The complicated structure of joints and cartilage coupled with a lack of protection makes knees especially vulnerable to injury. Knee injuries in turn can lead to osteoarthritis (OA), a form of arthritis that affects your joints. In fact, half of all baby boomers who suffer tears to knee ligaments and cartilage will develop OA in as few as five years, says rheumatologist Patience White, M.D. Other conditions that make knees more prone to pain: bursitis, tendinitis, rheumatoid arthritis, and the inevitable wear and tear due to age. 

While you can’t reverse the effects of knee damage or arthritis, you can slow them down. You may even stave off surgery, and save yourself thousands of dollars. The best time to do it is now — before the pain gets so bad you no longer can do what you love.

1. Discover the cause of the pain

If your knee hurts, make an appointment right away with your primary care physician, recommends Dr. White. The sooner you discover the cause of the pain, the sooner you can treat it and get relief. 

The best thing your doc can do is refer you to a physical therapist, who will give you specific strengthening exercises. “The earlier you can come in and build strength in your knees, the better chance you have of avoiding surgery,” says Robert Agosto, DPT. In fact, a study in the New England Journal of Medicine found that physical therapy was as good at easing pain and improving range of motion as knee surgery for people suffering from OA or a torn cartilage. And while a third of the 351 patients (all over 45) did eventually get surgery, the study showed that physical therapy is a good first option. And a cheaper one, too. 

2. Shed pounds

Sure, it’s a no-brainer, but knees bear the brunt of your body weight — and every pound you gain is the equivalent of four pounds of pressure on your knees. “So if you gain ten pounds, it’s like forty pounds across the knee, which is why the knees are so susceptible to weight problems,” says Dr. White, who’s also a professor at George Washington University School of Medicine.

You can cut knee pain in half — as well as your risk of osteoarthritis — by losing 10 or 15 pounds, she adds. But even shedding one pound can help — if you couple weight loss with staying active. Osteoarthritis doesn’t necessarily have to go hand-in-hand with getting older, she adds. 

3. Target key muscles

The key to preventing wear and tear is building up the muscles in the front and back of your thighs — the quadriceps and hamstrings. Warm up first by walking around the house or on a treadmill and then try these exercises, recommends Agosto: 

Short arc quad: 
This one’s easy, but great for people who need to ease into knee exercises. Lie on your back with your knee resting on a rolled towel. Tighten your thigh muscles while lifting and straightening your knee slightly. Hold for five seconds. Repeat with the other leg.

Wall slides: Using a wall can be a gentler, safer way to build up your quadriceps. For slides, press your spine against the wall and slide into a sitting position as far down as you can comfortably go. Hold for a few seconds, then slide back up. Work up to longer holds and more reps.

 This exercise boosts hamstring strength (as well as strengthening your core and butt). Lie on your back with your feet flat on the ground, and knees over the heels. Lift your pelvis off the ground. The aim is to make a straight line between your knees and your shoulders.

4. Be gentler when you exercise

Running on roads can jar your knees, while a jog through a wooded trail carries the risk of falls and twists to knees and ankles. A better way to run is on a treadmill or track, or alternate jogging with walking, Dr. White suggests. Biking doesn’t put as much strain on your knees, but it can cause pain if you ratchet up the resistance too high on a stationary bike or the saddle is pushed back too far or is too low. 

If you bike a lot outdoors, you might want to spring for a professional bike fitting, which can help you with seat and handlebar height and pedal strokes. Whatever exercise you do, just remember to warm up.  You lose muscle strength as you get older — especially if you sit at a desk most days — and that just increases your chances of injury when you head out to exercise. 

5. Spice things up

Inflammation can exacerbate knee pain — as well as increase the risk of chronic conditions like arthritis, says Beth Reardon, RD, former director of integrative nutrition at Duke Integrative Medicine Center in Durham, NC.  While pain relievers like aspirin and ibuprofen can inhibit the COX enzyme, a key player in inflammation, certain foods and spices can too. Chief among them is quercetin, a flavanol found in apples, onions, and green tea. Turmeric, cumin, ginger, and capsicum, found in red pepper, are also high in anti-inflammatory properties, says Reardon. 

To get the effects of these anti-inflammatories, drink at least three cups of green tea a day and add these spices into your cooking rotation. Also eat more fruits, vegetables and fish that are high in omega-threes, like salmon.

6. Ditch the heels — and the flats

“High heels aren’t good for your knees, they’re not good for your feet. The lower the heel, the better,” says Dr. White, who recommends footwear with heels no higher than two inches. Also bad for knees: Shoes with no arch support, like loafers and ballet flats. If you love the ease of either, get over-the-counter inserts that can provide a bit more support. And if you walk a lot, splurge on a good pair of kicks that can really cushion your steps. Then slip on those heels or loafers once you get to your destination, says White.

7. Keep a food journal

In some people with OA, eating foods like eggplant, tomatoes, and citrus can cause painful flare-ups, while others get a reprieve from their symptoms, explains Reardon. That’s why it pays to keep a record of what you eat and how you feel each day, she suggests. Or you can experiment with various foods. Eliminate tomatoes, potatoes, eggplant and peppers for three weeks, and record your symptoms. Do the same with citrus. Then add each food back gradually and see if the pain worsens. 

8. Try supplements

Two supplements that promised pain relief to people with osteoarthritis have gotten mixed reviews from observational studies — glucosamine, found naturally in shellfish and animal bones, and chondroitin, made from animal cartilage. Both seem to benefit some people with OA and not others. “I don’t have any trouble with people trying either, especially if they help. But if they don’t, save your money,” says Reardon. 

Instead, check out Zyflamend, a blend of anti-inflammatory spices like rosemary, green tea, ginger, turmeric, and Chinese herbs. The OTC supplement has been found to relieve pain in people with OA. “We should be eating more of those foods, but if you don’t then that’s one supplement I would recommend anybody take,” Reardon adds. The reported side effects: A bad taste in your mouth, heartburn and diarrhea.

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