Pain in the knee is common…just ask my mother. 

At the age of 54 she just underwent a total knee replacement because of severe osteoarthritis and rheumatoid arthritis of her knee.  She has been complaining of pain in her joints especially her knees for years now.  I remember being in high school…many years ago, of course….and my mother wearing knee braces to work and often asking me to get her a bag of ice so she can ice her swollen joints after a hard day of work. 

I was very active in high school running track during the spring and performing on the Pom Squad during the fall and winter months.  So I was always outside doing something, whether it was working out at the track or trying my hand at tennis. 

Because of my mother’s worsening arthritis, she couldn’t participate in these activities with me.  She’d drive me to practice, to the park or to the local outdoor track but had to sit on the sidelines…on the benches and just watch me.  When she did try to venture out on the track and just take a walk around a couple of times, she’d wind up paying for that small bit of exercise for the next several days with soaks in the bathrub, knee rubs and even with me walking on her back as she was sprawled across the living room floor.  This was her life. 

The manual labor she performed on a daily basis at work and her being slightly overweight all contributed to the total knee replacement surgery she eventually needed.  She’d already gone through the rounds of ibuprofen, glucosamine and chondroitin, steroid joint injections and even had courses of oral steroids and stronger, more potent medications to try and control her autoimmune disorder—rheumatoid arthritis.  She even contemplated other alternative techniques to control her knee pain, from acunpuncture to cartilage injections.  After much discussion with her physicians and her family, my mother ultimately decided to have her knee replaced.

I’m going to take you through her journey of treatments to help you make the right decisions when it comes to fighting back against your knee pain. 

Let’s first talk about the basics.

Arthritis is one of the leading causes of disability in the United States, which means millions of Americans are unable to work full-time or even part-time due to disabling joint or skeletal pain.  Arthritis has significantly impacted the pharmaceutical industry with the onslaught of prescription medications like Vioxx, Bextra and Celebrex and the highly publicized removal of Vioxx from the market and the resultant Vioxx lawsuits.  When you hear people talk about arthritis in the joints, it’s typically osteoarthritis, one of the most common joint disorders. 

Osteoarthritis refers to the degeneration of cartilage in the joint—usually weight-bearing joints, such as the knees and hips—and resultant narrowing of the space between the opposing bones, causing the bone-on-bone pain and discomfort you may experience.  As the cartilage wears down, the normal lubrication of your joints disappear increasing the irritation and inflammation of your joints which can lead to swelling in the joint, decreased range of motion and of course, pain!

Osteoarthritis can be hereditary or a direct consequence of prior injury to your joint—like a torn ligament, fracture or surgical intervention.  But there are several other factors within your control that can help slow the degeneration process…..

These modifiable risk factors for osteoarthritis include being overweight and overuse injury.  For those athletes who have made careers in sport, osteoarthritis is the price you pay for fame.  Ask any retired football player, baseball pitcher or elite judo player and you’ll find someone who’s dealing with osteoarthritis on a daily basis. 

Ibuprofen and other Non-Steroidal Anti-inflammatory Drugs help to reduce the joint inflammation and swelling and therefore, can decrease pain and help restore your normal functioning at the joint.  The newer but more controversial anti-inflammatory prescription drugs like Vioxx and Celebrex also help to reduce joint inflammation along with decreasing the risk of gastrointestinal irritation which can limit your ability to tolerate this class of drugs.  Acetaminophen is in a different class of drugs and is useful in decreasing pain although acetaminophen is not as effective as NSAIDs in reducing the inflammation associated with arthritis.

If these over-the-counter drugs don’t bring relief, nutritional supplements such as glucosamine and chondroitin sulfate have inconsistently shown significant improvement in joint pain and physical function but just talk to anyone who has had success with these supplements and you’ll become a believer.  Research studies have also shown that joint injections of corticosteroids result in significant reductions in pain and many of my patients typically have noticeable improvement in function….like being able to take walks after dinner, work in the garden or even now walk from the car to the grocery store without the assistance of a cane or walker. 

Other nonpharmacological treatments include rehabilitation therapy like physical and occupational therapy which concentrates on restoring joint range of motion and developing muscle supporting strength about the joint (especially your quadriceps) to take the pressure and load off the joint…..exercise programs (either land-based or aquatic)….and of course, weight loss.  The more weight your hips and knees must carry the more trauma and damage they undergo and the sooner you’ll develop severe degenerative changes with complete loss of cartilage and destructive changes to the bones. 

Alternative therapies such as acupuncture have recently become more popular with people trying to find a more holistic approach to chronic conditions such as osteoarthritis.  Acupuncture is becoming a more accepted alternative to traditional medical therapies and is open as an option for people willing to explore the possibilities.  Clinical trials do exist that show a moderate improvement in pain relief in the short run but longer, more robust studies are needed to compare acupuncture to other traditional medical therapies such as anti-inflammatory drugs. 

And when all else fails….there is surgical intervention….knee replacement.  Surgery should not be taken lightly and should be considered after you have exhausted other non-invasive therapies because along with surgery comes work…with rehabilitation and recovery. 

So, when you’re faced with knee pain, discuss treatment options with your doctor.  Develop a gameplan to help fight the effects of arthritis which may include physical therapy, weight loss and exercise. 

To your wellness,

Dr. Traci Ferguson, The Health and Wellness Queen

P.S.  When your physician says you’re ready to participate in an exercise program,  don’t let another day pass before getting your copy of the Working Out With Rhadi DVD that strengthens your upper body, your core musculature and your lower body for a total body workout!