions, see your doctor.

  • Severe pain and numbness in the legs even without weight
  • Edema, redness and deformation of the affected area
  • Fever and cyanotic discoloration in caviar
  • click or lock in leg

Medial Knee Pain Treatment

Treatment varies depending on the doctor’s diagnosis and the type of complication. The podiatrist may ask for an X-ray or MRI to accurately diagnose the cause of the pain.But this is not always necessary, and based on your examination and medical history, your doctor may prescribe the best treatment for you. While some patients think the treatment is just surgery, knee surgery is a last resort after medication and proper exercise. In addition to specific medications, the following exercises are also very effective in treating pain and must be performed under the supervision of a physical therapist:

  • Stretch ATV
  • Hamstring stretch
  • Half Squat
  • Heel and Calf Stretch
  • Calf lifts
  • Hamstring curl
  • Raises a straight leg
  • Swimming
  • Yoga
  • Stationary cycling


it can be said that medial knee pain is a common discomfort caused by short or long term problems.While it is not always possible to prevent injury, there are some conservative and simple steps you can take to prevent these types of injuries. Strengthening exercises, weight loss and a balanced diet, massage, aromatherapy and leg muscle strengthening are examples of simple measures to prevent knee injuries.

The causes of pain are varied and knowledge and experience may be required to make a diagnosis. The diagnosis and treatment is different for each patient, so the effect of the medication can vary from person to person.Even exercise varies depending on the type of injury in patients, because they all have their own physiology and anatomy. In this article, you’ve read everything you need to know about medial knee pain, its causes and symptoms. You can also get a summary of the treatment. But the main challenge is the introduction of little-known home and traditional remedies. Treatment methods that are very popular today and are used instead of chemical drugs. How many of these methods do you know or even use? What’s the best home remedy for pain relief or injury treatment? If you have suitable treatments, please write below so we can help medical science and even patients.

90,000 Knee pain | ortoped-klinik.com

Knee pain © Fotolia.com

Knee pain is a signal of danger
and it is a “popular” disease: from five to ten million people in Germany suffer from this disease. There are different types of knee pain. Its possible causes are also varied. A thorough medical examination is necessary to determine the exact causes in each individual case.

Both the flashing red light of the engine oil level warning light and the knee pain should be assessed not as an enemy, but as a necessary warning.She indicates that something is wrong in the knee. And if you respond to this warning in time and eliminate the causes, then you can solve many problems. More dangerous are painless defects, such as small cracks in the meniscus or incipient destruction of cartilage, which can imperceptibly lead to arthrosis of the knee.

There are two main reasons that cause the vast majority of knee complaints: trauma and arthrosis of the knee joint.

List of treatment methods (the appropriate method is determined according to individual indications):

Conservative treatment methods

  • Acupuncture
  • Special injections
  • Training and muscle building
  • Weight loss
  • Arch support

Operative methods of treatment

Various types of knee pain

How does it hurt?

Depending on the cause of the occurrence, knee pain makes itself felt in different ways.Outwardly, bruising, redness, swelling, fever, and limited mobility are common.
Knee pains can be pulling, stitching, pressing, as well as continuous dull or convulsive.

Where does it hurt?

It is also very important where the main source of pain is located in the knee: inside or outside, on the front or back of the knee, or in the entire knee region.

When does it hurt?

In many cases, knee pain begins when running or climbing stairs.Sometimes symptoms appear only after heavy or prolonged exertion. Some knee disorders are characterized by pain even at rest or in a sitting position: knee pain during prolonged sitting can be a sign of damage to the cartilage under the patella, which the earlier it is detected, the more effectively it can be treated.

Frequent crackling of the knee can also signal joint damage – although it is usually not painful. In the same way, by the way, as well as the feeling of instability in the knee with cruciate ligament injuries.

Causes and consequences

Knee pain after external injury (trauma).
Although the knee can withstand up to 1.5 tons of load for a short time, it is very prone to injury, since it is not surrounded by a protective layer of muscle. Bruises, bumps from sports or from traffic accidents occur directly on the joint.

