What Travelers Need to Know About Knee Pain

The evening before my husband and I were scheduled to leave for a safari in Kenya and Tanzania, the previously dull pain in my knee got so bad, I thought I might not be able to make the trip. I wondered if I could manage walking through lengthy airport terminals, sitting in one position during a long haul flight and getting in and out of cramped puddle-hoppers.

Even the prospect of last-minute packing was daunting. Luckily, a friend came over to help me just in case we could make the trip, because cancelling didn't seem like a very viable option either. We hadn't purchased trip cancellation insurance (a lesson learned) and I certainly didn't want to disappoint my travel partner.

The pain didn't come on totally out of the blue. I had previously visited an orthopedist close to home a few weeks earlier who ordered both an X-ray and then an MRI of the knee. After looking at the test results, he said he saw a combination of a torn meniscus and some osteoarthritis. He couldn't be sure which was causing the pain. He suggested conservative treatment to start, with a course of anti-inflammatory medication and a cortisone injection.

But almost miraculously, by the morning of our trip, something kicked in and the pain subsided enough so I felt confident I could handle traveling. Still, I called British Airways to arrange a wheelchair to get me to and from the plane at both ends.

Though it sounds bad, the story has a very happy ending. The pain abated during our travels and the experience of a first-time trip to Africa was beyond our expectations. I was even able to cancel wheelchair transport for the flight home.

It is estimated that persistent knee pain affects one out of four adults in the US and its incidence increases with age. A large, nationally representative study found that symptoms of knee pain, and the prevalence of knee pain and symptomatic knee osteoarthritis tripled over the 20-year period from 1974 to 1994 irrespective of age and weight.

So if you are a boomer or beyond who is about to embark on a long haul flight and you're experiencing knee pain, you're certainly not alone.

Expert Insight

The Hospital for Special Surgery (HSS) in New York City is the world's leading academic medical center focused on musculoskeletal health. Dr. David J. Mayman, MD, is an HSS orthopedic surgeon who specializes in hip and knee replacement; he is also chief of the Surgical Arthritis Service at the hospital. We asked Dr. Mayman what travelers need to know about knee pain. This interview has been edited for clarity and length.

How common is knee pain, and how does it usually present itself?

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Dr. Mayman: Knee pain is very common in the adult population. Most people will experience some knee pain in their lifetime. As you get into your 40s, 50s and older, knee pain gets more and more common. The most common area for knee pain is in the front of the knee. This pain is typically worse when climbing or descending stairs, getting up from a chair or squatting. The pain is often worse after sitting for a long period of time, such as on an airplane, and is usually worse after sitting with the legs bent.

Knee pain can be due to a specific injury such as a torn meniscus or can be due to slow wear and tear of the joint. Wear and tear is by far the most common, and gets more advanced with age. If we think of the cartilage in our knees as being similar to the soles on your shoes, or the treads on the tires of a car, you can imagine how time, age and use can all make these symptoms worse.

Why should you determine the cause of the pain before a long trip?

If you do have pain, you want to know its cause as well as what sort of activities can make it more symptomatic. Knowing that uneven ground, such as walking on cobblestone streets or a sandy beach, can make the pain worse may suggest that you limit those activities. If your pain is more in the front of the knee, then cities with lots of stairs or hills may be more difficult.

Why do long trips on planes or trains aggravate knee pain?

Sitting still with the knees bent for long periods of time can aggravate the pain. Getting up and walking around the plane or train can be helpful. This is easier if you have an aisle or bulkhead seat. Many seasoned travelers suggest buying the best seat you can afford. The most important thing is not to sit in one position for too long. Walking every couple of hours can help.

What preventive measures can a traveler take before flying?

Taking an over-the-counter pain reliever or an anti-inflammatory medication prescribed by your doctor prior to flying can help as well. Cortisone can be a good option for someone with arthritis and a flare of their symptoms. A cortisone injection often takes a few days to really show benefit and the length of time that the injections last is really variable from one person to the next. I wouldn't recommend it for mild pain in the knee, but if the person was having severe pain, it is a good way to help symptoms prior to a trip.

What can travelers do if knee pain develops while traveling?

If you develop pain while traveling you should use all of the standard measures to address the pain. These include:

1. Try to get off of the knee and rest it
2. Apply ice
3. Use compression socks or a bandage
4. Elevate the leg
5. Take acetaminophen, being careful not to exceed the recommended dosage
6. Use anti-inflammatory medications, as prescribed

Of course, if you are experiencing severe pain, you should have your condition evaluated by a medical professional.