As a woman living with Hashimoto’s, have you ever had knee pain which comes and goes without any rhyme or reason? You’ve noticed there’s no logical cause for the knee pain, like stepping off a curb wrong, twisting your knee getting off the floor, or pushing yourself too hard at the gym. Your knees simply ache without a clear or definitive “mechanism of injury,” or MOI.

As a chiropractor for the last 13 years and as a woman who has Hashimoto’s (now in remission), I see knee aches flare-up in women with Hashimoto’s every single day. Their knee pain often goes hand in hand with other common symptoms of Hashimoto’s including but not limited to: anxiety, weight gain, gastrointestinal issues, mood swings, fatigue, depression, cold hands and feet, and brain fog.

Hashimoto’s often goes undiagnosed in women, and these patients are sometimes mistakenly sent to the orthopedist and physical therapy, without ever getting to the root cause of the knee pain.

Doctors are good at hunting down a host of biomechanical causes of knee pain. Everything from structural abnormalities, torn ligaments, nerve damage, and dysfunctional movement patterns, while the possibility of inflammation related to an autoimmune condition is often overlooked. This is a true disservice to women with Hashimoto’s.

Finding the time and energy to attend physical therapy three times a week combined with feeling even worse during traditional exercises can lead to even more frustration and discouragement amongst women with Hashimoto’s.

You might be someone like me who used to take NSAIDS like Ibuprofen or Aspirin for my knee pain, but ladies, there’s a better way. While over the counter medications are effective at reducing inflammation in the short run, they won’t get to the root cause, and the knee pain will eventually return. The steps I took to help my knee pain gave me relief within a month, even while living with Hashimoto’s.

Signs and symptoms of knee pain with Hashimoto’s

Women often report knee pain while going upstairs and especially going downstairs. As you take a step down the stairs way, there is more load and more work from the quadricep muscle, especially where the infrapatellar tendon meets the bone. This additional load on the muscle while it lengthens can pull on the knee cap and irritate an already inflamed knee joint.

Sometimes the women I meet with Hashimoto’s have such severe knee pain that even putting slight pressure on the knees can cause a flare-up. They even avoid getting down on the floor for fear of not being able to get off the floor. Does this sound like you?

Knee pain will come on and go and often moves around the body. These aches and pains around the knee joint can exist as muscle tension, tenderness and stiffness. In other extremity joints like shoulders and hips, swelling of the small joints of the hands and feet, or carpal tunnel syndrome.

Knee pain living with Hashimoto’s is often accompanied by knee effusion or a build-up of fluid inside the knee joint. Effusion can make the knee feel like the following:

• As if it’s floating
• Unstable
• Stiff
• Has a limited range of motion in a deep knee bend (flexion) or full knee straightening (extension)
• Locked when getting up from sitting

Unsure if you have swelling in your knees and want to test for this on your own? These are simple orthopedic tests used by orthopedic specialists but can be easily replicated at home. These 2 tests are:

The Bulge test

Sweep your hand up the inside of your knee, then sweep your hand along the outside of the knee down towards your shin. As you sweep down the outside of your knee, if a bulge of fluid appears on the inside of your knee, there is synovial fluid build up in the knee joint.

The Baker’s Cyst Check

Feel the back of your knee and compare it to your other knee. You may feel a lump, like a water-filled balloon, behind the knee that becomes more obvious when the knee is straight. While this is not a medical term, a feeling of “bogginess” behind the knee is what I often describe to patients. Women with Hashimoto’s in my clinical experience will have knee pain in both knees but swelling will be more significant in just one.

Hyper-mobility and Knee Pain

While hypermobility has not been researched to be directly tied to Hashimoto’s, clinically I find the women I meet with Hashimoto’s to have hypermobile joints. This increased range of joint motion and often joint range that goes beyond what is normal adds a layer to the pain picture. When the joints and especially the knees are hypermobile, muscles around the knee will feel tight because they are trying to hold together the unstable joint.