In an acute injury or accident, knee pain usually occurs immediately after the accident. Often, at rest, pain after injury diminishes, but returns with exertion.As a rule, after an injury in the joint, an inflammatory process begins and, therefore, night pains at rest.

When the cruciate ligament of the knee is injured, a feeling of lack of stability in the joint is typical.

Knee pain due to joint wear (arthrosis)

With age, more and more people suffer from joint wear and tear. The reason is the wear of the cartilage layer, which provides easy sliding of the joint and the subsequent damage to the cartilage. In diseases associated with wear and tear, gradually increasing pain is usually observed, which increases with exertion.Initial pains are also characteristic during the first movements after a period of rest. Since there is usually no inflammatory process with arthrosis, then, as a rule, no pain is observed at night or at rest, unless it was preceded by severe overload.

Osteoarthritis sometimes progresses from continuous (chronic) irritation to inflammatory arthritis, resulting in edema and effusion.

Other reasons are:

  • overload in sports or at work

  • congenital deformities of the legs (e.g. X and O legs)
  • arthrosis
  • arthritis
  • rheumatoid arthritis
  • ligament injuries
  • meniscus injury
  • gout
  • bursitis
  • dislocation of the patella
  • degenerative wear
  • chondromalacia
  • Baker’s cyst

Knee pain can also occur after overuse with harmless short-term irritation.In addition, a radiating pain from another affected joint can cause knee pain. Typical of these “shifted pains” is that in addition to knee pain, there is also pain in other joints.

Knee pain with inflammation in the joint (arthritis)

Characteristic features are joint stiffness in the morning, severe pain in resting position and pain relief during exercise. The pain is usually worse at night.

Knee pain due to cartilage damage
A painful change in the cartilage of the patella (chondromalacia of the patella) manifests itself in severe pain during prolonged sitting or climbing stairs.It is often seen in adolescents. Damage to the cartilage on the surface of the sliding part of the joint often makes itself felt at later stages of the development of the disease.

What to do with knee pain?

In any case, if you have persistent knee pain, you need to consult a specialist. With the help of the necessary diagnostic measures, he can determine the source of the pain, as it can be radiating pain from another diseased joint. It can also detect diseases such as osteoporosis, bone infarction or tumors, which in rare cases can also cause knee pain.

Knee pains are often the result of short-term overload of the joint and disappear without a trace after a period of rest. Often the pain goes away as quickly as it appeared. Local cooling and the use of light anti-inflammatory and analgesic drugs can speed up the process.

However, in any case, do not hesitate to visit a specialist: prolonged treatment of a knee injury can lead to irreparable damage. A short diagnostic test is better than the prospect of chronic knee pain due to refusal or inappropriate treatment.

Knee pain: how to restore mobility

Free admission and diagnostics of a chiropractor, osteopath, neurologist

Free appointment
and diagnostics

Pain relief
for 1-2 sessions

Author’s method

Internships in the USA,
Israel, Germany

Knee pain

Publication date: 2020-06-08



Knee pain can appear unexpectedly, accompanied by crunching, creaking and stiffness of movements.Sometimes it develops gradually, intensifying and causing severe discomfort. Signs of pain are different. The nature of localization is one-sided (on one knee) or bilateral (on two). With symmetrical severity, degenerative changes are most often the cause.

The deterioration of the condition is observed with age and as a result of unbearable physical exertion. With an increase in pain at night, the suspicion falls on the deposition of salts, overstrain of the ligaments and joints, venous insufficiency.In weather-sensitive people, it begins to twist the joints in response to changes in the weather. Most often, chronic bursitis, a decrease in synovial fluid in the joint, becomes a pain provocateur.

Why does the knee joint hurt

The prerequisites for the development of pain in the knee joint are pathologies of the ligamentous and cartilaginous apparatus. A metabolic disorder, a failure of blood supply, an inflammatory process in tissues can cause destructive changes. Ankylosing spondylitis, rheumatoid conditions, systemic diseases – all this is at risk for the development of joint pathology.

