Putting Knee Pain into
Perspective
Article contributed by:
Dr Lim Yii Hong,
Clinical Director
Inliven Center for
Osteoarthritis Solutions
So you have been
experiencing pain in
your knees for a while
now when you walk,
especially up and down
the stairs, and when you
get up from a sitting or
squatting position. You’ve tried a number of
different things to ease
the pain including
painkillers, knee guards
and heat packs, which
seem to provide
momentary relief, but
the pain still persists. Could it be due to over
exertion? Is it
something more serious
or is it just part of
ageing?
Our knees are one of the
most important joints in
our body as it plays a
critical role in all
movements that carry our
body weight. It is a
more complex structure
than most of us realise,
consisting of skin, fat,
bones, tendons, muscles,
ligaments and synovium
(soft tissues
surrounding the joint).
According to a knee pain
survey by Sanofi in
2012, about half the
Singaporean population
above the age of 18 has
been or is currently
affected by chronic knee
pain1. But the upside to
that statistic is that
by understanding the
cause of the pain and
what can be done to help
alleviate it, you can
continue to enjoy an
active life.
One of the most common
causes of knee pain is
knee osteoarthritis,
which occurs when there
is excessive stress on
the bones and joint
surfaces, causing pain
on movement. The signs
and symptoms of this
condition include:
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Pain in the
joints when doing simple
activities that involve
bending your knees such
as getting up from a
chair, walking up and
down the stairs or
playing sports.
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Inflammation in
the knees.
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Sudden swelling
in the knee joints, with
or without pain.
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Risk Factors for Knee
Osteoarthritis
A common misconception
of knee osteoarthritis
is that it is part of
ageing and that we are
all predisposed to
developing it as we get
older. However, age is
but only one of the many
factors that could
increase the likelihood
of a person developing
knee osteoarthritis. Other risk factors
include:
Sedentary lifestyles
– Movement and exercise
are essential to
strengthen our muscles
and keep our joints
healthy. Therefore, lack
of physical activity
increases the risk of
degeneration of our
cartilage.
Prolonged sitting
– Our muscles become
tight and stiff when we
sit for long periods of
time and this places
stress on the knee
joints when we try to
stand up from the
sitting position.
Weight –
Excessive body weight
increases pressure and
stress on your knee
joints.
Gender – It has
been found that women
above the age of 502 are
more likely to develop
knee osteoarthritis than
men.
Injuries – Trauma
caused by injuries from
sports may increase the
risk of osteoarthritis.
Certain occupations
– Tasks that place
repetitive stress on the
knee joints, without
providing it time to
heal, pose a risk of
developing
osteoarthritis.
Age – The
regenerative-degenerative
balance in our body
changes with time and as
we age our body’s speed
of healing slows down.
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Treatment Modalities for
Knee Osteoarthritis
The main goals in the
treatment of knee
osteoarthritis are to
alleviate the pain and
regain normal function
and mobility. There are
a number of non-surgical
treatment modalities
available today, which
entail a combination of
pain management, knee
bracing, physiotherapy
and strengthening
exercises for
sustainable results. Each patient may have
different causes of knee
pain and it is important
that each treatment plan
is carefully tailored to
fit individuals as there
is no one-size-fits-all
solution.
Pain Management
With the pain you are
experiencing in your
knees, exercise is
probably the last thing
on your to-do list, but
there are a number of
pain management
therapies that can help
alleviate the pain to
enable you to proceed
with physical therapy.
These include
pharmacological pain
management methods such
as oral medication,
hyaluronic acid and
anaesthetic injections,
corticosteroids and
anti-inflammatory
creams, as well as
non-pharmacological pain
management therapies
such as acupuncture,
heat and cold therapies
and ultrasound.
Physiotherapy and
Strengthening Exercises
It is natural to assume
that the right course of
action to relieve knee
pain is to let the
joints rest as much as
possible. But in reality
the treatment of knee
osteoarthritis is all
about maintaining the
right balance between
appropriate physical
activity and rest.
Physiotherapy and
strengthening exercises
are integral parts of
any treatment plan and
studies have shown that
people with knee
osteoarthritis who
continue to exercise
regularly have
experienced sustained
improvement and
reduction in pain in
their knees. This is
because movement helps
to prevent your joints
from stiffening and
restores range of
motion, while exercise
tones the muscles
surrounding the knee and
stabilises the knee. It
is important to consult
a healthcare
professional on
appropriate exercises
that would help to
strengthen your muscles
and not further
aggravate the condition.
Biomechanical
Interventions
Biomechanical
corrections using knee
braces, tape, proper
footwear or insoles can
help to improve gait and
reduce pain by
decreasing stress on the
knee joints. There are
several types of knee
braces such as valgus
knee braces, bilateral
hinge braces and
compressive knee braces,
which provide different
levels of support. The
valgus knee brace, in
particular, has been
clinically proven to be
effective in the
rehabilitation of knee
osteoarthritis by
unloading pressure off
the area of the knee
joint where the
arthritis is at its
worst. More than just
pain relief, this allows
the cartilage layer to
regenerate better.
Nutritional and
Lifestyle Adjustments
It is important to
maintain a healthy Body
Mass Index (BMI) and a
balanced diet throughout
your rehabilitation
process, as excessive
body weight adds stress
on your knee joints. Our
modern day diet tends to
consist of
energy-intensive
processed foods that are
poor in nutritional
value and provide our
body with more calories
than it needs. As a rule
of thumb, aim for your
meals to consist of at
least 50 per cent of
vegetable and fruits.
Certain lifestyle
modifications may also
need to be made to help
improve the recovery
process and reduce the
risk of further
aggravating the
condition. These may
include adjusting your
daily activities to
avoid movements that are
stressful to your joints
and incorporating
physical therapy and
rehabilitation as part
of your daily routine.
The treatment of knee
osteoarthritis is an
ongoing process and
deliberate action needs
to be taken to arrest
the progression of the
condition, so as to
maintain an active
lifestyle.
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References
1. Sanofi Knee Pain
Survey 2012 cited Half
of Singaporeans Hit by
Knee Problems, The
Straits Times, 15
October 2012.
2. Buckwalter JA,
Saltzman C, Brown T. The
impact of
osteoarthritis. Clin
Orthoped Rel Res
2004:427S: S6–S15 cited
Centers for Disease
Control and Prevention,
http://www.cdc.gov/arthritis/basics/osteoarthritis.htm
2013.
Article contributed by:
Dr Lim Yii Hong,
Clinical Director
Inliven Center for
Osteoarthritis Solutions
Dated: December 2013
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Dr Lim Yii
Hong MBBS (NUS),
CES (ACSM)
is the
Clinical
Director of
Inliven
Center for
Osteoarthritis
Solutions,
which
provides
non-surgical
treatments
for knee
osteoarthritis. He is a
general
practitioner
with a
special
interest and
more than 10
years of
experience
in sports, orthopaedic
and
rehabilitation
medicine and
biomechanics. |
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