Knee pain is a common problem and it can be caused by a myriad of things from running and ligament damage to arthritis. 

More than one in five people over the age of 40 have a form of chronic knee pain, according to global estimates.  

But just because it is common, doesn’t mean you should put up with it.

Chronic pain can impact how active you are and experts say basic exercises can significantly help most knee problems.  

Here, MailOnline asks the experts what causes knee pain and how you can treat it.  

Damage to the cartilage inside the knee and ruptured ligaments, which hold the knee together, are common injuries that happen due to trauma. This could be caused by a sports injury, experts say

Causes of knee pain 

In most cases, knee pain is caused by trauma due to a sports injury or at work. 

Damage to the cartilage inside the knee and ruptured ligaments, which hold the knee together, are common injuries that happen due to trauma. 

While cartilage tears can heal on their own, experts warn damage to the ligaments can require surgery.  

But experts say the most common culprit of knee pain differ with age. 

In younger people, knee pain is most often caused by injury or sudden movements that put strain on the knee, leading to sprained or strained knee ligaments, torn cartilage or tendon inflammation from overuse, according to Professor Karen Barker, an expert in physiotherapy at Oxford University. 

‘In young adults knee pain may result from sporting injuries where tendons around the joint, or cartilage inside the joint, is damaged,’ says Professor Philip Conaghan, an expert in rheumatic and musculoskeletal medicine at University of Leeds. 

This pain can be felt at the front of the knee and is usually related to problems with the tendon that the kneecap sits in. It can also be caused by the position of the knee cap. 

He added: ‘Another cause in young people is pain at the front of the knee which can mean inflammation of the tendon that surrounds the kneecap, and this might be more common in people with stretchy joints also known as hypermobility.’

However, for people over 40 knee pain is commonly a sign of arthritis. 

‘For most people over the age of 40, the most common cause of knee pain is likely a mixture of tendon problems and underlying osteoarthritis, the sort of arthritis most people get with age and the accumulation of minor knee damage over many years’, says Professor Conaghan.

The symptoms to watch out for

Swelling, pain and stiff joints are all symptoms of arthritis. 

It affects millions of people across the UK and can affect people of all ages including children.

Professor Barker explained it can cause the joint to feel warm to touch. 

She added: ‘There may be popping or crunching grating noises on movement, known as crepitus.

‘Other signs in more severe cases include an inability to fully straighten the knee and pain on walking or when taking weight through the leg.’

But there are many triggers for knee pain and types of arthritis. 

‘There are many different kinds of arthritis, but we try to distinguish mechanical joint problems, such as tendon problems and osteoarthritis which are very common, from inflammatory arthritis, such as rheumatoid arthritis or gout’, says Professor Conaghan.

Both mechanical and inflammatory joint problems can cause swelling, but there is a difference between the two.  

Mechanical joint problems are often associated with having stiff joints in the first 10 to 15 minutes after getting out of bed or after sitting for a prolonged period of time and then improve with moving around, according to Professor Conaghan.

He said: ‘Generally they get worse the more you are on your feet over the day. We know that people with osteoarthritis often start to get their symptoms when using stairs.’ 

But when it comes to inflammatory arthritis, people experience morning joint stiffness for hours or severely painful acute flares as in gout, he explains. 

Infections including salmonella can also cause an acute inflammatory arthritis with a large swollen knee, experts say. 

Although clicking joints is not usually a cause for concern, Professor Conaghan warns the ‘sensation of the knee “giving way” most often means weak thigh muscles rather than ligament damage’.

Mechanical joint problems are often associated with having stiff joints in the first 10 to 15 minutes after getting out of bed or after sitting for a prolonged period of time and then improve with moving around, according to Professor Conaghan

When should you see a doctor? 

Knee pain that gets worse with movement and pain that does not appear to be getting better, are both warning signs that you should see a doctor.    

Professor Conaghan said: ‘If you’ve had an obvious knee injury with acute and large knee swelling within an hour, it’s worth getting a checkup to see if you’ve torn a knee ligament. 

‘If you develop a lot of knee swelling without any trauma then you may need to see a doctor especially if the knee feels very hot or tender, or you’re running a temperature. 

‘If you have known arthritis like gout or rheumatoid arthritis and you get increased knee pain or swelling, you may need a change of medication.’ 

