Knee pain is one of the most common complaints we see here in my office. While especially common in our older patients, I have observed this problem occurring more frequently in ever younger patients. Let's look a little closer into the causes of this problem and what are the measures we can take for improvement that I share with my own patients.
Causes of knee pain
A lifetime of hard work, athletics, or just the grind of our daily lifestyle are the reasons I ascribe to these symptoms. The most common medical cause of this type of pain is osteoarthritis, which is very frequently seen in our seasoned citizens. Previous injury, such as a torn meniscus or ligament makes it more likely for this kind of arthritis to set in. This is the reason I believe that it is affecting our young people more often. The recent rise in "cross fit" or extreme physical exercise programs (marathons, "iron athlete" competitions), will predispose to this type of injury.
What Can I do about it?
No matter what the cause may be, there are some prudent measures to take that can improve your symptoms.
Here are some suggestions:
Weight loss and management
Your knees have to withstand one and half times your body weight with each step. Every pound of weight above your ideal weight actually exerts four times that value on the knee joint. For example, a man who is twenty pounds overweight places eighty pounds more pressure on his joint.
Change the way you exercise
High impact exercise, despite its popularity place a tremendous amount of stress on the joints, especially when we are overweight. Switching to lower impact exercise (swimming, walking, yoga, Pilates) will allow sufficient activity with less effect on the joints
Targeted muscle strengthening
While the thigh muscles stabilize the joint, other muscles play a critical role. The core and hip muscles help better distribute the forces that the knee has to withstand. Equally important is to make sure that muscle imbalances are corrected. Often, in effort to get in shape we neglect those muscles in the "posterior chain" (buttocks, hamstrings, calves) as they don't have the same appeal as working other muscle groups. That is a mistake, as the ensuing imbalance will worsen those mechanics.
What happens when I still have pain?
When those measures outlined above are not enough we have other means at our disposal to help. Rest, ice, Non steroidal anti-inflammatory medications (NSAIDs), are the mainstay of therapy and are readily addressed with the help of your primary care provider. They will often order X rays, and if needed an MRI to have a closer look at the anatomic cause of your symptoms. I am usually involved after this point, in the event that conservative therapy is ineffective and further options need to be evaluated.
Joint injections with steroids are effective in osteoarthritis and provide immediate relief of symptoms. These injections may be given as often as every three months as long as they remain effective. Hyaluronic acid, or the "rooster comb" medication is another option, and may be first line in those cases where the injection of steroid and local anesthetic is not advisable. In this case, the hyaluronic acid acts as a lubricant, while the steroid injection acts as an anti-inflammatory. In those cases where pain does not respond to injection therapy the geniculate nerve (nerve to the joint) can be blocked. If that is effective radiofrequency ablation is the next step to provide longer lasting relief.
When do I have surgery?
Early involvement of an orthopedic surgeon is always advisable and can help decide when and if surgery is needed. A team approach is always the best approach to managing this problem. Let's discuss this all in detail on your next visit!
As published in Welcome Home October 2016