Knee pain? Don't stop exercising

PHOTO: Knee pain? Don't stop exercising

Deborah used to enjoy competitive ball games, such as badminton and tennis, but would sometimes suffer minor twists to her right knee.

She is now 49 and approaching menopause.

She started to have right knee pain on and off for two years, which has morphed into a daily pain, particularly when she walks for a long time and climbs the stairs.

The pain got so bad that she had to stop her badminton sessions and has since mostly stayed at home. She has also gained weight.

Her doctor told her it was the "wear and tear" of her knee that comes with age and prescribed painkillers.

However, she does not want to rely on painkillers and, therefore, does not take them. She wants to know how she can get better.

WORN-OUT CARTILAGE

Osteoarthritis is the most common form of arthritis. It occurs when the protective cartilage in the joint wears down as one ages. The condition can affect many joints in the body, including the hands, knees, hips and spine.

Osteoarthritis of the knee is more common among Asians than Caucasians. Up to 10 per cent of the population in Singapore may have it.

Knee osteoarthritis is more common among the elderly, post-menopausal women and those who are overweight or obese, and who have sustained joint injuries before.

It usually starts with a vague pain, ache or stiffness which comes and goes. Slowly, over time, the pain develops into a constant problem.

The symptoms worsen when one walks long distances, climbs the stairs and squats often.

Although there is no cure for Deborah's knee osteoarthritis, there are many ways to reduce her pain. Exercising and achieving a healthy weight is the best and most important way to treat the condition.

Deborah had a common misconception that exercise wears down the cartilage, which is why she stopped working out. However, research from around the world has shown that the more exercise those suffering from knee osteoarthritis do, the healthier their knees become.

BEING ACTIVE, LOSING WEIGHT

Exercise helps to strengthen the muscles around the joint, which reduces the stress it sustains.

Gentle exercises, such as swimming, brisk walking, slow jogging, cycling, slow dancing, taiji and yoga, are generally safe. But high-impact exercises, such as football, tennis, badminton or running, may not be suitable for every one.

Deborah was advised to change her workouts from badminton to gentler exercises. It was also important that she choose an exercise that she likes and enjoys, so she would continue doing it.

For some patients, exercise technique needs to be learnt.

I referred Deborah to a physical therapist, a trained professional who can work with patients to devise an appropriate exercise programme that will strengthen the muscles around the affected joint, increase its range of motion and reduce pain.

Body weight is the most influential factor for worsening knee pain. The heavier one is, the higher the chance he will get osteoarthritis of the knee and have it progress to end-stage disease.

Even though Deborah is not overweight, I recommended that she keep her weight in check and, ideally, lose 5 to 10 per cent of her weight.

This mild degree of weight loss will greatly reduce her knee pain and slow the progression of her disease.

ROLE OF MEDICATION

For some patients with greater knee pain, painkillers such as Panadol and non-steroidal anti-inflammatory drugs (NSAIDs) can help to reduce pain and inflammation.

NSAIDs can cause stomach upset or bleeding, heart problems, and liver and kidney damage. They should not be used by those who have stomach bleeding or heart diseases.

Topical NSAIDS (cream, gel or plaster) have fewer side-effects and may relieve pain just as well.

When the pain is severe, injections of hyaluronic acid may offer short-term pain relief. But this lasts only up to a few months.

Hyaluronic acid is similar to a component normally found in joint fluids.

Your doctor is the best person to help you choose the right treatment option. If joint pain and stiffness become severe enough to make your work or even daily tasks difficult, doctors may suggest knee replacement surgery.

A common misconception is that painkillers will cause a person to become dependent on them and that the effectiveness of the medication will lessen over time.

Like many patients, Deborah would rather bear with the pain and move around less than take painkillers. As a result, a vicious circle has set in. With a lack of exercise, her muscles have weakened. She has also gained weight, which further increases the burden on her knees.

I recommended that she rest a few days when the pain worsens, take some painkillers to reduce the discomfort, then get back to doing gentle exercises.

Also, she should do adequate warm-up exercises, start slow and gradually increase the intensity of her workouts.

Many patients' conditions improve with weight loss. Only a minority eventually need to undergo surgery.

Deborah took my advice and started to brisk walk regularly. She also became more careful about what she ate and lost 5kg over three months. Her knee is no longer as painful as before, and she has been enjoying brisk walks in the evening with a group of friends.

Doctors from rheumatology, orthopaedics and radiology have been working in collaboration with Duke-NUS to conduct research on knee osteoarthritis and evaluate the use of blood tests and magnetic resonance imaging to identify patients whose condition may deteriorate faster. In future, patients like Deborah may get a new drug treatment that could potentially slow down the progress of knee osteoarthritis.

mysgh@sgh.com.sg


This article was first published on January 15, 2015.
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