Chronic knee pain from osteoarthritis, rheumatoid arthritis, post-surgical changes, or old injuries can make even simple activities difficult. When medications, physical therapy, and injections are not enough, genicular nerve treatments—including genicular nerve block and genicular nerve radiofrequency ablation (RFA)—offer targeted relief. This page explains how the genicular nerves contribute to knee pain, how physicians diagnose problems, and the full range of treatment options.
Understanding the Genicular Nerves
The genicular nerves are small sensory branches around the knee that carry pain signals from the joint to the brain.
By temporarily or permanently interrupting these signals, specialists can significantly reduce chronic knee pain.
Conditions That May Require Genicular Nerve Treatment
Osteoarthritis of the knee – cartilage wear causes pain, stiffness, and swelling.
Rheumatoid arthritis – chronic autoimmune inflammation damaging the joint.
Post-surgical pain – discomfort after procedures such as total knee replacement or arthroscopy.
Knee injuries – old fractures, ligament tears, or cartilage damage leading to persistent pain.
Signs You May Benefit
Persistent knee pain lasting 3+ months despite medications or injections
Pain with movement or weight-bearing (walking, climbing stairs, standing)
Night pain that disrupts sleep
Stiffness or reduced range of motion
Swelling or tenderness around the joint
Locking, catching, or instability during motion
Diagnosis: Identifying Genicular Nerve Pain
A comprehensive evaluation ensures the right treatment:
Medical history – details of pain onset, duration, triggers, prior treatments
Physical exam – checks for swelling, warmth, joint stability, and range of motion
Diagnostic imaging – X-rays, MRI, or ultrasound to assess arthritis, cartilage loss, or other structural problems
Diagnostic nerve block – a small amount of local anesthetic is injected around the genicular nerves.
Significant pain relief after this test confirms that these nerves are the main source of pain.
Genicular Nerve Block: First-Line Interventional Care
A genicular nerve block is usually the first procedure performed once diagnostic testing shows the genicular nerves are the source of pain.
It is minimally invasive, performed in the office or an outpatient setting, and often completed in less than 30 minutes.
How the Procedure Works
Local anesthesia only: The skin is numbed and a small needle is inserted under X-ray or ultrasound guidance.
Targeted injection: A small amount of local anesthetic—sometimes combined with a corticosteroid—is delivered around each genicular nerve branch.
Quick feedback: If knee pain improves significantly in the hours after the block, it confirms the genicular nerves are responsible.
Expected Benefits
Rapid relief—pain improvement within minutes to hours
Diagnostic clarity—guides next steps such as radiofrequency ablation
Temporary but meaningful relief—lasting days to a few weeks; can be repeated if needed
When to Consider Radiofrequency Ablation (Genicular Nerve RFA)
If the nerve block gives clear but temporary relief, the next step is often genicular nerve radiofrequency ablation (RFA).
This procedure uses controlled heat to disrupt the nerve’s ability to transmit pain signals, providing longer-lasting benefit.
Procedure Overview
Preparation: The knee is cleaned and numbed; mild sedation is sometimes offered.
Precision guidance: A thin probe is placed next to each genicular nerve using X-ray or ultrasound.
Targeted heat therapy: Radiofrequency energy creates a small lesion on the nerve to stop pain transmission.
Key Advantages
Pain relief lasting 6–12 months or more
Improved mobility and daily function
Reduced need for oral pain medications, including opioids
Minimally invasive with short recovery time
Possible Side Effects
Mild temporary soreness or swelling at the treatment site
Rare infection or bleeding
Rarely, numbness or weakness around the knee
Integrating Nerve Block and Ablation into a Complete Care Plan
For many patients, the ideal treatment sequence is:
Diagnostic genicular nerve block to confirm nerve involvement
Radiofrequency ablation for long-term pain relief
Ongoing physical therapy and home exercise to strengthen supporting muscles and maintain mobility
Lifestyle optimization—weight management, joint-friendly activities, and ergonomics
Recovery, Prognosis, and Long-Term Outcomes
Genicular nerve procedures are designed to reduce chronic knee pain and help patients regain daily function.
Recovery Timeline
After a nerve block: Most people return to normal activities the same day, with soreness at the injection site resolving in 24–48 hours.
After radiofrequency ablation: Light activity is typically possible the next day; mild swelling or tenderness may last a few days.
Pain-Relief Duration
Nerve block: Temporary relief (from a few days to several weeks), often used as a diagnostic step.
Radiofrequency ablation: Longer relief—typically 6 to 12 months and sometimes longer, depending on individual healing and activity levels.
Repeat Procedures
If pain returns, the nerve block can be repeated or another RFA session performed.
Many patients need only periodic treatments to maintain comfort and mobility.
Complementary Lifestyle & Physical Therapy Strategies
For best results, interventional treatments should be combined with rehabilitation and lifestyle management:
Strength training and flexibility: A physical therapist can create a knee-specific program to strengthen quadriceps, hamstrings, and hip muscles, improving joint stability.
Low-impact activity: Swimming, cycling, or walking on level surfaces to maintain cardiovascular health without overloading the knee.
Weight management: Every extra pound adds pressure to the knee joint, accelerating cartilage wear.
Proper footwear & orthotics: Good shoes or custom inserts help align the knee and reduce stress on the joint.
Joint-friendly daily habits: Using both hands to lift heavy objects, taking breaks from prolonged sitting or standing, and practicing good posture.
Why Choose Maywell Health for Genicular Nerve Procedures
Expertise in advanced interventional pain medicine led by Dr. Brian Mayrsohn.
Image-guided precision (fluoroscopy & ultrasound) for safe and accurate procedures.
Personalized treatment plans combining interventions, physical therapy, and lifestyle coaching.
Whole-person approach addressing both the physical and emotional impacts of chronic pain.
Citations
Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152(3):481-487.
Bhatia A, Peng PWH, Cohen SP. Radiofrequency procedures to relieve chronic knee pain: an evidence-based narrative review. Reg Anesth Pain Med. 2016;41(4):501-510.
Qudsi-Sinclair S, Borrás-Rubio E, Abellan-Guillén JF, et al. Efficacy of genicular nerve radiofrequency ablation for pain contrul in knee osteoarthritis: a meta-analysis. Pain Physician. 2017;20(5):349-358.
