3 Things You Should Not Do If You Have Knee Pain

One of the most common questions people with knee pain email me is “What do you recommend NOT to do?”

Since 2012 I’ve heard thousands of different stories about how knee pain happened and what made it worse. So here are three things you shouldn’t do if you have knee pain or want to prevent it.

#1 – Return To Sports Too Aggressively

This is how it all starts, more often than not.

You’re an active athlete, but for one reason or another, you take an extended break from sports.

Maybe you broke an arm and have to wear a cast for 8 weeks, maybe you went on a business trip, or maybe the rumors I’ve been hearing about this thing called “vacation” are true and it really exists.

Regardless, you’ve been slacking off for a month or longer. To make up for it, you decide to give maximum effort on your return. You want to match your last PR or at least want to give maximum effort. You also want to make up for lost training time.

The guaranteed result?

Sore muscles, sore joints, and big chance to develop patellar tendonitis or another type of knee injury.

This happens because ligaments and tendons slowly begin to atrophy with extended rest, say a month or longer. The weakened connective tissue will not be able to handle your previous intensity level of jumping, running, and cycling.

The longer your hiatus has been, the more careful you need to be on your return.

Solutions:

• After more than 3 weeks of rest from sports, start at a lower intensity and build up slowly to your previous level, OR
• Keep up a once weekly maintenance program, however possible
• If you’ve just recovered from knee pain, start with one short training session per week and build up from there

#2 – Stopping rehab too soon

If I had to guess, I’d say the majority of rehab attempts fail because people quit too soon, not because rehab itself fails.

Once pain is mostly gone, resisting the itch to get back into sports becomes more and more difficult. Many give in to the temptation and a few days later pain is back.

Sometimes this has to happen several times, before the mind is ready to accept that rehab isn’t complete yet.

Solutions:

• Continue rehab until you reach a high pain-free level of strength (e.g., for patellar tendonitis, doing two-legged squats is not enough, work up to single-leg squats)
• Understand the psychology behind why you feel pressure to return to sports and find another outlet for it
• If in doubt, continue rehab
• Return to sports at a safe level of intensity with just one weekly training session, then build up from there

#3 – Repeated cortisone injections for chronic pain

Sometimes a cortisone shot may be necessary. However, if you have to keep going back for repeated injections, you’re putting yourself at risk of a patellar tendon tear. This happened to several of my readers and the combinations of factors that cause it are:

• Getting several cortisone injections AND
• Continuing regular sports activity at a high level OR
• Suffering a fall on the knee

I’m not talking about a partial tear either, but a complete tear, with the tendon’s connection to the shinbone totally severed. After that, you’re looking at surgery and at least six months of rehab, all because the injections were a convenient “solution” for the pain.

Cortisone can definitely help in certain situations, but it’s used too often and too liberally, without enough emphasis on the risks. For example, if a simple fall on the knee can lead to a tear, you’re already at risk just getting out of the bathtub.

Bonus: Mistaking surgery for a quick-fix solution for chronic pain

The last mistake I want to mention isn’t a mistake per se, but rather a wrong assumption about surgery. I’m not sure whether this is because of how surgery outcomes are explained to patients or whether it is because patients only hear what they want to hear.

The wrong assumption is that surgery offers a quick-fix solution for chronic pain, regardless of whether it’s patellar tendonitis or another knee injury.

After surgery, people are surprised they’re still in pain and still have to go through months of rehab. Sometimes they’re even in more pain than before the surgery. I’ve heard variations of this story countless times over the last 8 years.

This tissue damage, in addition to the original injury, combined with the general uncertainty about the surgery’s success, is why I’d only recommend surgery for chronic pain if rehab through exercise is not producing any positive effects even after many months of trying a variety of different approaches.

To be clear about this, I’m not saying not to get surgery! I am saying to have reasonable expectations about the outcome of surgery. Never think of it as a quick-fix or a guaranteed solution, because it’s neither.