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How to keep your knees healthy and prevent knee surgery

We give them little thought when they're healthy, but painful and damaged knees can be hugely debilitating. Our knees are subject to wear and tear throughout our lives, resulting in a large number of us aged over 50 having to undergo knee surgery or knee replacement surgery. The good news is, that we can dramatically reduce the chances of knee injuries in later life by following active lifestyles that promote good knee health.

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How to prevent knee injuries

Throughout our lives, our knees are subject to wear and tear. While this increases our chances of knee injuries, we can reduce the risk of injury through positive lifestyle habits. If damage does occur, early physiotherapy can aid a speedy recovery.

Healthy lifestyle choices - including keeping your weight within recommended limits and exercising regularly to keep muscles strong and joints mobile - will greatly reduce the chance of joint, cartilage or ligament damage.

If you do experience knee injury, physiotherapy and the right exercises will aid recovery and will often reduce the risk of the problem recurring or worsening. It can also reduce the risk of requiring surgery - which while often successful, is a major commitment.

Hila Glick is vice president of physiotherapy and patient experience at Onestep, a virtual physiotherapy service that provides highly personalised recovery plans. She advises: "The best way to take care of your knees is to keep active, to strengthen the muscles around the knees and the entire body, as well as to work on muscle flexibility and length."

Leg strength exercises

The knee is one of the largest joints in your body, connecting your upper and lower leg bones and enabling a wide range of movements and manoeuvres. The strength of these bones and of the muscles that surround them provides crucial knee support, helping to reduce the stress and weight placed on them.

There is strong evidence that maintaining adequate leg muscle strength is important at any age. Strength training exercises have been shown to improve bone density by up to 3% and to slow down the rate of bone and muscle loss associated with ageing.

Danielle Wills, balance and yoga specialist at WithU Training, says: "Focus on exercises that target your hamstrings, quads, glutes, and hip flexors, and slowly increase the amount of weight you use."

Stretching and flexibility training

By stretching regularly, you can keep your supporting muscles long and flexible. This will increase the range of motion (ROM) in your knees, protect against the tightness in the surrounding muscles, and improve your balance - reducing your chance of falls and injuries.

Wills says: "Exercises like yogi squats and child's pose can help stretch the muscles that wrap around the joints. Remember only to go to where you feel a stretch, never to the point of pain."

Low-impact cardio exercises

As well as helping to build muscle, cardiovascular exercise (cardio) keeps the circulation around your knees constant: "The ligaments around your knees don’t get as much blood flow as other parts of the body," Wills explains. "It's important to engage in activities that keep flushing oxygen and nutrients through to these spaces."

This helps to keep knee cartilage healthy and may prevent atrophy (the deterioration of protective muscle and nerve tissue). While this is true of both high-impact and low-impact activities, low-impact cardio also limits the knee-jarring impact of your feet forcefully hitting the ground. As such, activities such as cycling and swimming are particularly effective at maintaining knee health.

Maintaining a healthy weight

Major weight gain can add significant stress to your knees," Wills warns. "Where possible, try to keep to a regular weight through regular exercise and healthy eating."

Every five pounds of body weight exerts an additional force on your joints of 25 pounds. Being overweight also increases your risk of injury and conditions affecting the joints like osteoarthritis and gout.

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What are the most common types of knee injuries?

"There are numerous types of knee injuries. The type of injury depends on the area that was injured, the severity, and a person’s physical background," explains Glick.

Some of the most common injuries include tears in the ligaments, tendons and cartilage, kneecap fractures, and kneecap dislocations. If you're experiencing persistent knee pain that's limiting your mobility, a physiotherapist can help diagnose the issue and create a tailored treatment plan.

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How do you recover from a knee injury?

Recovering from a knee injury will typically involve exercises to improve strength and flexibility - delivered in a way that protects against further damage. In many cases, physiotherapy exercises can restore range of motion and help to prevent the need for knee surgery.

Glick's physiotherapy exercises to help avoid knee surgery

Repeat 10 times or more depending on your ability. These popular exercises will be modified according to the type of injury.

Strength exercises:

  • Short arc quad - lie on your back and place a bolster under the knee of the quad you wish to strengthen. Slowly straighten your knee and tighten your quad until your leg is fully straightened.

  • Bridge - lie on your back with bent knees and feet flat on the floor. Push into your heels to lift your hips off the floor until your body forms a straight line between your knees and shoulders. Hold for two seconds, then lower.

