Hip or knee pain? Consider these non-surgical approaches to pain relief.

Hip and knee pain are among the most frequent sources of persistent—and at times disabling—musculoskeletal discomfort. Their prevalence continues to rise as the population ages and as the number of people living with excess body weight, which places additional stress on weight‑bearing joints, continues to rise.

A wide spectrum of conditions can drive this pain, including degenerative arthritis, traumatic injuries, and nerve compression. Although surgical interventions such as joint replacement, resurfacing, arthroscopy, debridement, and soft‑tissue or tendon repair can be highly effective for select patients, many people benefit from exploring well‑established non‑surgical strategies first. These approaches can reduce symptoms, improve function, and in some cases delay or even allow you to avoid the need for operative treatment.

Explore your options

The first step is to talk with your primary care physician or an orthopedic specialist to uncover the underlying cause of your pain. Once you have a diagnosis, ask your physician to outline what non-surgical treatments you can try to reduce pain and increase mobility.

There are a range of non-surgical hip and knee pain treatments available and in development, including:

• Weight loss: Excess body weight places substantial additional stress on the hip and knee joints, accelerating wear and increasing the likelihood of arthritis and other forms of joint damage. Weight gain is also linked to heightened systemic inflammation, a factor that can exacerbate joint pain and impair normal joint function.

The pressure that excess weight exerts on your hip and knee joints may be greater than you realize. When walking on level ground, the force on your knees is 1.5 times your body weight. On an incline, it rises to two to three times your body weight, while squatting increases the pressure to four to five times your body weight. Being just 10 pounds overweight increases the force your knees absorb with each step by 60 pounds.

If you are overweight, your doctor may recommend increasing your activity level and eating a lower calorie diet that focuses on lean meats and fish, fruits, vegetables, low fat dairy, whole grains, and healthy fats to help you gradually reach a healthy weight and reduce stress on your hips and knees.

• Exercise: Weak or imbalanced muscles can increase mechanical stress on the joints, so targeted strengthening is an important strategy for reducing discomfort. While hip and knee pain can make moving uncomfortable, the right forms of exercise can build the musculature and connective tissues that support these joints and, over time, lessen pain. Before starting an exercise plan, talk with physician to find out what types of exercise are most appropriate for your condition.

Partnering with a physical therapist is often the safest and most effective way to start; they can design a personalized regimen aligned with your diagnosis, functional goals, and comfort level. Your health advisor can connect you with an experienced physical therapist to guide your exercise program.

Exercises for knee and hip pain generally focus on the muscles and soft tissues that surround the joints to increase strength, stability, and flexibility. Additionally, manual therapy techniques and targeted stretches can improve flexibility and help with pain management. Some low impact exercise options include water-based workouts like swimming and water aerobics, tai chi, and strength training. Other therapeutic approaches to joint pain include massage, ice, deep heat, and nerve stimulation.

• Braces, sleeves, orthotics, and assistive devices: Knee braces and sleeves provide structural support for the joint, which can in turn decrease hip pain because you’re not standing or walking abnormally to favor your painful knee.

Misaligned feet, flat arches, or other structural foot issues can cause pain and improper body mechanics. The stress travels up the leg, causing pain in the knee and hips. Orthotics in your shoes can help reduce knee and hip pain by preventing your feet from rolling in or out and putting extra stress on your knees and hips. Although you can buy these types of assistive devices at your local pharmacy, it’s wise to talk with your physician first to find out what type of device is most appropriate for you. In many cases, custom orthotics that are tailored to your feet will be a more effective approach.

Assistive devices like canes and trekking poles can help also help decrease pain and increase mobility. Holding the device in the hand opposite the affected hip or knee transfers some of the downward stress of your body weight to the device.

• Medication: Pain relievers, especially non-steroidal anti-inflammatory drugs (NSAIDs), can provide relief, but talk with your physician about the potential risks and side effects of using these medications. Long-term use of NSAIDs can cause gastrointestinal ulcers and bleeding. These medications are also not recommended for people with kidney disease or cardiovascular disease because they can cause acute kidney injury and increase the risk of heart attack and stroke. Topical versions of non-steroidal anti-inflammatory medications may also provide relief without the risk of gastrointestinal side effects.

Long-term acetaminophen use also carries risks, including liver damage. Your physician may recommend antirheumatic drugs and biological response modifiers (drugs that modify the response of the immune system) to treat pain and inflammation.

• Injections: There are several types of injections that are used to treat hip and knee pain. Cortisone injections may relieve pain and reduce inflammation in the joint, though long-term use of these medications is limited due to potential side effects such as cartilage damage and weakened tendons and ligaments.

Hyaluronic acid is a substance found in joint fluid that helps lubricate the joint and reduce friction. For people living with osteoarthritis, the natural hyaluronic acid in the joint may break down. Injecting a synthetic form of hyaluronic acid into the joint, which is also called viscosupplementation, can restore the lubrication and provide pain relief for weeks to a few months.

Other types of injections include platelet rich plasma. Blood is drawn from the patient and treated in a centrifuge to create blood that contains more platelets than usual. This blood is then injected into the affected joint to increase the concentration of bioproteins or hormones, called growth factors, to accelerate the healing process. The mechanism of action of PRP injections is not completely understood. Some studies show that the increased concentration of growth factors in platelet-rich plasma may stimulate or speed up the healing process. It is worth noting that the American Association of Hip and Knee Surgeons does not currently recommend this as a routine treatment for advanced hip and knee osteoarthritis.

Another type of injection is created from harvested and processed patient fat tissue. This treatment is currently the subject of a clinical study in the U.S. The injection, brand name Lipogems, is manufactured from micro-fragmented fat. The theory behind the treatment is that adipose tissue has a rich micro-environment of reparative cells, growth factors, and structural matrix, which can support healing and reduce inflammation.

• Cooled radiofrequency ablation: For knee pain caused by arthritis, a non-invasive treatment called cooled radiofrequency ablation may provide relief. The treatment targets the nerves in the knee that send pain signals to the brain and interrupts them with radiofrequency waves. Studies found that pain relief from this procedure can last six to 12 months, depending on how quickly the nerves regenerate.

 

• Genicular artery embolization: This relatively new, FDA-approved, minimally invasive treatment uses a thin catheter inserted into a blood vessel in the knee through a small incision into the genicular arteries, which supply blood to the lining of the knee joint. Tiny particles are injected into the artery to reduce abnormal blood flow and deaden the nerves causing pain.

 

• Treatments in development: Numerous clinical trials are underway examining new treatments for joint pain. In one completed study, researchers used birth tissue particulate injections to treat patients with moderate to severe knee arthritis that has not responded or has ceased responding to standard therapies. Trial results have not yet been published.

In another study that has not yet started recruiting patients, researchers are evaluating the effects of injected bone marrow aspirate concentrate compared to traditional corticosteroid injections in patients with hip osteoarthritis.

The RECLAIM (Recycled Cartilage Auto/Allo Implantation) study focused on a knee joint restoration procedure that uses the patient’s knee cartilage and donor mesenchymal stem cells to create a treatment that is injected into the patient’s knee, allowing the body to repair the cartilage defect.

Connect with PinnacleCare

With a PinnacleCare health advisor team and medical directors available 24/7 to assist, we can help you understand what the various medical, surgical, and non-surgical options are available to you, and help you decide on the best course of action for your condition. For more information about how PinnacleCare’s Health Advisors could assist you with hip/knee pain management and support, connect with us today.