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Knee degeneration and osteoarthritis: what works and what’s a waste

June 28, 2011

Middle age and osteoarthritis of the knees: Walter, a 49-year-old heavy equipment operator, could barely climb out of his cab without his knee giving way, and he’s popping his wife’s Vicodin on bad days. Finally, he goes to the doctor and gets an x-ray. “You hardly have any cartilage left in your knees,” says the doctor. “There’s nothing that can be done. I’ll have you see the orthopedist in a few years and he might want to do a joint replacement.” Many doctors can get frustrated treating degenerated knees.

But, a lot can be done, before getting that final cure – a titanium and polyethylene knee implant. And, there are some things that shouldn’t be  done. Wanting a quicker fix, Walter sees the orthopedist who sends him for an MRI and recommends arthroscopy. “It’s 50-50 but it’s your best chance for improvement,” he says. Walter gets the procedure but he is on the wrong side of the coin toss. Six therapy sessions and six months later, he is having problems – limping, swelling, and sharp pains when he steps off a curb. “The doctor says I have to tough it out until I’m old  enough for a knee replacement. He prescribed some pills and told me to lose weight,” he says to his wife. But, treatment by conservative methods can improve symptoms and delay surgery for years, sometimes even indefinitely.

What should you do? What works?

  • Rehab, rehab,  rehab 3 days a week. More on rehabilitation  below. 
  • Losing weight. Even 20 pounds can make a difference.
  • Apply a cold ice pack after activities and before bed.
  • Use anti-inflammatories as needed, if they don’t make you sick.
  • Use a simple brace or sleeve if it helps you increase activity.
  • Cortisone shots 1-3 times a year during flares can help tolerate exercises.
  • Learn how to properly use a cane, especially if you’re limping.
  • Careful narcotic dosing, but only if it increases activity tolerance.
  • Walking on flat surfaces and cycling.

What doesn’t work:

  • Unless you have a big meniscus tear, arthroscopy won’t help much.
  • Recent NIH trials for glucosamine and chondroitin show they don’t work. Sorry!
  •  Expensive ant-inflammatories, unless you have a medical indication.
  •  Sleeping pills and muscle relaxants can slow you down, interfere with rehab.
  •  Experimental cartilage injections. If you really want it, go to a university.
  •  Synvisc or Hyalgan injections might help, but wear off quickly in many.
  •  Walking on uneven ground, including some hiking trails.
  •  Jogging or playing singles tennis, unless your totally rehabbed.
  •  Acupuncture. Always choose PT instead.

Physical Rehabilitation. It’s amazing what a dedicated rehab program can do for almost any degenerative joint, especially knees. There are some high-performance athletes with knee arthritis, and even a few marathon runners. They have symptoms, but their well-conditioned muscles minimize them. How rehab works:

You will see a physical therapist who doesn’t waste your time with heat, ice, or ultrasound. He will take you through a full set of exercises until you are trained to do them correctly on your own. The goals will be:

  • Increased muscle strength in the lower extremities
  • Increased cardiovascular and muscle endurance
  • Improved reflexes and balance, known as dynamic stabilization
  • Guidelines for proper use of a brace or possibly a cane
  • Guidelines for sports and other activities that may be hard on your knees
  • A customized program that works for you as an individual

Tips on physical therapy

Any doctor can prescribe it. Get 6-12 sessions, twice a week. Do the exercises at home as directed. Be religious about it. If you aren’t getting a serious, sports medicine approach by the second visit, get a referral to a therapist who treats sports injuries.

Special notes about knee rehab and pro football players

Physically rehabilitating an arthritic knee does not happen during six PT sessions, or after a few weeks. Muscles will be wasted, and fatigue easily. There will be loss of motion and inflammation. It takes at least 3-6 months of properly performed exercises 2-4 times a week. Improvement can continue for up to 12 or even 24 months. Also, be aware it took years for your knee arthritis to develop. Don’t compare yourself to pro football players who were already highly conditioned before they got sidelined from a knee injury or wear and tear. Pills and cortisone shots can reduce pain and help you tolerate the exercises. A brace can give some support while your muscles are being trained to stabilize the knee. Arthroscopy has been shown to be ineffective  in treating knee arthritis.

My review of the information available on the internet revealed mostly garbage. Only specialized literature gives accurate facts, so get a good therapist, and a good doc when you can’t tolerate doing the exercises or daily activities.

References

I have no accurate references that can be understood unless you’re a health professional. This post is entirely from my professional training and experience. As always in medicine, there will be controversies. Feel free to write a comment if you run across any – you’ll get feedback.

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6 Comments leave one →
  1. January 18, 2016 11:50 pm

    Hi, of course this post is truly nice and I have learned lot of things from it
    about blogging. thanks.

  2. February 18, 2013 2:47 pm

    I savor, lead to I found exactly what I
    was looking for. You’ve ended my four day lengthy hunt! God Bless you man. Have a great day. Bye

  3. amazon.com permalink
    December 30, 2012 9:26 pm

    Hi there all, here every person is sharing these familiarity, thus
    it’s good to read this weblog, and I used to go to see this weblog daily.

  4. cat permalink
    November 29, 2012 2:42 am

    How can one say acupuncture does not work? Not only have I read and met people who have benefited from acupuncture for their arthritis , I had a dog that showed remarkable results from it for an ACL injury .The dog was in real distress before the procedure. Dogs don’t heal from the ” placebo effect.”.

  5. Marilyn permalink
    April 10, 2012 1:01 am

    Hi, Thank you so much for your article. I am a woman fighting 60 who recently developed really a really painful right knee. The xray showed only early stage osteoarthritis, however, terrible pain, swelling etc, GP not much use just gave me anti-inflamatories. I am determined to do as much as I can for myself and your info. very incouraging.
    Thanks
    M in London UK

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