In young people, knees hurt due to increased activity, sports injuries. Discomfort increases due to unbalanced nutrition, lack of vitamins and valuable substances. The main prerequisites for the development of violations:

  • overweight, obesity;
  • violations in the work of the musculoskeletal system;
  • physical inactivity, sedentary work, lack of physical activity commensurate with age and health;
  • injuries and injuries (ligament ruptures, joint dislocations, tendon sprains).

Sometimes people who come to the diagnosis find out that the pain in the knee provoked coxarthrosis (lesion of the hip joint).

What does acute knee pain say

Acute pain syndrome is usually triggered by external influences. It manifests itself when bending the knee, twisting, abrupt stops during exercise. The causes of acute pain are as follows:

  • Mechanical injury – it can be a shock, a fall, an accident on the road, as a result of which the joint is affected.A bruise is evidenced by the cyanosis and beauty of the skin in the area of ​​damage.
  • Stretching of ligaments and tendons, muscle apparatus – as a result of this injury, all adjacent tissues suffer. Pain that appears suddenly persists for a long time. The joint itself remains unstable for a long time, with sudden changes in body position it can “act out” by increasing unpleasant symptoms.
  • Rupture of muscles, ligaments and tendons – this violation is evidenced by the appearance of exudate, limitation of the functions of the joint, loss of its stability.
  • Meniscus injury is a common injury in athletes (soccer, volleyball, athlete and tennis players). The meniscus pops out when the knee is strongly twisted and at the same time bending. A sharp pain, limited movement testifies to the injury.

Free consultation and diagnostics of a doctor

  • Chiropractor
  • Vertebrologist
  • Osteopath
  • Neurologist

At the consultation, we carry out a thorough diagnosis of the entire spine and each segment.We for sure
determine which segments and nerve roots are involved and causing pain symptoms. Following the consultation
we give detailed recommendations for treatment and, if necessary, prescribe additional diagnostics.


We will carry out functional diagnostics of the spine


We will perform a manipulation that significantly relieves pain


We will compose an individual treatment program

Sign up for a free appointment

When chronic aching pain appears

The pulling pain develops gradually, intensifies slowly, then passes.After some time, there is a repeated increase in symptoms. As a rule, exacerbation is explained by the influence of a provoking factor (hypothermia, change of weather, prolonged sitting in one position, excessive load). The main cause of chronic pain is degenerative changes in the joint, the developing inflammatory process.

Diseases causing chronic knee pain:

  • Rheumatoid arthritis – immune cells target the synovium as a foreign target.This provokes the release of substances that have a destructive effect on cartilage and connective tissue. When violations only increase, the symptoms of the disease are dim, hidden. Then the temperature rises slightly, the person begins to get tired quickly even from an insignificant load. In the morning, stiffness of movements begins to be felt in the area of ​​\ u200b \ u200bthe joints, pain, redness of the skin, and swelling appear.
  • Primary osteoarthritis is a disease that causes wear and tear of the cartilage lining the joint. This impairs the ability of the contacting bones to slide in the joint area, causing painful friction in the joint capsule.As a result, the normal range of motion is significantly limited, mobility and activity are lost.
  • Patellofemoral pain syndrome (PFPS) – discomfort is concentrated in the front of the knee. It usually affects young women. The examination does not show changes in the structure of the cartilage tissue. The kneecap moves forward, causing pain.

All these conditions require immediate medical attention. You can treat them in different ways.Dr. Length’s clinic uses non-invasive approaches that exclude the use of aggressive medications.


At the first appointment, the doctor asks the patient about the nature of the pain, the duration of its manifestation, and accompanying symptoms. The specialist clarifies complaints, studies the history of heredity to identify signs of a disease with a genetic predisposition. The doctor is interested in the patient’s lifestyle in order to accurately diagnose. Motor tests are used, X-rays, ultrasound, MRI of the knee joint, arthroscopy can be prescribed.

