It is also known that if the knee pain is not dealt with properly, it is referred to as one of the global states of disability. No pain is more difficult to deal with than global health states as it leads to more pain as an effect of attempting to reduce pain. This downward spiral can greatly affect one’s quality of life.
What we really find about knee pain is that over 80% of the time it is caused by damage to one of the 4 tissues located in and around the knee: bones, cartilage, ligaments, and tendons. The most common of this damage is to the articular cartilage in the joint surface. Any number of things can cause damage to the cartilage: a single significant injury of any of the other tissues or simply the accumulation of normal wear and tear over time. This can result in inflammation (swelling), which is the body’s natural response to an irritation, and chronic inflammation can cause the pain to become worse.
Contrary to popular belief, knee pain is not caused by age. Birthdays do not cause knee pain any more than gray hair causes heart disease. In fact, we now know that age is very poorly correlated with the degenerative changes in the knees that cause knee pain. Some people may have a great amount of arthritis on x-ray and no pain, while others may have a small amount of arthritis and a lot of pain.
Understanding Knee Pain
Knee pain has many causes. It can be as a result of an acute injury or an overuse injury. A common acute injury is a meniscal tear. This occurs when twisting or rotating the knee when the foot is planted and the knee is bent. These tears can occur during any physical activity. Older people are more likely to have knee pain from osteoarthritis. In Malaysia, one in six people above the age of 60 have knee pain at some time in their life. This is a result of the knee joint bearing the weight of the body and the significant wear and tear over the years. The pain can be unbearable and cause restriction in activities. High-impact athletes and soldiers are also prone to knee pain as a result of post-traumatic arthritis. This is a progressive wear and tear of the cartilage in the joint surface. It will appear a few years after the fracture, ligament injury, or meniscus tear.
Knee pain can be attributed to both short-term acute injuries as well as long-term chronic injuries. Some acute injuries can include a ruptured ligament or torn meniscus. This could be as a result of a sudden trauma, such as a twist in the wrong direction or a hard blow to the knee. These could happen while playing sports. People with such injuries usually report pain, swelling, and a limitation in movement in the joint. In the case of a severe ligament or tendon rupturing, surgery may be necessary to repair the injury. Some chronic injuries can include arthritis, which is a common cause of chronic knee pain.
The knee is the strongest and one of the most important joints in the human body. It is a hinged joint made up of bones, ligaments, and tendons. The ends of the bones are covered with cartilage, a smooth substance that cushions the bones and enables them to move easily. Between the bones of the knee are two pieces of cartilage called the medial and lateral meniscus. They act as shock absorbers that cushion the movement between the bones. There are many muscles and tendons that surround the knee, attaching to the bones to move the joint. Finally, the knee joint is wrapped in a joint capsule lined with synovial membrane which secretes synovial fluid for lubrication. All of these structures make the knee an extremely complex and important joint.
Importance of Nutrition in Managing Knee Pain
As such, weight management is crucial in controlling knee pain and related issues such as arthritis. Studies have shown that losing weight can help alleviate pain and prevent further damage to the knees. Another study to support weight management was by Stephen and colleagues. In their study, they found that a 5.1% reduction in body mass index above weight participants resulted in an 18% reduction in knee pain. Complying with a healthy diet with emphasis on weight reduction is easier said than done. However, research has shown that adopting a low-fat, vegetarian, or Mediterranean diet is effective in not only inducing weight loss but also more sustainable in the long term compared to other diets. Consumers may also feel a sense of accomplishment in controlling and being responsible for their health as these diets have been found to not only improve rheumatoid and associated arthritic diseases but also result in a lower reliance on anti-inflammatory medication. Local Singaporeans would benefit from eating a low-fat diet by consuming less meat and treating it as a side dish, and instead eating more grains, fruits, and vegetables. This is also in line with the Health Promotion Board’s healthy eating guidelines. A study published in the Annals of the Rheumatic Diseases reported that a non-meat diet resulted in significantly fewer rheumatoid arthritis symptoms compared to a control omnivorous diet.
Dietary Guidelines for Managing Knee Pain
Dehydration has been found to raise the risk of gout attacks and can actually bring on an attack in a person who is susceptible. It is also believed that dehydration can affect the excretion of urate from the body. Urate is a salt of uric acid, and high levels of uric acid in the body are a known factor for gout and gout attacks. To reduce the risk of gout, it is important to keep hydrated by drinking plenty of water and reducing consumption of drinks containing alcohol and caffeine.
