Saturday, January 31, 2015

Knee Pain and the Influence of Genetics

Is knee pain a family affair?

A recent study shows there’s apparently a gene-related link to the development of knee pain associated with osteoarthritis.

The study included 219 subjects, average age 48. Roughly half were the children of parents who had knee replacements; the rest belonged to the control group. The knee pain of all subjects was assessed three times: at baseline, two years later, then eight years later.

Even after the proper adjustments were made to control for such factors as age, sex and BMI, “individuals with a parental history of knee replacement had a more than twofold greater likelihood of worsening total knee pain.”

Interestingly, the adjustments were even made for radiograpic and MRI abnormalities. So that meant researchers were comparing people of similar age, sex and BMI who also had similar-looking MRIs and X-rays. Even then, the offspring of the knee replacement group had a twofold greater likelihood of worsening pain.

The study’s authors speculated that “implies that the genetic contribution to knee pain may be mediated through factors outside the joint, possibly involving pain processing.” I interpret that to mean that, if you’re a child of a patient who had a knee replacement, you may be more likely to experience a worsening of pain simply because you may be more sensitive to it -- an interesting and curious finding.

In any event, I’d argue that the takeaway is that, if you’re in this high-risk group, being proactive about not developing knee pain in the first place makes a lot of sense. Build up the leg muscles around your knees. Find good joint-friendly activities (cycling, walking). Take good care of your knees before they start to hurt.


  1. Hello Richard. I'm reading your book and it is being very useful to me, specially the insights.
    I know that you are not a doctor, but a I have a question: I have cartilage failures at both lateral condyles, that hurt a lot. Do you think that is it possible to restore the cartilage or improve the simptons by moving my knees such as walking? Do you know any case like mine?
    Thank you,

    1. Not sure what you mean by failures -- no cartilage maybe? Can the cartilage be restored? This is tricky. Definitely damaged cartilage can improve. Mine did, I'm pretty sure. And in clinical studies, cartilage has regrown where it was worn to the bone. But it all depends, I'm sure, on how much damaged cartilage you have, and whether you can nurture the joint enough without overstressing it -- which becomes tricky as you have less cartilage at key locations. Still, I'd try some kind of easy movement program, as this should offer your best hope -- slow walking sure, if it doesn't produce symptoms.

    2. Yes Richard. At the end of my thigh I have no cartilage, just like Jim, the guy that you describe at the end of your book. It's not a huge area, but the bone is exposed, what causes me pain. I could undergo to a microfracture surgery, but I will try the easy movement program first.
      Thank you,

  2. Lorimer Mosely is a physiotherapist with a very interesting TED talk about pain sensitivity & the role of expectations. My dilemma has always been how seriously to take knee stiffness & soreness. I tend to cut back on number of steps & squats when maybe I should just be pushing on. I'd love to know what knee soreness & stiifness means.
    I assume it means your joint is not coping with what you are asking it to do. But I do know it gets worse if you back off too much & do to little joint movement.

  3. Interesting! In my case I'm pretty sure genetics have an influence in my knee pain... I have developed chondromalacia ... my father has practically no cartilage at all in both knees ... and now my mother starts to complain about knee pain as well! I've always thought my father had damaged his cartilage for being overweight all his life but I guess I would never know the real cause, maybe genetics + being overweight was the perfect formula for him to destroy his cartilage.
    I've never been overweight, had eaten pretty well all my life, been sporty... and yet here I am with my knee pain. Thanks dad :P
    The funny thing is he had pain for like a month or two, and now he is almost pain free! Bone to bone and almost no pain...myself just a bit of cartilage softening and struggling!
    Aaaah life is hard!

    Take care everyone