Knee Pain Treatment

With the development of pain in the patella, it is better to consult a doctor in the early stages of changes. In this case, the therapy will show the maximum effect and will pass faster. Our doctors do not recommend using NSAIDs for pain relief. These drugs negatively affect the condition of the digestive tract, liver, and the hematopoietic system.

The clinic uses the following therapy methods:

  • Manual techniques, osteopathy – gentle methods of influencing the human body.An experienced doctor relieves pain in 1-2 sessions and consolidates the result during subsequent visits. The specialist “subtly feels” with his hands painful points and foci that require correction. A deep study of tissues relieves the symptoms of inflammation, eliminates the causes of pain, normalizes metabolic processes and blood flow.
  • Kinesio taping – tapes are used to fix the joint capsule in a certain position. The elastic band keeps the muscles in good shape so that they correctly distribute the load imposed on them.
  • UHT – the quick result of shock wave therapy can be easily explained. Acoustic waves deliberately enter the site of pain localization. This causes violent cavitation processes, which destroys salt deposits, normalizes blood flow, and restores the broken integrity of cellular structures.
  • Di-Tazin therapy – the method has found application in leading foreign hospitals, and in the clinic of Doctor Length it is enriched with the author’s fundamental developments. The application impregnated with Photoditazine is applied to the surface of the knee joint.It is exposed to light and electric currents, providing deep penetration of the drug. The technology quickly relieves acute pain and relieves the condition.

Do not force yourself to suffer from knee pain, there is effective treatment, and it will help you to forget about the symptoms that torment you.

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Hernias in the lower back and neck

I came to the clinic of Doctor Length with spinal problems.With two intervertebral inferior hernias and two intervertebral hernias in the neck. I was assigned a comprehensive 10 step program. In 4 months my lower vertebrae completely disappeared and the crunches in my neck disappeared …


Lumbosacral hernia

“After the first time, my back stopped hurting.I felt relieved. Now I have already passed 7 sessions and my back really does not hurt. I began to forget about it. And at first it hurt badly. ”


Inflammation of the sciatic nerve

“For 4 months I suffered from severe inflammation of the sciatic nerve on the right side. After the first visit, relief came immediately within six hours.After 6 courses, the pain practically disappeared. ”


Pain in the lower back and leg

Yakovleva Natalya Mikhailovna
Head of the department, surgeon of the highest category, oncologist-mammologist
I want to express my deep gratitude for the fact that they put me on my feet in the truest sense of the word.I came to the clinic a month and a half ago with severe pain in the lower back and leg. These complaints were of a rather prolonged nature and the ineffective treatment that I used in the past. Fortunately, I ended up at the clinic of Dr. Length and his team of super professionals!


Osteochondrosis of the cervical spine

“Appealed 2 months ago with osteochondrosis of the cervical spine.I have a sedentary job and my neck muscles cramped very badly. It was impossible to work. Before that I turned to other doctors, but this did not solve my problem. For 2 months I have quite positive dynamics. It gets better and better every week. ”


Ankylosing spondylitis

“I have had ankylosing spondylitis for 10 years.The vertebrae began to move out, I began to slouch. I have consulted other chiropractors, very famous media therapists. As a result, I did not get the result. After 2 sessions, I felt much better. Now nothing hurts me. ”


Spinal pain

“I came with problems in the back, cervical, thoracic and lumbar spine.I was prescribed procedures, had a massage, and was assigned to do physical education at home. This made me feel much better. I’m already turning my head. I have no pain. ”


Shoulder-scapular periarthrosis

I went to the clinic with severe pain in my shoulder. My hand did not rise, I could not sleep at night, I woke up in pain.After the first session of procedures, it became much easier for me. Somewhere in the middle of the course, my hand began to rise, I began to sleep at night.


