Below are my top four recommendations for people who are overweight and who suffer from chronic knee pain:
1. Lose weight.
2. Lose weight.
3. Lose weight.
4. Lose weight.
No, I'm not trying to be clever here.
I'm convinced that controlling one's weight is critically important for overcoming knee pain. It's not an instant miracle cure -- after losing 30 pounds, you may not be able to leap up and shout, "Hallelujah, I'm healed" (you still need to work at it), but you'll be in a much better position to succeed.
If you don't believe that excess weight can have a huge effect on knee health, well, there's the anecdotal evidence.
For example, take a look at the picture below that ran with a newspaper article about aging baby boomers and knee surgery. This woman had a total knee replacement. Does anything jump out at you?
Obviously, she's nowhere near her ideal weight.
Here's another bit of anecdotal evidence to mull over: some months ago, while browsing the comment section below an Internet article about knee problems, I was struck by a remark posted by an orthopedic doctor. His comment went something like this: "In all my years of practice, I've never had a patient who had osteoarthritis of the knee who was also thin."
Of course there are thin people with knee pain and/or osteoarthritis (I was the former). But the fact that a doctor who sees dozens of patients a week would make such a comment tells you that they're more the exception than the rule.
The relationship between carrying around too much weight and knee problems doesn't surprise me. During my research for Saving My Knees, I was impressed by how human knee cartilage has made a lot of neat adaptations -- related to obtaining nutrients, dumping waste products, growing stronger -- based on movement and load (i.e., weight). The right amount of loading encourages the tissue to strengthen. Excessive load starts to break it down.
Researchers know this weight-knee pain link exists. During my recovery, while reviewing scientific studies about knee cartilage, I noticed the first thing that researchers did when organizing the results was separate the heavy subjects (higher BMI) from the thin ones. Which is basically a way of acknowledging that of course extra pounds put you at higher risk, so to keep the results relatively clean (and unskewed by this variable), the large people should be segregated out.
What if you can't lose weight? A while back I read a complaint from a girl with knee pain that went like this: "Don't tell me to lose weight! Every time I try to exercise in order to lose weight, my knees hurt!"
Ahem. Reality check. While it's certainly easier to lose weight through vigorous exercise, the best exercise is the one you don't do: repeatedly raising your hand to your mouth to insert food. Eat smarter, better, healthier, and you can lose weight. I managed to do so while living in Hong Kong, and that was at a time when I really had no extra weight to lose.