J is a 59 year old male who works as a roofer presents with bilateral knee pain. He was a high school athlete and had his ACL repaired on his left knee 20 years ago. He is currently obese and states the pain is worse going downstairs, with activity, and at night when sleeping. He reports the pain is interfering with his quality of life. He denies any recent injuries and is just here to "get something for the pain". He has not been to a provider for 5 years.
- Past medical history: Hypertension, Obesity
- Past Surgical History: Left ACL repair
- Medications: Lisinopril 10 mg QD
- Family History: Mother had Type II Diabetes. Father had COPD and Rheumatoid Arthritis
- Pertinent Physical Exam Findings: Bilateral knees are slightly swollen without erythema or warmth. No tenderness on palpation. Drawer, McMurray, and Lachman tests are negative. The bulge and ballottement signs are also negative. Mild non pitting ankle edema.
1. Describe the first line nonpharmacological treatment for this patient?