But Professor Barker says if the ‘onset is gradual or non high impact traumatic injury’ patients should use ice and rest the joint to counteract the swelling and use over the counter pain killers , such as paracetamol, to manage the pain. 

People that are 45 and over and have activity-related joint pain as well as stiffness in the mornings can get an osteoarthritis diagnosis without am X-ray or MRI scan, according guidelines by regulator NICE.

Exercise for knee pain with very weak muscles

Aim: To reduce pain by strengthening the muscles of the thigh/quadriceps. This will also improve standing, getting out of chairs, and walking 

The exercise: 

1. Lie down on flat surface such as a bed or couch 
2. Place a rolled up towel under LEFT knee (bend up other knee) 
3. LOCK the knee by pushing it down hard onto the towel while raising your heel off the bed, while pulling your toes towards your head 
4. Keeping leg locked and straight, hold for 10 seconds 
5. Lower leg slowly and relax for 3 seconds 
6. Repeat Steps 3-5 until your leg is tired or the thigh is aching. Try starting with 10 repetitions 
7. Swap the towel and repeat exercise on the RIGHT leg 

As you improve:

1. Hold the leg up for longer each time
2. Do more repetitions, aim for 30 per side 
3. When this exercise gets too easy, its time to take the towel away and try straight-leg raises (same technique, no towel) 

How often? 

Do these exercises in the morning and evening, perhaps whilst watching TV or relaxing.

Source: Professor Conaghan’s MSK Clinic – Chapel Allerton Hospital

But even after a diagnosis surgery is a ‘last resort’, Professor Barker explains.  

She said: ‘Surgery is a treatment of last resort for knee arthritis and should only be considered with severe osteoarthritis when other measures have failed to help such as weight loss management, exercises, physiotherapy, pain killers and after a minimum of 3 -6 months of non surgical treatment before referral.’ 

Managing knee pain

Knee pain can be caused by weak muscles and sometimes strengthening the muscles around the knee can help.  

‘Sometimes muscle weakness precedes knee pain; weak muscles lead to tendon pains around the knee’, says Professor Conaghan. 

He explains that as we age we lose muscle, this is especially the case in sedentary jobs. 

Plus, people who get knee pain also lose muscle quickly too. 

He said: ‘So, everyone needs thigh muscle strengthening. 

‘The main signs of weak thigh muscles are difficulty getting out of a deep chair or car without using your arms, difficulty getting out of the bath or a sensation of your knee “giving way”.’

But there are a few exercises that can target the right muscles.  

‘The good thing is that for most people, basic exercises can have a profound effect on improving knee pain and also in improving joint function,’ says Dr Darren Player, Lecturer in Musculoskeletal Bioengineering at University College London (UCL). 

Dr Player encourages strengthening and stability exercises, such as knee extensions, stair climbing, simple lying knee bends, static quad exercises and sit-to-stand exercises. 

He said: ‘Based on initial strength, symptoms and the underlying condition, it may be possible to perform more complex exercises, such as lunges which help with strengthening and stabilisation. 

‘Progress should be steady- working towards 8-10 repetitions for each exercise, repeated 3-4 times with sufficient rest.’

But these exercises should not cause acute pain, if they do Dr Player suggests reducing repetitions or sets and include more rest time. 

He added: ‘As with any form of exercise, there may be some pain felt in the days afterwards, but this is part of the natural regeneration process.’

For some people with very weak knees lighter exercises are needed.

Professor Conaghan said: ‘Many people who are very weak may find that walking multiple laps in a swimming pool is an easy way to build muscle. 

‘See a physiotherapist to give you one or two thigh muscle exercises to do everyday, such as straight raises when lying down. 

‘The key is to get into a habit of doing your muscle strengthening exercises and, as you get stronger, to move to more aerobic muscle strengthening exercises like exercise bikes or cross trainers.’

So you think you know what’s cool? Top 100 brands favoured by children are revealed with Netflix, YouTube and McDonald’s leading the way – and a few surprising entries you may not have expected

• Lego, Spotify and TikTok all found places in the top 100, as did Greggs 

By Elizabeth Haigh

Published: 06:45 EDT, 16 August 2023 | Updated: 07:45 EDT, 16 August 2023

The top 100 coolest brands favoured by children have been revealed with Netflix, YouTube and McDonald’s leading the way – joined by rather surprising entries.

