The knee is a complicated structure made up of joints and cartilage. Knee pain is the most common joint problem for several reasons. The knee is also especially vulnerable to injury which can lead to osteoarthritis. In this article, we’ll get to know all about knee pain, its main causes, knee pain injuries, knee pain treatment with Ayurveda, and home remedies for knee pain relief.
We’ll also share a natural and nutritious diet specifically for keeping the joints and bones healthy and strong. Here’s a list of what we’ll cover in the article.
The Knee Joint
Ayurveda And The Knee Joint
Knee Pain Causes
Knee Pain Injuries
Knee Ligament Injuries
Meniscal Tears + Tendon Tears
Other Symptoms Of Knee Injury
Medical Conditions
Chronic Use + Overuse Conditions
Janu Marma: The Marma Point In The Knee Joint
The Importance Of Janu Marma
The Knee Joint + Sciatica
Knee Pain Causes (Janusandhi shula): An Ayurvedic Perspective
Knee Pain Treatment + Management In Ayurveda
Palliative Therapy (Shamana)
Purificatory Therapies (Shodhana)
Topical Or Local Application (Bahya Prayog)
Knee Pain Relief: Ayurvedic Home Remedies
How To Strengthen The Bones + Knee Joint
When To See Your Health Practitioner
READ MORE: Ayurveda’s Panchakarma Treatment, Therapy + Cost
The knee joint is a compound joint made of two joints, one between the femur and tibia (tibiofemoral joint), and the other between the femur and patella (patellofemoral joint). It is a hinge type of synovial joint. It is the largest joint in the human body which mainly allows for flexion and extension (and a small degree of medial and lateral rotation).
According to Ayurveda, the knee joint is known as ‘Janu sandhi’. It is situated in the lower extremity and forms the junction of the femur (uru or uruvasthi) and tibia bone (jangha or janghasthi).1 It is a type of movable (chala sandhi) hinge joint (kora sandhi) lined with a synovial membrane (sleshma dhara kala) which helps in its smooth movement. Kapha is responsible for keeping the joints firmly united and helps in their movement. Sleshmaka kapha resides in the knee joint.
Now let’s have a closer review of the main causes of knee pain.
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Knee pain can be due to three major reasons.
Let’s look at each one.
Common types of knee pain injuries include knee fractures, dislocations, and contusions.
Knee fractures occur from direct blows to the bones. Patella or kneecap, fractures occur on direct falls onto the knees which results in a crack in the patella or kneecap due to the force.
Knee dislocations are considered extremely traumatic injuries and fall under one of the most serious types of knee injuries. The reason is, that they may be associated with potential neurovascular damage. They occur when the bones that form the knee are out of place.
Dislocations can be due to abnormality in the knee structure.
A knee contusion or bruised knee occurs when the skin of the knee and the underlying tissues suffer a direct blow resulting in capillaries breaking open and spilling blood into the tissues, muscles, and tendons of the knee.
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Knee ligament injuries can also occur. There are four major ligaments in the knee. The ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), the MCL (medial collateral ligament), and LCL (lateral collateral ligament). Each of these ligaments is responsible for the stability of the knee. When one of these ligaments is injured, it is known as a knee sprain. It may occur due to unnatural movements during physical activity.
The anterior cruciate ligament (ACL) is located toward the front of the knee and is the most commonly injured ligament of the knee. Female athletes have a higher incidence of ACL injury than male athletes. This injury occurs mostly when ACL is stretched or torn during a sudden twisting motion.
The posterior cruciate ligament (PCL) is located toward the center of the knee. PCL injury usually happens with sudden, direct impact or blow to the front of the knee while the knee is bent. It occurs mostly in motor vehicle crashes and sports-related contact.
The medial collateral ligament (MCL) is located on the inner aspect of the knee. It is injured more often by a direct blow to the outside of the knee, usually during sports activities. The lateral collateral ligament (LCL), which is on the outer side of the knee, is less often injured.
READ MORE: The Osteoporosis Diet + Lifestyle Plan From Ayurveda
The menisci are two articular discs of the knee joint situated between the thigh bone and shinbone. These pieces of cartilage can be torn suddenly during sporting activities. Meniscal tears may also occur as a result of arthritis or aging. After the initial injury to these parts, pain, swelling, and tightness may increase over the next few days resulting in defective joint movement.
