Non-Surgical Knee Treatment
The treatment options covered here relate to osteoarthritis, although many of them may be helpful for patients with other knee conditions. Please ask your physician before starting any treatment.
- Physical Therapy
- Modify Your Activities
- Weight Control
- Self-Help/Assistive Devices
- Heat and Cold Treatments
- Nutritional Supplements
- Over-The-Counter Medications
Moderate doctor-prescribed exercise is an integral part of treating arthritis. Joints that are not regularly exercised can become tight and painful. Activities such as walking, swimming or gardening can assist in keeping your bones strong and your joints limber, which may help relieve stiffness. Low-impact exercise will not wear out your joints. Although exercise may sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen the muscles, and prolong the life of your joints.
Aquatic therapy is an excellent form of exercise to help manage arthritis pain. Water’s buoyancy helps protect your joints from impact injury. Water also resists movement, which is helpful for strengthening. Hydrostatic pressure can also assist with reducing the swelling in joints and edema in the legs.
Walking is an excellent form of endurance exercise for almost anyone, including those with arthritis. Be sure to have a good pair of walking shoes to help cushion impact. Check with your physician to obtain any exercise precautions or guidelines. You should be able to speak clearly without feeling out of breath when you are walking. Always warm up and cool down by walking slowly.
How much exercise is too much?
If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue or continuous pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning an exercise program or have changed exercises. Joint pain should not last more than several hours after exercise.
For an in-depth guide on starting and maintaining a walking program, reference Walk With Ease by the Arthritis Foundation.
How do I stay consistent with exercise?
- Seek help from a health care professional to assist you in setting up an individualized program.
- Make a plan! Write it down! Set goals!
- Exercise at the same time each day so it becomes part of your routine.
- Find an exercise buddy.
- Look for an appropriate exercise class.
- Stay in the habit of doing some exercise each day.
- Vary your exercise routine and rotate your exercises.
- Evaluate your progress and enjoy your success
A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your knee joint. However, you should only perform the exercises that are ordered by your surgeon.
Proper body mechanics can lead to less strain on your joints. The following activity modification guidelines may be helpful:
- Practice good posture by standing up straight.
- Avoid stooping while standing.
- Avoid sitting in low chairs to reduce stress on your knees when sitting and standing.
- Avoid impact-loading activities (e.g., running, jumping, etc.).
- Reduce climbing activities (e.g., stairs, hills, etc.).
- Avoid any activity that causes prolonged discomfort.
Being overweight puts weight-bearing joints under extra pressure and stress. Because the joints are eccentric (not in the centerline of your body), the force across the joint is three times greater than a person’s body weight when that person balances on one leg. For example, a 150-pound person places up to 450 pounds of pressure on the joint. The good news is for every single pound lost; subtract three pounds of force off the knee. The bad news is for every one pound gained; add three pounds of force to the knee. Extra pressure on your joints can make arthritic symptoms worse, leading to pain and stiffness.
A well-balanced diet coupled with regular doctor prescribed low-impact exercise can help reduce excess body weight, decrease pressure on the joints and increase joint strength. Many claims have been made concerning diet as a cause of arthritis but none have been proven to date. If you have been diagnosed with gouty arthritis, some dietary restrictions are indicated. Maintaining your ideal body weight will help keep your joints healthy. If you are overweight, ask your doctor to advise you on a weight-loss program to fit your needs.
Simple everyday tasks may be hard to accomplish with arthritis. Utilizing self-help/assistive devices can help. Ask your physician or physical therapist about the following self-help devices.
If you are walking with a limp, consider an assistive device such as a cane, a crutch or a walker. Ask your physician or occupational therapist about different types of assistive devices and which type is best for you.
It is important to use canes properly since you can actually stress other joints with an abnormal gait (walking) pattern. Canes should be used in the opposite hand of the affected joint; for example, hold a cane in your right hand if your problem is with your left leg.
Walkers or Crutches
If you are unsteady with a cane or cannot grip it properly; you may be able to use either one or two crutches or a walker. This will provide support and balance.
The self-help devices listed below can help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:
- Orthotics to improve foot alignment
- Braces for knee support
- Abdominal supports to reduce stress on the back
- Long-handled reachers or grabbers to help you pick things up without bending
- Sock sliders to help you put on socks
Heat or cold treatments may be used to decrease pain and increase flexibility. Heat or cold treatments may be combined with the exercises prescribed by your physical therapist.
You may want to purchase a gel pack that can be kept cold in your freezer or heated in a microwave.
Recently, nutritional supplements have become popular with arthritis patients. Glucosamine and Chondroitin have been the most widely used. Consult your physician before beginning treatment.
