My knee hurts. Is it okay to walk?

We turn your list of "don'ts" into a list of "do it like this"

Key points in 30 seconds

1. If you walk less to spare your knee, your thigh muscles weaken, and the joint takes more impact from the very same step.
2. What major clinical guidelines name as the first treatment for knee arthritis is exercise, and whether it's walking or strength training, anything you can keep doing will do.
3. People don't follow "don't do this" well. So instead of prohibitions, we give you four things to do: walk on flat ground in shorter bouts, take stairs one step at a time holding the railing, practice getting up from a chair, and switch activities on painful days.
4. Achiness that settles within an hour or two after exercise is usually fine. If it hurts more the next day, cut back one step.
5. If your knee is swollen and warm, hurts even at night, suddenly locks, or started hurting after an injury, getting it checked comes before walking.

What we often hear

• "I was told to spare my knee, so I even cut back on walking."
• "I live in an apartment, so I can't avoid stairs, but all they told me was not to use them."
• "Even after resting, my knee is stiffer, and it hurts more easily than before when I walk even a little."
• "If it hurts while I'm exercising, should I stop or push through?"

Once you're diagnosed with arthritis, advice pours in from everyone around you. "Spare your knee." "Don't take the stairs." "Give up hiking." "Don't squat." Every one of them is a "don't."

Follow them all, and you end up giving up walking too. Yet a knee that's been spared actually gets stiffer and starts hurting more easily.

Why sparing it makes it weaker

Your thigh muscles are shock absorbers that take the impact coming into your knee with every step.

When you cut back on activity, these muscles are the first to waste away. As much muscle as you lose, that much more impact goes straight to the joint. Trying to rest the knee ends up pounding it more.

That's why the first treatment major clinical guidelines recommend isn't injections or surgery, but exercise. In an international review pooling many clinical trials, exercise improved pain and function, and the effect lasted for months after the program ended.

There's one piece of good news. Whether walking or strength training, there was no clear difference by type. You don't have to put off starting while you try to pick the best exercise.

That said, exercise won't transform your knee all at once. It's a safe treatment that builds up little by little. The real size of the effect and the original studies are written up in the knee arthritis evidence post.

Why "don't do this" doesn't work well

Here's something we often say in the clinic. If someone tells you "don't think of an elephant right now," the first thing that comes to mind is an elephant.

The human brain isn't good at carrying out "don't." It's not weak willpower; it's true of everyone. But "do it like this" works.

So in our knee prescriptions, we cross out the list of prohibitions and give you a list of things to do.

Four "do it like this" tips for your knees

One: walk on flat ground in shorter bouts. Rather than one long walk, break it up and walk several times, stopping before it starts to hurt. For example, two or three 10-minute walks are easier on the knee than 30 minutes at once. Loosen up your knees gently before walking, and wear sneakers with cushioned soles. The trick of resting before it hurts and then walking again is the same as in the post on walking with spinal stenosis.

Two: on stairs, "hold the railing going down and take one step at a time." "Don't take the stairs" is a prescription no one living in an apartment can follow. Just change how you take them. The knee carries more load going down than going up. Going down, hold the railing to share the weight, and bring both feet together on each step.

Three: turn getting up from a chair into exercise. The easiest way to start building your thighs is with a chair. Every time a TV commercial comes on, try slowly standing up from your chair and slowly sitting back down a few times. Once you're used to it, increase the number. How many times and at what speed depends on your knee, so we set it at your visit and check next time.

Four: on very painful days, don't stop; switch activities. If you quit exercising on painful days, it's hard to start again. On those days, switch to exercise that puts less body weight on the knee, like a stationary bike or walking in water. You're making it not a day off, but a day for a different activity.

How much pain is okay?

Mild pain during exercise, and achiness that settles within an hour or two afterward, are usually fine.

If the pain is noticeably worse even the day after exercising, that's a sign you did too much. In that case, cut back one step.

If you wait until there's no pain at all, you'll never start. If you ignore the pain and push hard, it'll hurt again. Working out the amount in between with you is our job.

Knees to get checked before walking

If you have any of the following signs, we need to look at the state of your knee before deciding how you should walk.

• The knee is swollen and warm
• It hurts at night even when you're resting
• The knee suddenly locks or gives way while you walk
• It started hurting after an injury

As we get older, it's easy to assume everything is wear and tear, but in these cases it may be a different problem. When we see these signs, we also check the joint first in partnership with the radiology clinic on the 2nd floor of the same building.

Care follows this order

First, we measure the load on your knee. We look at leg alignment with an X-body posture analysis, and at weight and muscle mass with an InBody test.

Second, we make a knee that can walk. We manage pain with acupuncture and pharmacopuncture (herbal acupuncture) so you can start exercising.

Third, we fit the to-do list to your knee. We set the four tips above with the method and number of reps that suit your knee, and check at your follow-up visit whether you're doing them. We judge progress by your pain score and how long you can walk without resting.

What changes

A morning when you're not afraid of how many steps you'll manage today. A day when, instead of waiting for the elevator in front of the stairs, you try going down holding the railing.

What we're aiming for is for you to use your knee again.

How fast things improve differs from person to person depending on the state of the joint, leg alignment, weight and strength.

Today's takeaway

Instead of sparing your knee, decide on ways to use it with less pain.

Here's one thing to try today. Write down on paper the list of "don'ts" you've been told, and next to each one, rewrite it as "instead, do this." If any items are left that you couldn't rewrite, bring that paper with you. We'll rewrite them together.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.