The most certain way to elevate the risk of knee joint problems or to boost symptoms is by increasing weight. Weight loss can help to improve pain, prevent future damage to your joints, and improve your general health. A study has shown that by losing even a small amount of weight, it can help to ease the pain and reduce inflammation of osteoarthritis in the knee. The best method of weight loss is to combine increased physical activity with a reduced calorie intake. Try to avoid crash diets or quick fixes as these can lead to malnutrition and can increase the risk of other diseases. If you have an ongoing knee problem, it is always important to seek advice from a dietitian for the most appropriate nutrition and weight loss plan.
Incorporating Anti-Inflammatory Foods
The first change to make is to increase your consumption of fruit and vegetables. Aim for a minimum of 2 servings of fruit and 5 servings of vegetables each day. To maximize your intake of anti-inflammatory compounds, think of the colors of the rainbow when selecting your fruits and include plenty of leafy green and bright orange vegetables. And no, Skittles don’t count!
Certain dietary components possess pro-inflammatory effects, which can increase oxidative stress in your body. Oxidative stress is thought to be an important factor in the development of many diseases, including heart disease, some cancers, and certain forms of arthritis. For these reasons, patients with osteoarthritis or inflammatory types of arthritis, such as rheumatoid arthritis, are advised to follow a diet that is designed to reduce the body’s overall inflammatory load. This can be achieved by increasing consumption of foods rich in anti-inflammatory compounds. These diet changes are also likely to be accompanied by weight loss and a general improvement in health and well-being.
Avoiding Trigger Foods
Avoiding trigger foods can help ease the symptoms of knee pain and help one have a better quality of life. There are many foods that can affect the body in a negative way. Trigger foods such as sugary drinks, white flour, and dessert can cause your body to be in an inflammatory state. Other trigger foods can cause people to eat too much. For example, nuts and seeds are healthy, but they are calorie-dense foods. If a person is trying to lose weight, he/she will need to eat these foods sparingly because the extra calories can lead to weight gain. In addition to calorie-dense foods, there are foods that are natural appetite stimulants. If a person eats a small portion of a low-calorie meal but is still hungry and overeats other foods, it can lead to more weight gain. By identifying and avoiding trigger foods, people will make fewer diet mistakes, reduce inflammation, and prevent knee pain from getting worse.
Maintaining a Healthy Weight
The study examined the knees of 3363 individuals over 48 months, using weight as the primary predictor and examining its effect on the incidence of osteoarthritis using bone scans. An epidemiologic study demonstrated that weight loss also has a carryover effect, as it was shown to reduce the risk of symptomatic osteoarthritis in the future.
Weight loss has been shown to slow the progression of knee osteoarthritis and can prevent future joint injury. A recent prospective study revealed that weight loss in obese individuals can prevent the onset of knee osteoarthritis.
With the understanding that excessive body weight can lead to osteoarthritis and accelerate cartilage loss, it is important to address weight management in those looking to prevent knee pain, as well as those looking to reduce the severity of their current symptoms.
Hydration and Knee Health
Patients with diabetes or kidney disease must consider how much water is appropriate, and patients with heart failure must balance fluid intake to avoid increasing swelling or shortness of breath. There is some evidence to suggest that drinking water can help reduce hunger. This seems to be most effective in older adults. One study examined 18,311 adults and found that those who drank 1-2 extra cups of water per day were less likely to eat sugary drinks or snacks. Another study in older adults found that those who were hydrated had lower body weights. Although further evidence is needed, these findings suggest that drinking water could have a beneficial effect on reducing calories and aiding with weight loss.
When discussing hydration with patients, it’s helpful to first assess the patient’s baseline intake. Do they drink other types of fluids such as coffee, tea, or soft drinks? Do they eat high-water-containing foods such as fruits, vegetables, soups, or smoothies? There is no specific recommendation for water intake in patients with OA. It is widely encouraged for health maintenance and weight loss. A common recommendation is drinking 8 oz glasses of water a day. This can come from beverages and water-containing foods. In patients who have increased heavily activity (intense or long-duration exercises) or in the summer months, they should increase water intake to match fluid losses. This can be assessed by monitoring body weight prior to and after activity to see how much water was lost.
Lifestyle Tips for Managing Knee Pain
Assistive devices can help with reducing the pain and pressure on the knees. For example, using a cane when walking can be a cheap and effective way of offloading weight from the affected knee. Knee braces can improve function and decrease pain in some individuals. Choosing the right brace is important. An “unloader” brace can shift load away from a damaged area of the knee. A “support” brace can improve the stability of the knee and control pain and swelling. Both of these devices can be fitted by a knee pain specialist or physical therapist.