Lego, Spotify and TikTok all found places in the top 100, with some less expected brands such as Greggs, Oreo and The North Face also making appearances.

The list, compiled by Beano Brain, the consultancy wing of the comics firm, is the second edition and has seen many new entries which has shaken up last year’s results.

Researchers spent a year speaking to 120,000 UK children aged 7-14, or Gen Alpha, as well as observing the clothes they wore and brands they used, before compiling the final list.

But in a blow to British companies, no UK firm featured in the top 30 with Harry Potter featuring as the first UK entry at 32. 

Netflix is the coolest brand for 7-14 year-olds, the research found

This was followed by Greggs, which entered the list for the first time at 34, Sports Direct at 40 and JD Sports at 47. 

The BBC has fallen 28 places in the cool league tables despite its efforts to pull in younger audiences, the largest drop of any company.

It is now just the 71st coolest brand among those aged 7-14 in a list in which no British brand made the top ten. 

Just scraping into the top 100 were Home Bargains, Under Armour, Oculus, Shein and Wagamama. 

Overall, almost 30 percent of the list is made up of food and drink brands, 26 percent retail and 23 percent gaming. 

Helenor Gilmour, Director of Insight, Beano Brain, said: ‘Netflix reigns supreme as the king of the streaming services. Its ever-changing catalogue means kids feel it’s impossible to tire of the streaming platform.

‘There is something for everyone and every mood and it opens a door for kids to explore the world beyond their doorstep. 

‘They can discover captivating content from across the globe and feed their desire for darker themes with shows like the hugely popular Wednesday and Stranger Things series, which provided universal thrills for kids and adults alike, with a feel-good side of nostalgia for the latter.’

She continued: ‘Kids love brands with salience and a clear proposition. It’s why Nike (Just Do It!) is cooler than Adidas and why Pringles, with their mouth-pleasing texture and shape are cooler than Walkers.

‘Kids love a sense of occasion from Apple releases to the ritual of Oreo dunking and they love sharing these with their families. 

‘Brands that are there at key life moments will rank highly for cool. McDonalds scored well for their FIFA World Cup promotions and Fun Football Centres while Nike is King when it’s back to school.

‘Gen Alphas are the original YouTube generation raised on influencer collaborations, and so their discovery and loyalty are often driven by collaborations such as Nike Chunky Dunkys in collaboration with Ben & Jerry’s.

‘And let’s not forget, Gen Alpha are still finding their way and shaping their own opinions, and they really get behind brands that are brave such as Disney tackling puberty in the movie Red or championing diversity in the live action Little Mermaid.’

Top 100 coolest brands 2023 

1. Netflix

2. YouTube

3. McDonald’s

4. Nike

5. Oreo

6. Nintendo

7. Pringles

8. Disney

9. Roblox

10. Coca Cola

11. Apple

12. Amazon

13. Lego

14. Skittles

15. Doritos

16. Adidas

17. KFC

18. Pepsi

19. Google

10. Spotify

21. Tiktok

22. Jumpman

23. Pizza Hut

24. Domino’s

25. Doritos

26. Playstation

27. Xbox

28. Minecraft

29. Cadbury

30. WhatsApp

31. Haribo

32. Harry Potter

33. M&Ms

34. Greggs

35. Starbucks

36. Burger King

37. Snapchat

38. Smyths

39. Sour Patch

40. Sports Direct

41. Dunkin Donuts

42. Sprite

43. Fifa

44. JD Sports

45. Tesco

46. Primark

47. Squishmallows

48. Kinder

49. Nerf

50. Costa Coffee

51. Monopoly

52. Marvel

53. Game

54. Epic Games

55. Instagram

56. Pokemon

57. Nando’s

58. Star Wars

59. Puma

60. Snickers

61. Fortnite

62. Asda

63. H&M

64. Ikea

65. Smiggle

66. Microsoft 

67. Sainsbury’s

68. Argos

69. Next

70. Walkers

71. BBC

72. Mojang

73. Animal Crossing

74. EA

75. WH Smith

76. The North Face

77. Five Guys

78. Fitbit

79. Jolly Rancher

80. Hot Wheels

81. Ebay

82. Prime

83. River Island

84. Crocs

85. Lidl

86. Pinterest

87. Rocket League

88. New Look

89. Converse

90. Aldi

91. Claire’s

92. B&M

93. ZARA

94. Mini Brankds!

95. The Entertainer

96. Home Bargains

97. Under Armour

98. Oculus

99. Shein

100. Wagamama 

My husband has suffered with flatulence for some time but it has worsened over the past few months. He doesn’t eat excessive amounts of fruit and veg. Can you suggest any steps we could take to resolve this?