Glucosamine is a building block of cartilage and may be found as a hydrochloride or sulfate. It may be useful in strengthening and repairing cartilage. Studies have shown it to be effective in reducing pain, especially painful arthritis of the hands. Glucosamine is not a cure and has not been shown to rebuild cartilage.
Chondroitin Sulfate is commonly taken in conjunction with Glucosamine. It is found in cartilage and acts somewhat like a sponge for the fluid found in cartilage, which makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well.
Vitamins C and D
Some studies have indicated that patients low in Vitamins C and D may have a higher incidence of arthritis. Arthritis patients should take vitamins regularly, or as prescribed by a medical professional.
Some people confuse osteoporosis with osteoarthritis. Osteoporosis is a thinning of the bone, not the joint. High amounts of Calcium is not the cause of osteoporosis but calcium may accumulate in bone spurs around arthritic joints in response to increased pressure on the joint.
Talk to your physician before taking any medications.
Many medications are available to help treat arthritis and can function as a pain-reliever and as an anti-inflammatory to help relieve joint swelling and pain. These medications can lead to improvement in everyday function and quality of life. Always consult your physician before beginning treatment.
The non-narcotic analgesic Tylenol® is generally effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first-line arthritis treatment. Tylenol®, however, does not reduce the inflammation caused by arthritis. Ask your physician about dosing and safety.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be purchased over-the-counter with some common forms being Aspirin, Motrin®, Advil®, and Aleve®. NSAIDs are usually indicated for mild to moderate arthritis pain and may be effective where Tylenol® is not. They are very effective in reducing inflammation caused by arthritis. However, they can also increase your chance for gastric (stomach) ulcers and can alter your blood by affecting your platelets. Therefore, patients with stomach problems, bleeding problems or on blood thinners should not take these medications. Always check with your physician before starting NSAIDs.
Patients with chronic pain may need to take medication daily. However, many may only need to take it when necessary or when they anticipate a strenuous activity that is likely to lead to pain. This may not be true for patients with inflammatory forms of arthritis such as rheumatoid arthritis or lupus.
Many topical creams on the market can reduce pain from arthritis. The American College of Rheumatology does recommend Capsaicin as part of a treatment plan. Capsaicin is thought to help block the release of the body’s painkillers while also blocking a chemical that transmits pain signals. Check with your physician before applying any topical creams.
Talk to your physician before taking any medications.
Cortisone, which is injected directly into joints, may be used to help relieve both swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland. It helps regulate inflammation and when injected into a joint it can relieve or reduce both swelling and pain. Relief usually occurs within a day or two of the injection. Patients do not need to change activities following injections. Many patients elect to receive cortisone injections prior to big events when they will be more active.
Cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to a few times per year depending on the circumstances.
Always consult your physician before participating in any treatment option.
Hyaluronate injections have been approved for arthritis of the knee. They may help relieve osteoarthritis pain and restore joint function. Hyaluronate is a naturally occurring substance in joint fluid that provides lubrication and cushioning to the joint. As osteoarthritis continues to develop, the joint fluid becomes thinner, with less hyaluronate and thus loses its ability to properly lubricate and cushion the joint cartilage.
Several synthetic forms of hyaluronate have been developed to use in the knee joint. In order to be effective, anywhere from 3 to 5 injections must be given weekly. The effectiveness is usually not noticed for at least a month. Patients do not need to significantly reduce activity following injection. Various studies have indicated maximum effectiveness at anywhere between 50-70%. Studies have shown that the more severe the arthritis, the less effective the injections. However, when effective, the relief may last for 6 to12 months. Synthetic hyaluronate is made from rooster combs. Therefore, anyone who is allergic to feathers, chickens or egg products should not receive an injection.
Always consult your physician before participating in any treatment option.
Bionicare is a new, non-invasive therapy (FDA approved) for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand. A wrap is placed on the affected site and attached to a small battery-powered transmitter for six to eight hours every day. The transmitter sends an electrical signal to the hyaline cartilage cells in your joint. This signal has been shown in animals to stimulate the cells to regenerate the cartilage and reduce the inflammatory enzymes that cause pain and stiffness in joints. Although cartilage growth has not yet been proven in humans, Bionicare has been shown to reduce pain and associated symptoms as well as produce overall improvement. A long-term study has shown that treatment with Bionicare can delay the need for total joint arthroplasty in a majority of patients treated for an average of one year.1
Bionicare is based on technology that has been well established over the past 30 years in stimulating bone cells to produce bone. There have been no adverse effects associated with Bionicare, except for a few patients who developed a rash from the gel.
Positive results probably require treatment for 6 months or more. Although it is possible to walk around wearing the wrap during the day, most patients apply the wrap at night.
1 BioMechanics, April 2005; M. Mont, D. Hungerford, J. Caldwell et al.
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