The quadriceps and patellar tendons can be stretched and torn, forming a tendon tear. This is more commonly found among middle-aged people who play running or jumping sports. The most common causes of a tendon tear are falls, direct force to the front of the knee, and landing awkwardly from a jump.
Apart from knee pain, other symptoms associated with knee injury include redness and warmth to the touch, swelling, stiffness, weakness or instability, crunching noises from the knee joint, and inability to fully straighten the knee.
READ MORE: 11 Foods For Osteoarthritis, according to Ayurveda
1. Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition that can affect any joint in the body. It can cause severe pain, swelling, and disability.
2. Gout
A gout is a form of arthritis in which the joint at the base of the big toe is most commonly affected, though it can also affect the knee leading to swelling, pain, and redness. Gout is extremely painful during the acute episodes but during the rest of the time, the knee can be pain-free.
3. Septic Arthritis
In the case of septic arthritis (infectious arthritis), the knee joint can become infected which leads to pain, swelling, and fever.
Osteoarthritis is a joint inflammation that results from cartilage degeneration. It occurs with a wearing down of cartilage of the joint due to use and age. The most common symptoms are joint pain and stiffness.
Patellar tendinitis is an inflammation of the tendons connecting the kneecap (patella) to the bone of the lower leg. It is found mostly in individuals repeating the same motion during any exercise (such as runners and cyclists).
Patellofemoral pain syndrome, also known as ‘runner’s knee’, occurs in front of the knee and around the patella, due to degeneration or stress under the patella where it meets the thighbone (femur). It is found mostly in runners and cyclists.
Bursitis bursae are small fluid-filled sacs containing synovial fluid that cushions the knee joints, reduces friction, and allows the tendons and ligaments to slide easily over the joint. When the knee bursa gets damaged by applying additional pressure, the condition is known as bursitis.
Prepatellar bursitis is also known as housemaid’s knee. It is a painful inflammation of the prepatellar bursa (a frontal knee bursa) and occurs most commonly in athletes and people whose professions require them to spend time on their hands and knees.
Knee pain may disappear by itself. Depending on the underlying cause of the pain, the condition could also progress and lead to more serious injuries or complications resulting in worsening pain or an increasing difficulty to walk.
Janu marma is located at the meeting point of the leg and thigh in the knee joint. The measurement of Janu marma is 5.28 cm (3 angula). It is considered a sandhi marma. It comes under the vaikalyakara marma category two which means the injury to this marma point causes all symptomology and consequences leading to loss of muscle power, restricted movement, limping of the lower extremity and deformity (Khanjata).3
Janu marma controls lubrication of the joints (sleshmaka kapha). The marma of the right knee controls the liver and Pitta is responsible for the color of the blood and bile (Ranjaka Pitta) and the left knee marma controls the spleen, pancreas, and water metabolism (Udakavaha srotas).
Massage to this marma point is done using a gentle circular motion for about five minutes. The central point of this joint is best for acupressure, along with the points immediately above and below the joint.
In sciatica, thermal cautery (Agni-karma) is done by selecting an appropriate point 7.4 cm (four anguli) proximal or distal to the marma and applying a heated metal rod to that point.
For improving liver function, massage this marma point, located on the right knee, with Nalapamaradi oil, Brahmi oil, or plain ghee. Pitta-reducing aromatic oils like lime, myrrh, wormwood, or coriander are used in this area.
For improving spleen function, massage the marma on the left knee with Bhringamalakadi oil or plain sesame oil. Kapha-removing aromatic oils like ginger, lemon, or cardamom are preferred here for a massage. Saffron or turmeric oils can be used for either the liver or spleen.
For arthritis of the knees and Sleshmaka Kapha, warm massage oils like Ashwagandha oil or sesame oil and stimulating aromatic oils like eucalyptus, camphor, or cinnamon are preferred.
In case of any injury, camphor or wintergreen oils may be good for relieving knee pain.
The Ayurvedic sage Sushruta says that the knee joint holds therapeutic importance in the management of sciatica (grudhrasi).5 According to him, bloodletting, a type of detoxification technique done via vein-puncturing (Siravedha) at 7.4 cm (4 angula) either above or below the knee joint (Janu) can give relief to sciatica. In a practical way, this site correlates with the site of the great saphenous vein. The great saphenous vein is 7.4 cm (4 angula) below and above the medial aspect of the knee joint (Janu Sandhi). It may be considered for vein puncture in the case of sciatica.6 Of course this should only be attempted by a qualified Ayurvedic expert with experience in Ayurvedic para-surgical procedures.