What we do know definitively is women with Hashimoto’s have a harder time maintaining their muscle mass. This makes it more difficult to protect the hypermobile joints. So a tendency towards low muscle mass and a possibility of hyper-mobile joints, it’s understandable that knee pain is a common finding in women with Hashimoto’s.

A hypermobile knee can drive into too much extension and also rotate inwards as if the knee caps are wanting to look at one another. This places extra strain on the popliteus muscle leading to pain behind the outside of the knee and gets overworked at the end range of extension. Another muscle often overworked with hypermobile knees is the IT band which also creates pain on the outside of the knee. The strain on both of these muscles can be tremendously painful. Keep in mind rehabilitation of the knees without treating the thyroid is a long road with minimal results.

How to heal knee pain

When you have knee pain, stiffness or visible swelling, what do you do? My goal is to give you the tools for you to try at home to relieve the pain and inflammation. 

Exercise Recommendations for Hashimoto’s

A 2015 study showed just one hour of exercise each day improved thyroid function of patients with treated hypothyroid compared to those who did not exercise at all. The exercises prescribed in this study were running and/or playing sports, but I think the choice of exercise can be done with even more intentionality and strategy.

I recommend an exercise routine that focuses on maintaining strong muscles to help support and protect your joints, promotes a healthy range of motion of your joints and boosts your energy.

Strength training, which by my definition means physically picking up a weight with the correct form, putting it down and doing it again and again. This helps stabilize those hypermobile joints as well. I’m not referring to bicep curls, tricep dips, and lateral deltoid raises. Instead, I’m referencing compound movements aka full bodywork as opposed to a single muscle group. I suggest what I call the Essential 7 moves to get the entire body working.

Rehabilitation exercises for Hashimoto’s

I call this pre-hab, but you can call it a warm-up or preventative rehab. An exercise to prime the body before picking up a weight. This pre-hab is strategic in warming up the body with the breath, turning on the core with a brace, and moving the body in all three planes of motion since so much of our day is stagnant in one plane of motion.

I prefer a warm-up that taps into the part of the brain which stores our movement patterns similar to the patterns we learned during the first two years of life. We didn’t walk before we learned to crawl, and we didn’t crawl before we learned to bring our knees up to 90 degrees. A solid pre-hab warm-up should mimic our developmental patterns to prime the brain to get ready to lift.

Meditation for Hashimoto’s

Meditation doesn’t have to look like a monk on top of a mountain sitting cross-legged. Try sitting in a comfortable chair or lying on your back. Chronic pain is stressful and studies show that mindfulness meditation may help reduce sensitivity to pain.

Chronic stress and chronic pain are closely linked in the brain. One of my favorite schools of meditation comes from Emily Fletcher’s Ziva Meditation. It’s not for the monks up on the mountain, but for everyday people who live busy lives.

Supplements for pain relief with Hashimoto’s

Magnesium

For muscle aches, magnesium helped immensely. I dosed my magnesium in two different ways: first, Epsom salt baths, and the second: an oral combination of magnesium citrate, magnesium glycinate, and magnesium malate.

Fish Oils

Omega 3 fatty acids, in particular, have shown to anti-inflammatory benefits. One study showed Omega 3 to be equally effective at pain reduction as NSAIDS, especially in people with neck, back, and arthritic pain.

Tumeric

The women I’ve seen with Hashimoto’s swear by their Tumeric supplements to keep their knee pain at bay. Tumeric has shown to reduce pain and the active ingredient curcumin has anti-inflammatory benefits as well.

Ladies, knee pain with Hashimoto’s doesn’t have to be a lifelong struggle. Try the recommended movements, the supplements, meditation, and let me know how you feel. My hope is for the pain you feel the next time you kneel on the floor becomes a distant memory.

I hope you can chase your kids upstairs without fear and live a pain-free life. For every exercise on how to strengthen the knees and never live with knee pain again, check out Thyroid Strong, the only online exercise program for women living with Hashimoto’s. I put my own Hashimoto’s into remission with cleaning up my diet and strength training and have helped women every day live a pain-free life doing the same.

In Good Health,

Dr Emily Kiberd