Osteoarthritis of the Knee

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Osteoarthritis of the knee, or degenerative joint disease, is an arthritic condition in which the protective covering (articular cartilage) which lines the bones on the tibia, femur and/or patella has begun to erode and become soft and frayed. As the cartilage deteriorates, the bones begin to rub together causing pain, swelling and a decreased ability to tolerate various activities.

In treatment of this condition, we have found a few things in particular to be very helpful in reducing the symptoms associated with this problem.

First and foremost, modification of those activities that increase symptoms is essential. Finding the level of activity that your knee can tolerate with given activities will help in making the time spent performing them more comfortable. For instance, if you find that 1 - 2 days of doubles tennis a week is tolerable and does not significantly increase pain and swelling, then that is your guideline. If, however, your knee really bothers you every time you try to play singles or more than a couple of days a week, then it is time to listen to your body. It is helpful to equate your knees to a “bank account”. You will have to budget your knee money in order not to have pain that debilitates (or bankrupts) you.

The use of shock absorbing insoles and/or cushioned shoes is also very helpful in reducing the pounding to the joint throughout the day. Modification of shoe choice to accommodate insoles and preferably wearing a running-type shoe that has a significant amount of cushion can reduce the ground reaction force onto the joint by up to 20%. The less often you stress the joint repetitively, the less overall damage in the long run. Go to a reputable running store and try on at least 3 pairs of running shoes. Choose the one that feels the best to you.

If the standing posture of your knees is either bowlegged (varus) or knock-knee (valgus), then this also increases the stress onto the joint. We have found the use of unloading wedges in your shoes is also helpful in taking that load off the involved side of the joint and distributing it more evenly onto the knee. This aids not only in pain relief, but also decreased wear onto the joint.

Custom-made or off-the-shelf knee braces are another way that equipment may be utilized to reduce the forces onto the joint. If your physician feels that you are a candidate for an unloading brace, then one can be fit to your leg and used for activities that typically produce pain or symptoms. Some wear their brace just for activity, while others wear their brace more often throughout the daytime.

Glucosamine sulfate is a substance synthesized by the body and naturally present in cartilage. It is believed that it somehow stimulates cartilage cells to produce certain compounds that are the building blocks of articular cartilage. We have found that 1500 mg of glucosamine daily to be the most effective dosage. This can be obtained at most health food stores as a pill or in grocery stores in the form of Joint Juice.

Maintaining a healthful weight helps to reduce the extra stress onto the joint. This is accomplished by regular exercise, good dietary intake, and maintaining a healthful lifestyle.

Pain management techniques such as moist heat packs, warm baths and jacuzzis help to relax sore muscles and relieve the tightness and soreness. Also good to use as a warm-up prior to a good stretching and strengthening program. The use of cold packs for 15 minutes is very effective when the knee feels acutely irritated or inflamed, or any time after prolonged activity. The use of over-the-counter drugs such as acetaminophen (Tylenol) which is a non-aspirin pain reliever can also prove beneficial. Always consult your physician before taking any anti-inflammatory medication regularly.

Exercise is a critical component in the treatment of osteoarthritis because it helps strengthen the muscles that surround the joint and helps aid in shock absorption. Other benefits of exercise include improved stability throughout the day, increase in joint flexibility which lessens pain, and helping to keep the remaining cartilage healthy by supplying it with the oxygen and nutrients that the joint needs. Stationary bike with light to no resistance beginning slowly is one form of exercise that is non-pounding. Pool exercises such as leg lifts, smooth gentle kicking strokes with a kickboard focusing on the hip, and deep water running with the use of a flotation belt are also very effective in increasing strength without increasing symptoms. Keeping flexible through daily stretching exercises is also critical.

Image source: Newsweek Magazine