An active lifestyle is important. In order to effectively manage knee arthritis pain, it is important to maintain mobility and muscle strength in the legs. Low-impact activities such as swimming, walking, or riding a stationary bicycle are often recommended. Some individuals may also benefit from aquatic exercises. These exercises can be performed in a heated pool and may provide added pain relief. I have a bit more information on this in my “Water Walking” article. If instructed by a doctor, physical therapy using treatments such as ultrasound or electrical stimulation can also provide pain relief. Recent studies have shown that isometric strength training can help to reduce pain and improve function in individuals with knee OA. This can be done at home with the assistance of a physical therapist or a set of home exercises (again, I will cover this in more detail in a future post).
Regular Exercise and Physical Therapy
Physical activity is important in the management of knee osteoarthritis (OA). It can help to reduce pain and improve function. Exercise is also important for general health and well-being. People with knee OA may be reluctant to exercise because of pain and swelling that occurs afterwards. It is important for such people to discuss their concerns with a healthcare professional. They may be able to use an exercise program supervised by a physiotherapist or fitness instructor. Special exercises, called therapeutic exercise, can help to improve the strength and function of the affected joint. In this article, we will review the role of exercise and therapeutic exercise in the management of knee OA. The first thing to consider is the general amount of activity that the person undertakes. Many people with knee OA are relatively inactive. This may be due to their age or to avoid pain and stiffness. However, there are always opportunities to increase activity during the day, by doing more housework or gardening for example. Walking is often a good way to start. It is cheap and can be done at any time. There is no hard and fast rule about how much people should walk but as a rough guide, 3,000-6,000 steps per day is equivalent to 30-60 minutes of moderate activity and it will take 6,000-10,000 steps per day to equivalent to meeting the general physical activity recommendations for health. This is likely to result in a reduction in pain and enhanced function without causing a substantial increase in pain or inflammation. Too much walking or stair climbing can irritate the knee so care must be taken not to overdo it. High intensity activities such as running or tennis, particularly when it is done on hard surfaces or with poor technique, can be harmful to the knee joint and it is best to substitute these activities with a lower intensity alternative such as swimming or cycling. An individualized exercise prescription can be developed with the help of a healthcare professional, which takes into account the type and amount of activity that is most suitable.
Using Assistive Devices
Although not a popular choice among many younger people, using a walker or Zimmer frame has been proven to greatly reduce joint loads during walking. This can be a good choice for people with very severe knee or leg OA. Unlike using crutches, a walker provides an increased level of stability and support.
Another helpful ambulatory aid for people with knee OA is a walking stick. It does not have the same load reducing effect as a cane, but can be beneficial when walking on rough ground or up and down hills. If you have pain in both knees or in only one knee but an associated hip or back problem, then a stick in each hand or a hiking pole may be useful. A stick or hiking pole has the added benefit of improving your balance and can be especially useful if you have a knee replacement.
For most people with knee OA, the first assistive device of choice is a cane. If you are unsure about whether you need a cane, a good test is to try one out. If using a cane allows you to walk further with less pain, then you probably need one. Choose a cane that is comfortable and that you like, as this will make you more likely to use it. Hold the cane in the hand opposite to your most painful knee. This moves the load off the knee as you step forward. A cane can also be useful if you are going up or down stairs that are aggravating your knee pain.
Perhaps the most effective strategy you can use when you have knee pain is also the simplest – using an assistive device. There are several good reasons to use one. They help to reduce the compressive force going through the joint. This can help to lessen your pain and prolong the health of the joint. They can improve your ability to walk and the distance you are able to walk. This in turn can prevent weight gain, which would only serve to increase your knee pain. By decreasing pain and improving mobility, assistive devices can greatly enhance your quality of life if you have knee OA.
Applying Heat and Cold Therapy
There are many different types of heat and cold therapy available, ranging from the simple use of a packet of frozen vegetables to expensive whirlpool treatments. The choice of modality may depend on its suitability to the patient. For example, many older people are unable to tolerate a cold modality and find it increases their joint stiffness and pain. Heat and cold therapy can be self-administered, though caution and guidance should be provided to ensure a patient uses it correctly, for the correct period of time, and does not sustain a thermal injury. The inflammatory or acute flare of symptoms of osteoarthritis may rarely require the application of cold. However, the predominant majority of patients complain of chronic joint pain and stiffness, and it is these symptoms that are usually relieved by the application of heat.