Arthrosis of the knee joint of the 2nd degree

She came with a very serious illness. I could not walk, I have arthrosis of the 2nd degree of the knee joint. I have undergone a course of treatment in the Clinic and now I am going 100%.


Herniated disc

“I came to the clinic after I had back pain and there was a herniated disc. I went to other places, but there they only removed the attacks of pain. Only Sergei Vladimirovich, his golden hands, gave the hope for a return to ordinary life! ”



“From adolescence I was worried about scoliosis in the thoracic region.I felt a feeling of discomfort, tension, periodic pain in the spine. I turned to various specialists, a masseur, an osteopath, but I did not feel a strong effect. After treatment at Length S.V. I almost have an even spine now. Currently I don’t feel any problems or discomfort. ”


Herniated disc

“On the 5-6th session there was an improvement.I felt much better. The pain was gone. The improvement progressed more and more each time. Today is the 10th lesson. I feel great.”


Pain in the lumbar and cervical spine

“I am 21 years old. I went to the clinic with discomfort in the lumbar and cervical spine. I also sometimes had sharp pains.After undergoing therapy, I felt a significant improvement in my back. I have no pain. The general condition has improved. ”


Back pain

“At the beginning of the treatment, my back ached very badly. I could no longer walk. I take 5 steps and stop. My whole journey consisted of such stops.During the first procedure, I left the office with no pain in the spine. ”


Hernia of the cervical spine

“I came up with a problem in my neck and my right arm was very sick. The neck did not turn, the hand did not rise. After the 3rd session I felt better. After the 5th, all this pain went to decrease.It turns out that I have 2 hernias in my cervical vertebra. After the sessions, I did an MRI and one hernia decreased. Now I started to move, my hand started working. ”


Neck pain

“I went to Dr. Long because my neck was very painful on the right side. I fell on a snowboard 5 years ago, even went to an osteopath, but somehow it didn’t help much.Now everything is fine, there were some consequences, the muscles were spasmodic. When I came there were steel muscles, now my neck is very soft. ”


Pain in the thoracic region

“I went to the clinic with pain in the back, namely in the thoracic region. After 10 treatment sessions, I could calmly do my usual things, sit at work until lunchtime, without howling in pain.Now I have already come to the correction after 2 months. I’m fine, my back doesn’t hurt. ”


Hernia and protrusion

“I came to the clinic with hernia L4-L5 and protrusion L5-S1. The course of treatment ended today. The lower back hurt, it was difficult to bend over. After completing the course and receiving instructions in the form of physical exercises, it became much easier.After a month of treatment, I do not feel any stiffness of movements. ”


Pain in the lower back and hip joint

“From a young age I was worried about back pain. When they became unbearable, I went to the clinic of Dr. Length. After the first procedure, pain disappeared from the hip joint. After the third procedure, the shooting pains in the lower back stopped.»


Very effective procedures

The procedures turned out to be very effective. I used to go to other clinics and absolutely did not relieve my pain, they bothered me. After this specialist, after three or four sessions, my functions recovered, the pain in my joints went away.


90,000 Do your knees hurt? – DimaPetrov – your cycling specialist

Many of us have experienced various pain sensations while cycling.

Cycling is a relatively non-traumatic sport. Moreover, after some injuries, the bicycle is very suitable for rehabilitation due to the low stress on the joints. But there is always a “but”. Improper cleat placement or seating may result in injury.

According to statistics, cyclists experience the most injuries and pain in the knee joint. This is undoubtedly problem number 1, except for the rubbed priests of course 🙂 But with the saddle as a whole it is easier, you just need to pick it up one day and forget about this problem 🙂

Why do knees hurt and what to do?


Possible cause of pain Recommendation
Incorrectly installed cleats on cycling shoes, as a result of which there is a “skew” in the knee and additional friction in the joint appears and the load on the ligaments increases The cleats are adjusted not only by shifting forward and backward and closer and further from the frame.The angle relative to the sole is also adjustable. This is very important and fine tuning is one of the first steps in adjusting the fit.

