Relief from joint pain
DR. R.P MITTAL
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How to deal with osteoarthritis of the knee joint.
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Photo: Bijoy Ghosh
Save your knee: Climb stairs correctly.
THE knee joint is a complex joint made up of the articular end of two long bones and the knee cap. It is the biggest joint in body and allows movement in one plane only.
Osteoarthritis of knee joint is due to wear and tear of articular cartilage (soft bone or ends of bone). Patients complain of pain, stiff knee, swelling and deformity of the joint. Wear and tear is largely age-related and can also be influenced by lifestyle, already existing disease like rheumatoid and gouty arthritis. Other causes include postures like squatting, sitting crossed leg, obesity and use of stairs.
This illness is more common in India compared to western countries. Indians spend more time squatting while doing household chores. The other issue is the use of Indian style toilets.
Pressure on the knee
Normally, three times our body weight passes through one knee joint during normal and brisk walking. While running or jogging, the weight through one knee joint is about 10 times. For example if a person weighs 60 kg, about 180 kg passes through one knee joint while walking and about 600 kg while running and jogging. The joint is made of a soft tissue called cartilage, which gives in under heavy loads. Squatting and sitting crossed legged bend the knee completely, thereby increasing the pressure on the joint. This distorts the cartilage thereby causing an early onset of the disease. Obesity is the prime cause of premature osteoarthritis.
Foods that have high glycemic index like sugar, rice and potatoes should be decreased or completely avoided depending on the level of obesity. Fat intake should be cut to the minimum. Extra calories increase inflammation in body and joints are no exception. Reducing body weight brings relief from joint pain by reducing inflammation (swelling) and putting less mechanical pressure.
Strengthening the muscles around the knee will not only prevent osteoporosis but also prevent the tendency to fall by increasing the muscles’ stabilising strength. Strong muscles (quadriceps) will provide extra support to the knee.
Walk from the hip not from the knee. Make a larger arc at the hip by bringing the thigh more towards the abdomen and taking the thigh backwards as far possible and keep the knee relatively straight (stiff).This will not only increase the speed of walking but also put minimum stress on the knee. While climbing stairs, put weight on the healthy leg first, followed by affected leg. While coming down reverse this pattern, i.e., use the affected leg first as ground clearance is enough to allow weight on the affected side.
Any pain in the knee for more than two to three weeks should be reported to an orthopaedic surgeon. A detailed clinical examination and investigation will detect treatable causes like high uric acid, rheumatoid, hypothyroids and mild obesity. Early treatment will prevent further damage of the joints.
Self-medication with painkiller should be prevented as kidney damage is common (over 30 per cent of renal dialysis is from kidney damage due to prolonged use of painkillers). Drugs for cartilage repair like glucosamine and dicerine are useful only in some patients. A recent study has shown the efficacy of biphosonates (drugs for osteoporosis) in relief of osteoarthritic pain. Use of drugs like hyaluronic acid as an injection is debatable since they have not stood the test of time. However, some steroids are used as injections to relieve acute pain by decreasing joint swelling. Physiotherapy, hot packs, short wave diathermy and muscle strengthening exercises will help most patients.
Surgery
When the pain is so severe that patient requires daily painkillers and for long periods, there is an option of surgical treatment. Bone setting (oteotomy) is done when damage is limited to one side of the joint (in mild cases).This will correct the alignment of the joint and allow body weight to pass through the centre of the joint.
In total joint replacement, the damaged lining of the joint is replaced by metallic and plastic lining. This operation is successful in over 90 per cent of patients.
After surgery, the quality of life increases tremendously and the need for pain killer is minimum.
The writer is a Consultant Orthopaedic Surgeon based in New Delhi.
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