The use of deep heat and cold therapy has proved to be a valuable form of treatment for the relief of pain and spasm in muscles and joints. Though the use of heat and cold has long had a place in the first aid treatment of the acutely injured, the value of these modalities in rehabilitation is often overlooked. A chaired discussion on whether the use of deep heat and cold therapy is helpful for patients with osteoarthritis or a potential hazard was documented.
Seeking Professional Help for Knee Pain
There are several health professionals who are more likely to provide an effective course of treatment for knee pain. Often, a physiotherapist can be helpful in treating and diagnosing the specific cause of knee pain. This includes an analysis of lower limb biomechanics to identify any malalignments or irregularities in the way the knee moves or is positioned during weight-bearing activities. Identification and correction of these issues can relieve symptoms of knee pain in the short and long term. A physiotherapist can also be useful in strengthening or stretching muscles surrounding the knee joint because strong muscles act as shock absorbers for the knee. A gait analysis may be done to look at the way the person walks or runs. This can be relevant to knee pain if it is known that the pain developed after an increase in frequency or intensity of a particular gait activity. If identified as the cause of pain, altering the way the activity is performed or changing to a different activity may relieve the knee pain.
When knee pain experienced is frequent and chronic, it is essential that the sufferer seeks professional help and advice. A knee pain specialist is more likely to pinpoint the exact cause of the pain in order to be more accurate in providing dietary and lifestyle advice or making a referral to the appropriate allied health professional for a course of treatment. This is especially true for cases which have been diagnosed as osteoarthritis. Although the dietary and lifestyle advice provided in this book is useful for all people with knee pain, it is important that those with knee osteoarthritis do not delay in seeking effective treatment for getting rid of knee pain. This is because a proven course of treatment for osteoarthritis is likely to improve knee pain symptoms and functional ability, which in turn will lead to an increase in quality of life. If a person is referred to a dietitian by their doctor, the information in this book will be useful for the dietitian to help manage knee pain and the person’s general well-being through dietary means.
Consulting a Knee Pain Specialist
When should you consider consulting a knee pain specialist and how may they help you? Generally, a referral to an orthopaedic surgeon is made when it is felt that surgery may be necessary—although it doesn’t mean that it definitely will be. Knee pain success stories after consultation are common and in many cases, dietitians at Simply Nutrition can help improve the symptoms of osteoarthritis in the knee through diet modification. To determine whether you require surgery or not, the surgeon will ask you questions regarding your pain, such as what aggravates and eases the pain, how painful it is, and how much it is affecting your daily activities. They will then examine the knee to look for any signs of swelling, tenderness, warmth, or redness. Often, fluid may be present in the knee joint and the joint may not function properly. X-rays are usually taken to confirm a diagnosis of osteoarthritis and may also be used to determine the severity of the condition. If the arthritis is in the early stages, no significant changes on the x-ray may be seen—though this does not mean that your pain is not significant. For some, the idea of surgery can be very frightening and as the information above indicates, no definite decision can be made until the progression of the condition strongly warrants it. In most cases, it is worth trying alternative treatment methods before considering surgery. High success rates have been seen in physiotherapy treatment for osteoarthritis in the knee. A physiotherapist will not only work on improving the strength and function of the knee but can also help correct any abnormalities in your gait pattern that may be contributing to your knee pain. Other alternative methods of treatment may include the use of glucosamine to help relieve joint pain and improve joint mobility—please refer to our Diet and Supplements page for further information on this topic.
Available Treatments and Therapies
For more severe knee pain or the pain of a chronic knee problem, an injection may be advised. There are many different types of injection each with a variety of results. This is something that should be discussed with your doctor or a specialist in musculoskeletal medicine. He/she will explain to you the type of injection that would be suitable for your knee problem and the potential risks and benefits.
Physiotherapy is also an option to treat all kinds of knee pain and is often very effective. The main aim of therapy is to increase the function of the knee as well as strengthening the muscles that support the knee which will improve the stability of the joint. This will be done through an individualized exercise program which is specific to your knee problem, and may also involve the use of other techniques such as massage or mobilization.
When managing knee pain symptoms, either in the short term with a sudden flare-up, or long term that has been around for a while, a typical first line treatment is often with the use of medication. This might include simple analgesics like paracetamol or aspirin to anti-inflammatory drugs and in some cases stronger medication for more severe pain. Analgesics and anti-inflammatory drugs are used to relieve pain and reduce inflammation in the hope of improving mobility of the knee.
Assuming that you have it checked by a qualified doctor and have a precise diagnosis of your knee pain, there are many different treatment choices that may be obtainable to you. This will often depend on the nature of your knee pain and may vary from symptom management using pharmacology to curing the cause of the pain with a course of physiotherapy or even surgery.