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Managing Knee Pain – What are the non-surgical options?

Knee pain is a frequent symptom that can result from a wide range of sources. Typically, when a person's pain worsens, their ability to engage in various activities is severely restricted. ACTIVATE Musculoskeletal clinic in Kent provides a wide range of minimally invasive procedures/non-surgical treatments to manage knee pain.

These are some of the most prevalent causes of knee pain:

  • Osteoarthritis

  • Rheumatoid arthritis

  • Torn meniscus

  • Bursitis

  • Injuries around the knee

Non-surgical treatments options for knee pain:

PRICE (Protection, Rest, Ice, Compression, Elevation)

  • Protection – protecting the knee from further injury.

  • Rest – Reducing daily activity. Using crutches or similar walking aids may help

  • Ice – Applying an ice pack to knee for 15-20 minutes every two to three hours. This could be a bag of frozen peas wrapped with a towel.

  • Compression – Compression bandage or crape during the day to help minimize swelling.

  • Elevation – Elevating the knee and leg above the heart level to help reduce swelling.


A personalised program that includes strengthening and stretching exercises, and sometimes the use of orthotics, is one of the main management options for knee pain. Depending on the diagnosis, a tailored physiotherapy regime can be prescribed and followed with a specialist physiotherapist or digitally at home.


  • Acetaminophen (Paracetamol): Acetaminophen is a metabolite of phenacetin effectively relieves pain in people with mild to moderate joint pain.

  • Non-steroidal anti-inflammatory drugs: NSAIDs are a diverse group of chemicals. They function by inhibiting the formation of prostaglandins, the initial step in all inflammatory diseases. The non-selective Cox-inhibitors (e.g., diclofenac, ibuprofen, aspirin, etc.) block Cox-I and Cox-II receptors to slow prostaglandin formation. Selective Cox-II inhibitors (such as Celecoxib and Valdecoxib) exhibit a strong preference for Cox-2.

  • Opiates: These drugs are derived from opium and include morphine, codeine, and several semisynthetic compounds.

  • Chondroitin sulfate and glucosamine sulfate are effective nutritional supplements frequently prescribed to patients with joint pain.

(Please Consult ACTIVATE or a GP for medical advice regarding medications)

Knee injections

Injections of the knee joint are very effective in managing knee pain and decreasing inflammation, possibly for several months or longer. Most patients will experience rapid pain reduction and enhanced joint function. Some knee injections for knee pain include hyaluronic acid and Corticosteroids.

Hyaluronic acid: Hyaluronic acid is a non-sulfated glycosaminoglycan composed of repeating units of N-acetylglucosamine and D-glucuronic acid. Several tissues contain Hyaluronic acid naturally. Hyaluronic acid is a component of the synovial fluid of healthy joints that lubricates and functions as a shock absorber. Hyaluronic acid knee injection can therefore help restore its viscoelastic characteristics. Injections of hyaluronic acid into the knee over many weeks may relieve chronic knee discomfort. In addition, it can help reduce inflammation and slow cartilage degeneration.

Corticosteroids: Corticosteroids possess anti-inflammatory properties, interacting with nuclear steroid receptors and disrupting the inflammatory and immunological pathway at multiple levels. They decrease vascular permeability and prevent the build-up of inflammatory cells, development of neutrophil superoxide, phagocytosis, metalloprotease, and metalloprotease activator, as well as the production and secretion of numerous inflammatory mediators, including leukotrienes and prostaglandin. Cortisone directly injected into the knee joint can provide pain relief during flare-ups, with effects lasting up to several weeks. Not everyone reacts similarly to cortisone injections, and they cannot be administered frequently due to potential muscle and tendon atrophy, bone weakening that result from continuous use and a risk of infection.

  • Ultrasound-guided injection: Numerous imaging techniques can assist in visualising the knee joint and increase injection accuracy. An ultrasound-guided injection is among the most effective approaches since it is a non-invasive imaging technique that allows for real-time observation of the needle as it is directed into the injection target structure. Ultrasonography is a valuable and cost-effective imaging modality for soft tissues and fluid-filled areas. Furthermore, there is no exposure to radiation and can be performed at the same clinical appointment.

About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent and London Harley Street


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