CHARLESTON, WV -- Maybe it hurts when you head down the stairs or step off the curb.
Maybe it's worse. You've given up something you used to enjoy, like running or hiking.
As people reach middle age, knee pain is a common complaint.
Have you headed down the path that leads to surgery, with no turning back?
Not necessarily, say local orthopedic surgeons and partners Tony Majestro and Manuel Molina.
Majestro, who operates mostly at Charleston Area Medical Center, has been solving knee, hip and other bone and joint problems for more than 40 years.
Molina, another longtime practitioner, works mostly at Thomas Hospital.
Both say there are several non-surgical ways to address knee pain, including weight loss, appropriate exercise or physical therapy, anti-inflammatory medication and injections.
Majestro starts with an X-ray and conservative treatment.
Medication or injection will reduce the pain and give the knee a chance to heal "if it's a mild injury or aggravation of mild arthritis," he said.
Sometimes no further treatment is needed.
But if the pain persists, he'll move on to order an MRI, a more sophisticated imaging tool.
A scan that reveals clear fluid is an indication of mild arthritis.
"If we see blood, that indicates a torn ligament," he said.
However, a mild tear still can be treated conservatively, perhaps with a knee brace.
Severe tears require surgery.
Most people suffer from "a little wear and tear" on their knees, especially if they're overweight, and Majestro noted that West Virginia has a 30 percent obesity rate.
"One extra pound puts 4 pounds of pressure on the knee," he said. "Twenty-five extra pounds is like carrying a 100-pound sack on your back."
Molina expressed sympathy for those who struggle to lose weight. The exercise needed to take off those pounds "can be hard with stiff, painful joints," he said.
However, a loss of 20 to 25 pounds can mean a significant reduction in pain. Even if the pain persists, exercise will improve joint strength and flexibility and put the patient in better shape for surgery and recovery, he said.
If surgery is indicated and the joint is not completely destroyed by arthritis, the orthopedist can perform arthroscopic surgery, which involves a small incision and use of a camera to let the surgeon see inside the joint and repair as needed.