Name and address supplied.

We all have gas in our intestines, produced by our gut microbes breaking down food, and much of it has to be passed in moments of flatulence (passing wind anything up to 20 times day is considered normal).

But you say in your longer letter that the odour is offensive. The main culprit for smelly flatulence is the gas hydrogen sulphide, which smells like rotten eggs.

In fact, we know from research that this particular component of wind is actually good for us.

The main culprit for smelly flatulence is the gas hydrogen sulphide, which smells like rotten eggs (File image)

A study in the journal Nature Microbiology published last month showed that hydrogen sulphide improves the health of the intestinal lining.

It’s previously been found to act as an antioxidant, protecting cells from damage; it also encourages greater resistance to certain infections.

Despite this, it’s worth noting that some foods do contain more sulphur, which is broken down into hydrogen sulphide by the bacteria in the gut — and restricting those foods may, to some extent, help manage gas production.

These include meat, chicken, eggs and vegetables such as cabbage, leeks, broccoli, onions and garlic.

Of course, these are just the sort of foods that help feed the good bacteria in the gut, so you don’t want to cut them out altogether.

I suggest that it’s worth bearing in mind that the embarrassing problem your husband has may actually give him some advantage in respect of his health. Perhaps, knowing this may help change your attitude to it.

I have had a glaucoma test every year for 40 years. I’ve now been told to go every two years, because of Government cutbacks. I was advised if I want to have them yearly, I would have to pay. What do you advise?

Eddie Marsh, Newbury, Berkshire.

Thank you for writing in about what is such an important subject to so many people. Around half a million Britons have glaucoma, which typically leads to a slow decline first in the edges of your vision. Left untreated, this may ultimately result in blindness.

The problem is that, in the early stages, vision loss is so slow as to be almost imperceptible; other characteristic symptoms such as blurred vision may not be apparent until the later stages.

Around half a million Britons have glaucoma, which typically leads to a slow decline first in the edges of your vision (File image)

That is why screening — checking everybody with or without symptoms — is so important. There are various types of glaucoma: the most common is known as silent primary open-angle glaucoma. Here, fluid in the eye (the aqueous humour) builds up, causing an increase in the pressure within the eye.

We used to think this pressure caused irreversible damage to the optic nerve which sends vision signals to the brain — but recent thinking is that glaucoma stems from a disorder of the optic nerve.

This then damages the control of fluid in the eye. And this pressure then further damages the optic nerve, leading to a gradual loss of vision at the edges of vision which gradually closes in. (Another form, narrow-angle glaucoma, comes on quickly, causing a painful red eye and needs urgent treatment.) Although glaucoma is most common in adults over the age of 70, anyone over the age of 40 who goes for an eye test will be examined by an optician for it.

This involves measuring the pressure in the eye, and checking for deterioration in the peripheral vision. Best practice is to be screened for this every two years — the fact that glaucoma progresses slowly means there is nothing to be gained by testing more frequently. This is not so much a cutback as a sensible policy to ensure that, at a time of limited resources, nobody is missed out.

Those at higher risk — people who have a close relative with the diagnosis — will be advised to have more frequent screening.

If glaucoma is diagnosed then you need to be immediately referred to an ophthalmologist: after further tests, most people would then be started on regular eye drops that reduce the pressure in the eye and the potential for ongoing nerve damage.

My view is that it is acceptable for you to be screened every two years. I understand you are not confident in this but if the pressure in your eyes has been stable and if there has not been a gradually increasing trend over the years, then I think you have little to fear.

Write to Dr Scurr 

Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk — include contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries. 

Establishing the difference between Great Britain, the British Isles and the United Kingdom can cause confusion even among Britons.

The region, off the northwest coast of mainland Europe, has a collective history with a long list of terms to refer to different areas, both geographically and politically.

Scroll down to learn more about what differentiates them – and never mistake Britain for the UK again!