Vata imbalance is the main culprit which causes pain anywhere in the body including the knee joint (Janu sandhi). According to the ancient sage Sushruta, Vata situated in the joints causes loss of functioning of joints along with pain and swelling, Besides this, Vata situated in the bones, causes degeneration, cracking, and pain.7 According to the ancient sage Charaka, aggravated Vata in the joints causes edema of the joints which on palpation, appears as if it is a leather bag inflated with air and pain.8 The location (Sthansamshraya) of the vitiated Vata dosha at the knee joint (janu sandhi) results in the development of janu sandhigata vata which is a very painful condition and closely correlates with knee-osteoarthritis.
READ MORE: Vata Diet: Everything You Need To Know
As aggravation of Vata dosha causes knee pain (sandhi shula). The line of treatment then mainly focuses on the alleviation of Vata dosha. This includes oleation (snehana), fomentation or sudation (swedana), oil massage (abhyanga), medicated enema (basti), massage (utsadan), a sprinkling of herbal water over the knee joint (parisheka) and all other Vata pacifying remedies.9
In the case of minor knee injuries, oleation (snehana) as massage, sudation (swedana) with Vata pacifying herbs (with or without vapor) and oil pooling (local vasti) therapy with herbal oil is quite beneficial. In the case of major knee injuries as mentioned above, these therapeutic measures along with intake of herbal preparations are preferred.10
So as you can see, overall Ayurvedic management of knee pain (sandhi shula) can be categorized into three types, palliative (shamana), purification (shodhana), and topical or local application (bahya prayog) therapy.
READ MORE: 29 Marma Points For Pain Relief
Shamana includes Vata-alleviating specific herbs to ease knee pain, aid lubrication, and strengthen the knee joints. Single herbs can also be used for knee pain.
Ginger (Zingiber officinale, Shunthi)
One research study found that ginger extract possesses activity that may help reduce knee pain and aid in walking in clients suffering from osteoarthritis.11 Another research study found that ginger powder was found as effective as ibuprofen, a commonly used nonsteroidal anti-inflammatory drug in alleviating the pain of the knee joint. The study says, ‘Ginger is as effective as ibuprofen in controlling postoperative sequelae, especially pain, and it can be an efficient substitute for synthetic agents’. However, the research also suggested that further studies were needed in this field.12
Turmeric (Curcuma longa, Haridra)
One study specifically examined the efficacy of turmeric as compared to ibuprofen in treating knee pain. This study was done on clients having knee osteoarthritis. They were divided into two groups, one of which received ibuprofen and the other turmeric. At the end of six weeks, both groups demonstrated improvements, though the clients in the turmeric group reported less pain on the stairs. They also performed better while walking. They also reported a higher rate of satisfaction with their treatment and experienced fewer negative effects.13
READ MORE: 50 Ayurvedic Herbs You Need To Know
Indian Frankincense (Boswellia serrata, Shallaki)
According to a research study, Shallaki possesses analgesic, anti-arthritic and anti-inflammatory activities. It also acts as a COX-2 inhibitor and reduces pain and inflammation. In addition, it soothes the joints, lubricates the entire structure, and makes them easy to rotate or move.14 The intake of Shallaki along with application of Shallaki ointment showed enhanced results or a better reduction in pain and inflammation during the study.15
Indian Ginseng (Withania Somnifera, Ashwagandha)
A research study found that Ashwagandha taken for 12 weeks showed analgesic activity in clients with knee joint pain and discomfort. This may be due to higher percentages of withanolide glycosides present in the roots and leaves.16
READ MORE: Will Ashwagandha Help You Sleep?
White Willow Bark (Salix alba)
Preliminary research suggests that willow bark extracts have analgesic, anti-inflammatory, and antipyretic effects. A research study showed that willow bark extract demonstrated moderate analgesic effects.17
Gum Guggulu (Commiphora mukul, Guggulu Kalpas)
Guggulu has properties like unctuous (snigdha), stickiness (picchila), hot potency (ushna virya), Vata pacifying (vatanashka), anti-inflammatory (sothahara) and analgesic (vedanasthapaka). It reduces inflammation, joint stiffness as well as pain associated with arthritis. It also increases joint mobility. It has shown anti-inflammatory and anti-arthritic activities in research.18
Plain Ghee (Ghrita)
Plain ghee in a limited amount is said to contain Vitamin D which plays an important role in utilizing calcium and phosphorus in blood and bone building.19
Compound Ayurvedic Formulations For Knee Pain
For internal use, these remedies may be used: maharasnadi decoction, dashamula decoction, rasnadi decoction, maha yogaraja guggulu, yogaraja guggulu or herbal ghees such as panchatikta ghrita, guggulu and gugglu tikta ghrita.
