How can I relieve my knee pain without surgery?

DEAR DOCTOR K:

I’m in my 60s. My knees have started to hurt, especially when I’m climbing stairs. Can you recommend any nonsurgical ways to relieve this pain?

DEAR READER:

Knee pain is one of the most common reasons for doctor visits. As you get older, knee pain can limit your mobility and take away your independence. The keys to keeping your knees healthy? Strengthening muscles around the knees, improving balance and losing weight.

Let’s start with muscle strengthening. Your knee joints bear your weight when you are standing, and that creates a lot of stress on them. That stress is reduced by different muscle groups above the knee that help extend and bend your knee. They also help hold your body weight on a bent knee. Therefore, weakness of these muscles can cause higher levels of stress in the knee joint.

I spoke to my colleague, Michael Orpin, a doctor of physical therapy at Harvard-affiliated Massachusetts General Hospital. He recommends exercises that work many muscle groups at once. One such exercise is the sit-to-stand, in which you move from a sitting to a standing position repeatedly. (I’ve put an illustration showing how to do a sit-to-stand below.)

Below the knee, the muscles in your calf are important for knee control. They also help propel the body during walking, stair climbing and running. Weakness in these muscles also adds stress to the knee joint. Heel raises can help to strengthen the calf muscles. To do a heel raise, hold on to a counter for balance. Slowly rise up on tiptoes, then lower heels to the floor. Try three sets of 15 repetitions.

You’ll also want to focus on balance to keep your knees healthy. Maintaining balance requires your knees to work with your hips and ankles. This coordination takes practice. Simple exercises, such as standing with one foot right in front of the other, as if you were standing on a tightrope, can help.

Weight loss is the important final piece. The force of each pound you carry is magnified by the time it reaches your knees. If you’re walking across a flat surface, for example, the force on your knees is equal to 1 1/2 times your body weight. Going uphill, it is two to three times your body weight.

Shedding extra weight reduces this force and can help prevent arthritis and injury. It can also reduce existing knee pain. To lose weight, try aerobic activity that doesn’t overload the knee. Swimming or walking in a pool, or riding a stationary bike are good options.

You’re right to ask about nonsurgical options for knee pain — and you’re asking at the right time: as your knees are starting to hurt, but probably before they have been badly damaged. By taking action now to protect your knees, you can postpone, or even avoid altogether, the need for knee replacement surgery someday. Surgery can be a godsend, but if you can protect your knees before they reach this stage — and you can — that’s even better.

Sit-to-stand exercise
 sit-stand This exercise helps work many leg muscle groups at once, which ultimately builds your knee strength.

Sit in a chair with your feet hip-width apart. Place your hands on your thighs. Tighten your abdominal muscles. Exhale as you slowly stand up. Slowly
sit down with control. This is one repetition (rep). Do eight to 10 reps.