UK vs Great Britain (or Britain)

Great Britain, or simply Britain, is not a country but an island made up of England, Scotland and Wales.

It is referred to as ‘Great’ because of its size, being the largest island in the British Isles according to Historic UK.

Great Britain is made up of England, Scotland and Wales, while the island of Ireland comprises Northern Ireland and the Republic of Ireland

Like Great Britain, the United Kingdom comprises England, Scotland and Wales, with the addition of Northern Ireland.

However just to confuse matters, the term Britain is sometimes used to refer to the UK as a whole, as noted by Britannica.

Is the UK a country?

The UK Prime Minister’s official site describes the UK as ‘countries within a country’, as shown by the National Archives.

To break this down, the UK is an independent ‘island country’ which is made up of four nation countries – England, Scotland and Wales (also known as Great Britain) and Northern Ireland.

The UK is also referred to as a sovereign state where Parliament has ‘supreme legal authority’ to ‘create or end any law’, according to the UK Parliament website.

‘For Americans, the best analogy would be that the UK is like the USA, whilst its four consistent countries are like states,’ says Historic UK.

England, Scotland and Wales make up Great Britain while the United Kingdom also includes Northern Ireland. The Republic of Ireland is an independent country of its own. They are all geographically located within the British Isles, though this is a controversial notion in Ireland

British Isles

The British Isles is a geographical term used to refer to a collection of more than 6,000 islands.

‘The group consists of two main islands, Great Britain and Ireland, and numerous smaller islands and island groups, including the Hebrides, the Shetland Islands, the Orkney Islands, the Isles of Scilly, and the Isle of Man’, Britannica says.

‘Some also include the Channel Islands in this grouping,’ it adds (more on this below).

British Isles – an Irish perspective

Pictured is Dublin, the capital of the Republic of Ireland 

‘Although the term British Isles has a long history of common usage, it has become increasingly controversial,’ Britannica explains.

This applies ‘especially for some in Ireland who object to its connotation of political and cultural connections between Ireland and the United Kingdom’, it adds.

The Irish government has not supported the use of the term ‘British Isles’ since September 2005.

Speaking at the time, then Foreign Affairs Minister Dermot Ahern said: ‘The British Isles is not an officially recognised term in any legal or inter-governmental sense. It is without any official status.’

Mr Ahern’s famous comments are quoted by Sean Moncrieff in his book ‘The Irish Paradox: How and Why We Are Such a Contradictory People’.

England vs Wales vs Scotland

The UK Parliament (above left) is based in London, in the House of Commons and the House of Lords 

The UK Parliament – made up of the House of Commons and the House of Lords in London – is ‘the supreme legal authority’ that can ‘create or end any law’, according to the UK Constitution.

However, Wales and Scotland both have parliaments with a certain level of autonomy. And though the English and Welsh legal systems are bound together, both Wales and Scotland can create their own laws.

For example, the drink-drive limit and the legal hours for buying alcohol are stricter in Scotland than in England and Wales.

Arson and manslaughter do not exist as offences in Scotland, where they are referred to as ‘wilful fire raising’ and ‘culpable homicide’ retrospectively, according to the Scottish Parliament.  

Ireland vs Northern Ireland vs Republic of Ireland

Ireland is an island located to the west of Great Britain, which is separated by the North Channel.

The island is the second largest in the geographical area of the British Isles, after Great Britain.

It is made up of two countries – Northern Ireland and the Republic of Ireland.

Northern Ireland forms part of the UK, which is no longer a part of the European Union.

While the Republic of Ireland is its own independent country and remains one of 27 members of the EU bloc.

All of the island of Ireland was part of the UK from 1801 to 1922. 

Where do the Channel Islands fit in?

The Channel Islands are not part of the UK but are dependencies of the British crown

The Channel Islands have been ‘dependencies of the British crown’ since 1066, according to Britannica.

Located off the coast of France, they are not a part of the UK and are self-governing with their own customs and laws.

The four main islands are Jersey, Guernsey, Alderney, and Sark.

Some say the Channel Islands are a part of the British Isles including the official website of the British Royal Family, which refers to them as ‘self-governing possessions of the British Crown’.

While others argue that they are not included because they are physically a separate archipelago from the rest of the isles.

The Channel Islands were the only British territory to be occupied by the Germans during World War II, Britannica adds.