As for the cleats themselves, I recommend those with at least 5 degrees of heel free play. They will help to avoid distortions and twisting of the knee and foot

Read more about cleats in the article on clipless pedals.

Knee movement

Possible cause of pain Recommendation
Wrong position of the foot in the shoe, poor fixation of the foot, insufficient support for the arch and tilt of the forefoot.As a result, lateral loads on the knee joint, excessive pressure on the lateral and medial condyles of the joint Many people do not even suspect what a large role a varus wedge can play under the insole or spine. Correct foot support is the key to healthy knee

Seat position

Possible cause of pain Recommendation
Seat too low.Or moved too far forward. This results in, again, more friction / pressure on the femoral condyle Try lifting or sliding the seat back. Or simply sign up for a fit setup to find your optimal fit for your current fitness


Possible cause of pain Recommendation
Q (q) -factor can be more or less than necessary, due to the different structure of the legs, the width of the pelvis, etc. It is best to leave the Q-factor adjustment to a specialist. I do not recommend experimenting on myself


Possible cause of pain Recommendation
Low cadence (cadence), resulting in high pressure between the back of the kneecap and the femur Buy a bike computer with a cadence sensor. Try to keep the cadence close to 90-100 rpm.Don’t drop below 70, even on climbs

Drinking mode

Possible cause of pain Recommendation
Dehydration – low body fluids Drink plenty of water / isotonic before and during exercise. Drink not when you are already thirsty, but in advance, do not allow dehydration

Temperature setting

Possible cause of pain Recommendation
Poor heat or cold during exercise Do not let your knees freeze.At +15, when it seems to be already warm enough to go in shorts, you should use heaters / knee pads or warming ointment

Soft load

Possible cause of pain Recommendation
Excessive loads, especially in spring, when there is still no base / volume in the legs Do not overdo it! Let’s smooth load! Always take care of your body during the first 1000 kilometers of the season!

The procedure for adjusting the fit on the bike Body Geometry Fit , as well as branded insoles / inserts / shoes Specialized Body Geometry , will help to identify and eliminate the causes of knee pain in most cases.

Sometimes the problem lies almost on the surface, but only an experienced cyclist or fit-technician can see it. A doctor at the clinic can help you eliminate the consequences, but not the cause of the pain itself.







Knee pathology, injuries and diseases

The knee joint is one of the largest joints in the body, it is formed by the two largest bones – the tibia bone and femur.

98% of body weight is in the knee joint, which makes it the most prone to injury and disease. The more a person’s weight, the more pressure on the knee joint, and accordingly it wears out faster. Disorder in nutrition, deficiency of trace elements and other components that are necessary for the normal functioning of the knee joints also affect the health of the joints.

Arthrosis of the knee joint.

The most common disease is gonarthrosis.This is a degenerative dystrophic disease. In simple language, the articular surfaces are grinded and poorly articulated, from this pain and discomfort appear. The main reasons for the development: injuries, or operations that have ever occurred. As a rule, people suffer from arthrosis after 40-50 years. But there are exceptions to every rule. There are cases when the disease is detected in young people aged 25 and 30 years.

There are 4 stages of gonarthrosis from the first (mild) to 4 (severe), in which knee arthroplasty is necessary.Radiographically, at each stage, we determine the narrowing of the joint space, respectively, if the gap between the articular surfaces becomes smaller, the range of motion in the joint is reduced and the movement becomes painful. To diagnose arthrosis, an X-ray image and the presence of the patient at an appointment for a clinical examination are sufficient. Also, MRI is used in diagnostics, sometimes, but very rarely, ultrasound and CT are informative, but you always need to start with the simplest thing – X-ray.

