Can't Get Over the Obstacle? Try Going Around It!
There are many ways to maintain an active lifestyle with knee arthritis. There are several forms of arthritis. In the United States, osteoarthritis is the most common form, and it affects an estimated 21 million adults.
Simply put, arthritis is the result of mechanical wear of a joint. Joints are designed to be very smooth to allow us to move with very little friction. When joints become arthritic, the smooth cartilage surface wears down and the surrounding bone forms spurs. This leads to high friction, unusual pressures, inflammation and pain. When joints become badly worn down, they can often be replaced with artificial materials that restore the joint to a smooth, low friction surface. But, there are also many ways to reduce pain related to an arthritic joint without surgery.Activity Modifications
One of the simplest ways to reduce arthritis related pain is to alter your activities. Weight loss can reduce the amount of stress of weightbearing joints. But, it is often very painful to exercise with an arthritic knee. There are many ways burn calories without putting undue stress on your joints. People with knee pain can benefit from low impact exercises such as:- riding a stationary bike
- swimming
- walking or running in a pool
- use of an elliptical trainer
Bracing and Orthotics
When a knee becomes arthritic, the process of cartilage wear usually starts on either the inner or outer aspect of the knee (more commonly the inner, or medial aspect). A simple shoe wedge can help alter the knee position such that body weight is shifted towards the "good" side of the knee. This can also be accomplished with a knee unloader brace.Physical Therapy
Physical Therapy can be effective in reducing pain from knee arthritis. Pain from arthritis leads to diminished use of the leg, which then leads to muscle atrophy and weakness. Lack of use can also lead to stiffness. Therapy can help one regain range of motion and strength, both of which help with pain reduction.Medications
Tylenol can be very effective at reducing pain from arthritis. More potent pain medicine may be useful for a specific injury, but is generally not appropriate for the long term management of knee arthritis.Anti-inflammatory medications or NSAID's, can also be very effective. Many over-the-counter forms are available and include: Motrin, Advil and Aleve. It is important to be aware that NSAID's can cause side effects including effects on the kidneys and liver. NSAID's can also contribute to thinning of the blood, so people on blood thinners should not take an anti-inflammatory without consulting with their personal physician.
What About Glucosamine?
Glucosamine and Chondroitin Sulfate have gained a lot of attention as nutritional supplements that supposedly reduce pain and protect or repair cartilage. Both substances are naturally found in the body. Glucosamine stimulates the formation and repair of articular cartilage. Chondroitin prevents the degradation of cartilage building blocks.Both substances are sold as supplements in health food stores and pharmacies in pill or powder form. Manufacturers claim that taking glucosamine and/or chondroitin sulfate will reduce pain from arthritis and actually repair or protect cartilage from damage. There have been numerous scientific papers that have studied the efficacy of glucosamine and chondroitin.
In 2005, the Cochrane Collaboration reviewed the use of Glucosamine. The Cochrane Collaboration is an international not-for-profit and independent organization. The organization does systematic reviews of health-care interventions and makes them available worldwide. The 2005 review included 20 studies with 2570 patients. When all the study results were pooled together, glucosamine was not shown to be clearly better than placebo. But, certain types of glucosamine preparations demonstrated benefit over placebo. Glucosamine was generally found to be safe.
In 2006, the New England Journal of Medicine published a large study that reviewed glucosamine, chondroitin sulfate and the two in combination for the treatment of painful knee arthritis. 1583 patients were studied, and the authors concluded that glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in people with knee arthritis. But, they also found that the combination of glucosamine and chondroitin sulfate may be effective in the treatment of the subset of people with moderate-to-severe knee pain. Adverse effects were mild and infrequent.
It is important to note that supplements that contain glucosamine and chondroitin are not analyzed by the Food and Drug Administration before they are sold. A recent study by ConsumerLab.com demonstrated that many commercial products did not contain the amount of ingredients stated on the labels.
In summary, the effects of glucosamine and chondroitin may provide some benefit in some people. The side effects are generally mild.
Injections
Knee injections can be helpful for people who continue to have significant knee pain despite trying the above treatment options. The most common injections that have been found to be helpful include:- steroid injections
- viscosupplementation
Hyaluronic acid is a naturally occurring lubricant in joints. Commercially purified forms of hyaluronic acid can be injected into the knee in an attempt to reduce pain. This is called "viscosupplementation". Viscosupplementation has been used in Europe and Asia for several years, but the U.S. FDA did not approve it until 1997.
Viscosupplementation is usually done in a series of three to five injections. Hyaluronic acid appears to have anti-inflammatory and pain-relieving properties. While some may notice immediate pain relief, most people will notice pain reduction over the course of the injections and after the series is completed. On the other hand, viscosupplementation does not work for everyone.
A 2006 Cochrane review demonstrated that viscosupplementation is effective at reducing pain and improving function, in particular at 5 to 13 weeks after the injections. In some studies, viscosupplementation has been shown to provide more long term effects than steroid injections.
Viscosupplementation is felt to be safe. However, many of the products are purified from rooster combs, so those allergic to poultry products should consider a product that contains an "artificial" form of hyaluronic acid.
There are many ways to live an active lifestyle with knee arthritis. A carefully planned, step-wise approach to knee arthritis can often delay the knee for surgical intervention.
