Knee pain can start in 40s. Watch for ‘cinema sign’

People in their 40s and early 50s are increasingly complaining of knee aches, and experts attribute that to lifestyle changes, obesity and high-impact fitness routines. Dr Rajesh Malhotra, orthopaedic surgeon at Indraprastha Apollo Hospitals, Delhi tells Anuja Jaiswal how to protect one’s knees before permanent damage sets in.


Once seen as an old-age issue, knee damage is now showing up in those in the 40s. Why?
Poor lifestyle, obesity, sedentary habits, and desk jobs — especially among IT professionals — increase stress on the knees. Long hours of driving and frequent travel also contribute. Flats without lifts means repeated stair climbing, and Indian-style toilets require deep knee bending, which can aggravate symptoms. Wearing high heels alters knee alignment and increases pressure on joints over time. High-intensity sports, contact injuries and aggressive gym workouts also lead to early joint degeneration. Hypothyroidism can also predispose people to joint problems. In young males, acute pain on one side and swelling may be due to a sudden rise in uric acid levels, as in gout. In young females, it can present as atypical rheumatoid arthritis or undifferentiated arthritis.

What early signs do people usually ignore?
Pain while climbing stairs is a common sign, as is difficulty getting up from the floor. Discomfort after wearing high heels or doing squats, lunges or lifting heavy weights in the gym indicate that the knee joint is under stress. It’s important to seek medical evaluation rather than assume it is normal ageing.

How do long hours of sitting cause pain in the knee?
Yes, very much so. Many patients report stiffness after prolonged sitting — what we call the “cinema sign” — where the first few steps may be painful after sitting in a movie hall for an hour or more. When muscles around the knee are weak, the joint bears more load. Long flights, car journeys, and prolonged driving can also worsen symptoms due to reduced movement. Lack of regular strengthening exercises further compounds the issue.

How does extra body weight affect knees?
Every kilo of extra weight increases one’s knee load by 3-6 kg while walking. Over time, this quickens cartilage wear and tear. Excess fat also increases inflammation, which leads to joint damage. Studies have shown even modest weight loss can reduce risk of knee osteoarthritis and slow its progression. In fact, losing even 5-10% of body weight can meaningfully reduce pain and improve mobility.

Is knee replacement too early for those in their 40s or 50s? When is surgery needed?
Knee replacement is generally avoided in patients in their early 50s or younger as they are likely to outlive the artificial joint, and revision surgery later can be complex. Surgery is considered only when pain severely affects quality of life. I usually assess whether the patient can stand or walk for half an hour without much pain, whether sleep is disturbed, whether painkillers are needed often, and whether daily or social activities are being avoided because of knee pain. If several of these factors are present, surgery may be considered.

What non-surgical treatments work best?
Weight reduction is the most important step. Walking and swimming are excellent low-impact options. Stationary cycling with zero resistance is helpful. Physiotherapy plays a major role. Nutraceuticals like glucosamine or collagen may offer some benefit, but there’s no strong scientific evidence.

We are seeing more gym-related knee injuries. What mistakes are people making?

The most common cause of gym injuries is overuse and high-intensity exercises without adequate warm-up or proper technique. Lifting heavy weights, doing repeated lunges or squats despite discomfort, and increasing workout intensity too quickly are common mistakes. People should listen to their bodies and seek guidance from trained professionals. Upper body workouts and strengthening exercises for the quadriceps, hamstrings and hip muscles are crucial as strong muscles support the joint. But deep squats, lunges, heavy deadlifts and high-speed treadmill workouts with incline can aggravate pain.

What daily habits can protect the knees?
Maintain a healthy weight, walk regularly and strengthen muscles around the knee and hip. Eat a balanced diet and avoid sudden increases in activity levels. Think of physiotherapy and muscle strengthening like servicing your car — it keeps the joint functioning smoothly for longer.