Our knees are the most frequently cited joint experiencing pain. And no wonder, they are engaged in almost every daily activity. We use our knees in everything from a seemingly mundane task like sitting, to walking, running or jumping. But, when is pain something we should be concerned about, and what are our best options for non-surgical treatment?
To best understand why our knee might be causing pain, it helps to understand how our knees work.
Our knee joint is comprised of the following parts:
- Acl - front
- Pcl - back
- Mcl - inside
- Lcl - outside
Cartilage is the substance which covers the end of the bones and acts as a shock absorber. Cartilage has no nerves or blood vessels
When we experience knee pain it is due to issues with the ligaments, bones or cartilage. Causes can be natural aging, weight related excessive pressure, instability due to injury or inflammation such as arthritis.
Cartilage breakdown is the most common issue, as it can affect athletes or the general public. We can think of the wear and tear we experience on our cartilage in a similar fashion to the wear we see on our tire treads. Some actions break down the tire faster, but wear and tear is inevitable.
First Step Treatment Options
In this section we review how our activities, oral medications and injected medicines can help.
Modify your Activity Levels
- Decrease high impact activities
- Cross train
- Use an elliptical
Attend Physical Therapy
- Learn safer ways to move
- Establish good muscle control
- Improve strength
- Best knee brace is a strong Quadriceps muscle
- Practice at home
- Even small weight loss can reduce pressure on the knees
- Find a gym that isn’t intimidating
- Understand your limitations
- See a nutritionist to understand good food options for weight loss and anti-inflammatory properties
- Set realistic goals
- Find a workout buddy
Bracing can be helpful for arthritis in one area
- Osteoarthritis brace attempts to offload the arthritic areas
- Keep in mind the downsides: skin sores; cumbersome; clothing difficulty
Oral Medicines have the ability to reduce swelling and potentially slow degeneration
Nonsteroidal anti-inflammatory (NSAIDS) drugs (Ibuprofen, Aleve, Motrin, Celebrex) reduce inflammation
- Anti-inflammatory properties help with pain
- Questionable influence on cartilage preservation
- Potential complications: GI – ulcers, Elevated blood pressure
- Glucosamine and Chondroitin and Glucosamine Sulfate
In one study glucosamine was found to be as effective as ibuprofen for the treatment of knee osteoarthritis. (Delafuente JC, 2000)
In a double blind randomized controlled trial in which patients were treated with either 1,500 mg/day of glucosamine or placebo for 3 years, the patients in the treatment group showed no significant joint space loss. (Reginster et.al., 2001)
- Chondroitin sulfate - In a number of studies compared to placebo, patients had improvement (50%) in symptoms compared to placebo.|
- Osteobiflex, Joint juice, Move Free, OsteoMove have been found to provide some relief to 2/3 of individuals studied.
Injected Medicines are delivered in the knee joint and provide a strong inflammation reducer and in some cases can slow down degeneration.
You can think of these in a similar fashion to an oil change. It helps things run smoothly, but must be done every 6 months or so. Injections are typically done at an office or surgery center.
- Steroids: Cortisone; Celestone; Depomedrol; Kenalog
- Viscosupplementation: Injecting hyaluronic acid acts as a lubricant and reduces inflammation. Several randomized trials with hyaluronic acid have shown decreased pain and improved function.
- Platlet Rich Plasma contains proteins that support cell growth.
- Stem Cells: Amniotic or placental cells can be used to treat acute or chronic injuries, injuries at risk of not healing and arthritis. When administering stem cells, physicians may use medical imaging, to deliver cells precisely at the site of damage.
Now that you have a basic understanding of your knees, what can go wrong and potential first steps, visit your orthopedic surgeon for options. Your plan will include a combination of lifestyle and medical options.
In the Louisville area, you can find me at Ellis & Badenhausen (502) 587-1236.