If a patient begins to experience pain in the knee joint, while walking, the pain intensifies – the patient walks less, respectively, the muscles around the joint atrophy and the disease progresses much faster.If the patient gives stress, the pain syndrome is so strong that the patient cannot walk. It is important to find a “golden mean” here: somewhere to walk with a cane, somewhere to rest. Then, as a rule, a non-steroidal group of anti-inflammatory drugs is prescribed (Ketonal, Ketoprofen, etc.). All medications are taken only as directed by a doctor. drugs now have a huge number of contraindications, and you also need to look at the reaction of the body in each patient individually.

For intra-articular injections.There are a great many injections, from the use of the drug “Diprospan” to “Hyaluroma”. Plasmolifting (PRP-therapy) is increasingly practiced now, this method has no contraindications, no allergic reactions, no side effects. The essence of the method is as follows: we take blood from the patient’s vein, from which we receive platelet-rich plasma, and put it in the patient’s knee joint. Platelets relieve inflammation and provoke the synthesis of collagen fibers, which are the building blocks of articular surfaces.PRP therapy is in 99% of cases harmless. The worst thing that can happen is that the procedure will not help (but it can happen with any drug).

A little about injuries.

As there are a lot of soft tissue formations in the knee joint: these are the meniscus, cruciate ligaments, etc. All of them can be injured.

Let’s start with the damage to the meniscus (this is the cartilaginous layer between the articular surfaces of the femur and tibia. The meniscus is necessary for shock absorption and better articulation of the articular surfaces, when it lies flat, it helps the femur to glide better along the tibia.When a meniscus rupture occurs, it gets into the wrong physiological position and the meniscus flap is pinched between the articular surfaces, and the knee cannot function normally, all this is also accompanied by pain. Most often, the meniscus is damaged after direct trauma.


  1. Pain after physical exertion
  2. Swelling of the joint
  3. Soreness when going down stairs

With these symptoms, you should immediately go to the emergency room, where you will be taken X-ray on which we will NOT see a damaged meniscus.An X-ray is done in a trauma center in order to exclude a bone fracture. Further, the doctor recommends a rigid artesia, or applies a plaster cast and sends it for further examination. If possible, this is an MRI (the best solution), or an ultrasound scan (less informative). Further, there are two options – conservative treatment: 2-3 months in a cast, taking anti-inflammatory drugs and limiting oneself to the maximum in physical activity. Or surgical treatment – arthroscopy of partial meniscus resection, when the doctor enters the knee joint with two punctures, a video camera is inserted through one puncture, and an instrument is inserted through the second, which cuts off the meniscus flap.Some doctors are now sewing it on, but this operation is much more difficult, and few people perform it. After the operation, a rehabilitation period is also required. In any case, an injury or an operation will make itself felt in a few years.

Trauma to cruciate ligaments (anterior / posterior) is not uncommon.

The anterior cruciate ligament is most often injured. She is responsible for the stability of the knee joint. The cruciate ligaments break mainly when the lower leg is rotated outward relative to the thigh, i.e.That is, the foot goes out, then it is overstrained and torn. These are not always complete ruptures, sometimes they are ripping, or partial damage. Symptoms are similar to those of a damaged meniscus.

Treatment: conservative method for incomplete rupture. With a complete rupture – surgery. The tendon is sutured and the cruciate ligament is replaced. The operation is very difficult and difficult recovery period, because the doctor in the operating room cannot always calculate the length of the ligament prosthesis and the knee may not bend completely, after which it must be developed.

Lateral ligaments of the knee joint. Responsible for lateral stability. Are rarely damaged.

Most often they become inflamed, they are treated like any inflammatory disease by rest and taking non-steroidal anti-inflammatory drugs, physiotherapy, shock wave therapy, treatment with magnets, etc. are also used. The methods are effective in each case individually, but the treatment, as a rule, will be long-term.

Is it necessary to check joints for prevention if nothing bothers you?

– No, if there were no injuries, surgical interventions and nothing worries – there is no need to expose yourself to radiation again.

Treatment is always individualized. See a specialist for any symptoms.

Mylnikov Ivan Igorevich

Orthopedic traumatologist

You can make an appointment with a specialist by phone: +7 (200-03) 220-03-03 -03