For external application, these oils may be used: mahanarayana oil, vishagarbha oil, narayana oil, mahamasha oil, saindhavadi oil and bala oil.
READ MORE: Triphala Benefits, Side Effects, Uses, Triphala Dosage, Churna + Guggulu
Shodhana therapy is performed to eliminate toxins from the body. The use of these therapies should be done under the guidance of a qualified Ayurvedic practitioner according to the condition of the client.
Basti
Basti therapy is considered the best management of vitiated Vata. The ancient Ayurvedic sage Charaka refers to oil as ‘marutagana’ which means, it is the best for pacifying aggravated Vata. So, an oil enema is preferred in this condition.20
Oil massage (snehana or abhyanga) and sudation or fomentation (swedana) are local treatments done over the affected part of the knee to alleviate pain, and stiffness and improve flexibility.21
Here are some examples of oil massage (snehna) and sudation (swedana) frequently used for this condition.
Janu Basti
Janu basti is a procedure in which pooling of herbal oil for a fixed duration of time is done in a compartment constructed around the knee joint using wet flour of black gram. Janu basti includes the effect of both external oil application (bahya snehana) and sudation (bahya snehana and swedana) simultaneously. Mahanarayana oil is used frequently for this procedure.23
Pichu
Pichu is an authentic traditional treatment for relieving stress and stiffness of joints. Cotton and linen pads (Pichu) soaked in hot oils are gently placed on the affected knee joints (janu sandhi) for a period of 30 minutes to offer relief from pain and discomfort. The warmth of the soaked pads seeps into the body and induces a deep sense of relief. A short, gentle massage followed by the application of a Vata pacifying herbal pack further alleviates stress, enhances the healing process, and imparts a soothing effect. At least three sittings are required for the maximum benefit.24
READ MORE: Everything You Need To Know About Shirodhara
Poultice Sudation (Upanaha)
Poultice sudation is the local application of a lukewarm herbal paste prepared by mixing the herbal powder into ghee or oil. It reduces local inflammation and acts as an analgesic. Studies have revealed the fact that a lipid medium is highly suitable for penetration of any herbal active component through the skin.25 On this basis, it can be assumed that the oil used in poultice sudation serves as a lipoidal medium for penetration of the active components of herbal paste and exerts an immediate anti-inflammatory effect.
Moreover, heat applied during this therapy increases the local circulation and thus the rate of absorption is also increased.
Patra Pinda Sudation
Patra pinda sudation involves the effect of both external oil application and sudation (bahya snehana and swedana). In this procedure, sudation is performed with a specially prepared bolus of herbal leaves. In this process leaves of Vata pacifying (Vatahara) herbs are cut into pieces and fried with rock salt and a suitable herbal oil. This hot mixture is tied into a cotton cloth as a bolus and applied hot to the skin, which is already smeared with warm herbal oil. Patra pinda sweda is found to be highly effective in the management of pain related to knee joints.26
In addition, when this technique is used in combination with purification (Shodhana) or pacification (Shamana) therapies, it is shown to enhance the therapeutic effect.27
Chaste tree (nirgundi, Vitex negundo) possesses analgesic (vedanasthapana) and anti-inflammatory (shothahara) actions. Its leaves along with castor oil are frequently used for poultice sudation (upanaha) and patra pinda sudation.28
Keep the leg in an elevated position while lying down. Give rest to the body and wear proper fitting shoes. These steps are extremely important to alleviate knee pain.
Here are some more ways which can help in tackling knee pain along with some important measures for keeping the knee joint, bones, and muscles healthy.