  • Wall squats - stand with your back against a wall, legs hip-width apart and arms at your sides. Bend your knees and lower to a squatting position, until your thighs are parallel to the floor. Hold for two seconds and then rise to stand.

Stretch exercises:

  • Standing calf stretches - stand facing a wall with one foot in front of the other, front knee slightly bent. Keep your back knee straight, and your heel on the ground, and lean towards the wall. Hold for 20-30 seconds, then switch sides.

  • Standing quad stretches - face a stable surface. Bend the knee back towards your buttocks by holding your ankle. Hold for 20-30 seconds and switch legs.

  • Lying down hip flexor stretches - lie on your back, with bent knees and feet flat on the ground. Lift one knee towards your chest and hold it with your hands. Slide your other leg out straight, hold for 20-30 seconds, switch sides and repeat.

How to avoid making a knee injury worse

If you want to make sure you don't make your knee injury worse, Glick advises the following:

  1. Don't ignore knee pain and continue with your existing routine.

  2. Do stay active - movement helps prevent your joints from stiffening up, gets your blood flowing and may ensure that no further damage is done to other body parts due to compensation.

Glick also highlights that while surgeons have a lot of experience and provide good judgement, you should also ask yourself the following questions before deciding to undergo a knee operation:

  • Do the pain or limitations affect my quality of life?

  • What do I expect to do and where do I expect to be after surgery?

  • Did I do everything I could up to this point?

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The rise of online physiotherapy

Depending on your knee injury, physiotherapy may help you to recover, avoid knee surgery, prepare your body for a procedure, or recover post-operation. However, knee injuries are often debilitating and could make visiting a physiotherapist physically awkward and uncomfortable.

You may prefer to use an online physiotherapy platform - like the Onestep app - from the comfort of your home: "Digital physiotherapy platforms offer tremendous flexibility, availability, and convenience without compromising on the quality of treatment," says Glick.

"Once you have the list of exercises and you feel comfortable performing them, you can then practise several times a day according to your schedule and routine. You don't need to wait for your next visit to ask a question or to request a modified exercise. Instead, you can easily follow up with your therapist online.

"This is a wonderful solution for anyone working on an ongoing condition that needs close attention, frequent modifications, and constant support from a clinician who can assist remotely."

Can you avoid knee surgery?

While knee problems and knee injury can occur at any age, the vast majority of people requiring knee replacement surgery - the main type of knee operation - are aged 50 years and above, and around half are over 70 years. Age is a common risk factor because over the course of your life your knees are subject to deterioration from wear and tear.

Looking after your knees is important at all ages, as placing them under excessive stress or incurring injuries can add to cumulative wear and tear in later life. As you get older your risk of developing conditions that affect your joints also increases. For example, osteoarthritis - the degeneration and inflammation of joint cartilage and surrounding bone tissue - is the most common cause of knee surgery.

Wills advises: "It's natural to be concerned about the potential of knee surgery, but it's also important to put this into perspective and remember that genetics do play a big part."

This is not to say that knee surgery may be inevitable. Healthy lifestyle habits can help protect against excessive damage.

What does it mean if you do need knee surgery?

If your knee becomes too worn, damaged or injured to the point that physiotherapy alone is unable to rehabilitate it, then knee surgery can significantly improve your quality of life. It's one of the most common elective orthopaedic procedures, contributing to around 160,000 total knee and hip replacements taking place in England and Wales every year.

Glick advises: "It's important to note that while there are ways to help prevent knee surgery, in some cases surgery is the right thing to do. I believe that this should be a mutual decision, made by both the patient and the surgeon."

While knee surgery can cure your knee pain and give you a better range of motion, like all operations it carries risks and considerations. These risks can include infection and complications such as deep vein thrombosis.

These days, knee replacements usually provide benefits for decades. Dr Sarah Jarvis, Clinical Director of Patient.info, says: "When I first became a GP 31 years ago, we had to counsel patients that they might need further surgery after a decade or so.

"That was a major consideration because the revision of knee replacement surgery carries a higher risk of complications than the original procedure. Today, by contrast, I can reassure my patients that more than 4 in 5 total knee replacements and 7 in 10 unicondylar knee replacements (in which only a portion of the knee is resurfaced with plastic and metal components) last for 25 years."

Just as physiotherapy can help you recover from knee injuries, it can make a huge difference to your outcomes following surgery. Expert physiotherapy input, and doing recommended exercises regularly, can speed recovery, get you back to normal, and help protect your new knee for years to come.

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The information on this page is peer reviewed by qualified clinicians.

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