This study sought to understand ideas around the prevention of knee pain in a group of asymptomatic adults. Most studies focus on people with symptoms, but by selecting this group we intended to explore perceptions about prevention that are not directly influenced by current pain or treatment, thus accessing thinking of a general rather than a clinically defined population.
In order to tackle musculoskeletal disorders as a public health problem it is necessary to understand the lay population’s understanding of the entity. In this instance, ‘knee pain’ is defined in various ways: through notions of intensity and impact on life; character and chronicity, as well as duration. The interpretation of knee pain as a ‘normal’ phenomenon may inhibit people from considering its prevention. This notion may be linked with the previously documented perception, and confirmed by this study, of knee pain as an inevitable and incurable outcome of an aging process
[12, 13]. Three schools of thought were revealed in our study with regards to the prevention of knee pain. First, those individuals who believe knee pain can be prevented; second, those who believe in prevention but are unsure what it entails and third, a group that dissociates prevention from knee pain. The latter two groups should be the targets for public health messages. Prevention may be encouraged through highlighting the potential long-term and wide-ranging impact of knee pain on one’s quality of life, and the benefits of timely preventative action.
Our study population demonstrated a breadth of preventative knowledge, including the use of exercise and pharmacotherapy. Similar to symptomatic individuals, our cohort perceived physical activity to promote health gain, provide symptomatic relief and generate a sense of well-being
. The health benefits of physical activity included joint-specific effects such as improving muscular strength, joint flexibility as well as general effects like weight reduction and control. Reduction in pain and improved mobility featured as principal improvements in symptoms. However, participants also considered exercise as potentially injurious, with fears of subsequent aggravation of disease through mechanical injury, potential reduction in function and exacerbation of pain. Symptomatic populations also display variable opinions on the benefits of exercise
[15, 16] with some individuals reporting increased pain with exercise
. Holden et al.
 found considerable uncertainty about the role of exercise in managing knee symptoms. Barriers and facilitators to exercise and physical activity included those relating to the person (e.g. enjoyment), symptoms (e.g. pain) and social and environmental factors (e.g. lack of facilities, weather). The importance of understanding the limits to exercise has therefore been highlighted in both groups.
While our participants recognised the general benefits of physical activity, they showed a reluctance in taking painkillers, and cited analgesics as being ‘un-natural’ and disruptive of the body’s inborn healing mechanisms. Resistance to taking medication has been documented in other studies
, while willingness to take ‘alternative’ preparations to analgesics has been recorded
. Participants in our study did not have knee pain, but were equally reluctant as symptomatic OA patients to accept pain-relieving treatment
Notions of prevention of knee pain were broadly in line with evidence, and people actively sought out information and ‘ratification’ by peers. Like symptomatic adults prevention was largely seen as an individual responsibility
 even though social and environmental factors were recognised as potentially facilitative.
Returning to the original aim of exploring the perceptions of asymptomatic individuals, the study has highlighted more similarities than differences with people who currently suffer with knee pain. It appears that knowledge about the importance of physical activity has permeated into the general population, and that the two groups only differ in terms of emphasis. A belief in maintaining levels of activity, and integrating these wherever possible into daily routines was stronger in the asymptomatic group. This may be because knee pain is in the background rather than in the foreground
 and being physically active is an actual and positive reality. In terms of the implications of our findings for clinical practice, the use of the NICE OA guidelines in consultations for knee pain appears to fit with lay experiences and those who are symptom free. However GPs and other primary care professionals may not be sufficiently familiar with this evidence and it is important that this is remedied because people consulting for knee pain are open to acting upon many of the recommended treatments.