1. Moist Heat Therapy
Moist heat therapy causes vasodilatation and penetrates deep into the muscle, reducing muscle spasms and pain. This is helpful for people suffering from knee pain. It can be given for 20-30 minutes using hot water bottles, steam towels, hot baths, or moist heating packs. Hot baths can be especially helpful because it targets both the injured muscles and the surrounding ones that may have tensed up to compensate for the injury.29
One more way found to be effective in relieving knee pain is lukewarm oil massage for 10 minutes followed by hot water immersion or steam bath of the affected knee joint.30 Massage with castor oil for 5 minutes followed by hot water bag application for 5- 10 minutes. This is helpful for reducing knee pain.31
2. Oil Massage (Abhyanga) Of The Knee Joint
Chaste tree (Nirgundi) oil massage may help in a considerable reduction of pain and inability to perform knee joint movements.32 Massage with orange oil, ginger oil, and olive oil has shown a significant reduction in knee pain, stiffness, and enhancement in the physical function of the joint.33
3. Herbal Ointment For Knee Pain
Analgesic effects of an herbal ointment containing cinnamon, ginger, mastic (saghez), and sesame oil were found to be as effective as salicylate ointment, a topical pain reliever.34
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1. Regular Exercise + Optimum Weight
Keep active. Make a regular habit of exercising, swimming, and walking to strengthen the knee joint.
Indulge in low-impact exercises and always do a warm-up before exercising. Take care while running and jumping as during these activities the anterior cruciate ligament and menisci of the knee joint may get injured. Stretch the iliotibial band. Do squats for strong gluteal muscles and to strengthen the hamstrings, jumping as it helps to strengthen the knees.
READ MORE: The Water You Swim In: An Ayurvedic Guide To Pools, Mountain Streams + More
2. Practice Yoga
Yoga therapy reduces ‘rest pain′, early morning stiffness, anxiety, blood pressure, and pulse rate and offers a good value addition as a non-pharmacological intervention in the management of knee pain.35 Regular practice of 60-minute sessions of hatha yoga, three times a week for eight weeks, significantly decreased pain and other symptoms in women with knee osteoarthritis. Scores of daily activities, sports, spare-time activities, and quality of life also increased. Hatha yoga involves consists of movement (asana), breathing (pranayama), and meditation practices.36
Yoga poses such Tadasana, Vrikshasana, Ardhachakrasana, Katichakrasananda, Trikonasana, and Padahastasana are also found to be beneficial in cases of knee injury.37
READ MORE: Watch: 12 Minute Calming Yoga Sequence For Vata Dosha, With Meditation
3. Follow A Healthy Nutritious Diet
Choose foods rich in calcium and vitamin C, D and E. Include sweet (madhura), sour (amla), salty (lavana), and unctuous (snigdha) foods.
A diet good for healthy joints and bones includes the following.
Garlic, ginger, asafoetida, turmeric, black pepper, fish, coconut oil, olive oil, ghee, grass-fed butter, nuts and seeds like almonds and peanuts, flaxseed, whole fruit like cherries, cranberries, pears, prunes, mango, and avocado. Cooked leafy green vegetables, artichokes, carrots, peppers, onions, broccoli, garlic, asparagus, cabbage, chard, collards, lettuce, spinach, string beans, summer or winter squash, sweet potatoes, tapioca and taro (poi). Fat-free milk, milk products, and bone broth are also beneficial.
READ MORE: Butternut Squash Benefits + Vata Pitta Pacifying Soup Recipe
4. What To Avoid
Avoid long periods of fasting and the intake of excess heavy foods or high-calorie foods. Try to avoid awakening at night (ratri jagaran), suppressing your natural urges (vega-vidharana), stress, prolonged standing, overexertion, sitting for long hours, wearing heels for a long duration, and injury to the joints. Limit or avoid excess sugar, hydrogenated oils (soybean oil, cottonseed oil, even canola oil), processed and refined grains, flour products, synthetic additives, processed meats, and fast food.
The above-mentioned Ayurvedic management and home remedies are effective and may provide relief in knee pain and swelling. They are also helpful in arthritis without causing any side effects. However, in cases of intense and intolerable knee pain and in case of knee injury involving an open wound, consult your health care provider immediately.
References
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34. Zahmatkash Comparing analgesic effects of a topical herbal mixed medicine with salicylate in patients with knee osteoarthritis. Pakistan Journal of Biological Sciences, 1 Jul 2011, 14(13):715-719] PMID:22308653.
35. John Ebnezar, Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: A randomized control study.
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37. Pandey Sandhya, Prevention & management of specific sports injuries through Ayurveda International Journal of Yogic, Human Movement and Sports Sciences 2017; 2(1): 04-08.
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