Tackling Knee Pain
The article below appeared in the January 12 issue of Health with Perdana, a regular column in The Star by Perdana University faculty members. This week’s article is contributed by Dr. Mohamad Hasif Jaafar, Manager, Research Management Centre, Perdana University and Prof. Dr. Agus Iwan Foead, Clinical Associate Professor of Orthopaedics, Royal College of Surgeons in Ireland, School of Medicine, Perdana University
Knee pain is a common complaint among older people, but can be managed with the appropriate treatments.
A study in Malaysia reported that 33% of community-dwelling older people had knee pain. Among them, Malays were the highest, followed by Indians and Chinese. As suggested by this study, you are more likely to experience knee pain if you are a female, have no partner with lower educational level and belong to the Malay or Indian ethnic groups. The risk will further increase if you have obesity, heart disease and hypertension.
Knee pain interferes with sleep, makes it difficult to get going after rest, and changes the way of doing everyday activities. The most common cause of knee pain in the elderly is osteoarthritis. However, knee pain may also arise from other causes including injury and inflammatory arthritis. Knee malignancy also presents with knee pain, but with other symptoms such as weight loss, fatigue, and sometimes with a low-grade fever.
Among individuals with severe knee osteoarthritis, 50% reported having at least one fall in the preceding year. Falls are scary things. Falls can cause pain, bruise, muscle injury, fracture (hip, elbow and wrist), or even death.
After having a fall, these older persons will develop an increase in anxiety. They no longer want to go out or even walk to the nearest shop or park. They are restricting their activities, their physical functions and their social participation. They are more comfortable to have sedentary lifestyles. Over time, they are more likely to develop muscle weakness or sarcopenia, which actually increases the risk of future falls! Limiting physical functions and social participation are also associated with depression and stress. Hence, it is not surprising that falls have been found to be associated with reduced quality of life and increased in mental problems.
Treatment of knee pain varies from non-operative to operative procedures depending on the causes. These include pharmacological treatment, dietetic management, physiotherapy, psychological treatment and surgery.
Medication for osteoarthritis is usually painkillers. Besides that, another type of medication can help to reduce the inflammation or infection of the joints. Older persons suffering from knee pain may also take supplements, for example, glucosamine sulphates and chondroitin sulphates to help the body to build new cartilage. Apart from these, patients with knee pain can also opt for intra-articular knee injections, which use a synthetic joint fluid or plasma-rich platelets (PRP) derived from the patient’s body, to be injected into the knee joint.
Although normal weight older people may still get knee pain, overweight and obesity pose higher risk factors that are affecting the knee, due to the simple fact that the knee absorbs as much as half of your body weight with each step that you take. That pressure, plus the normal wear and tear will cause the cartilages of the knee to deteriorate and thin out, while muscles and ligaments get weaker. Besides that, if you have a family history of osteoarthritis or a previous knee injury, you may be more prone to this deterioration. A visit to the dietitian is essential if you plan to reduce and control your body weight, to help to reduce the impact on your knees.
Your healthcare professionals will also discuss with you the appropriate interventions that you can or should do in order to improve the condition of your knee joints. Physiotherapists use several modalities to ease knee pain such as heat and cold therapy, electrical therapy and even interferential and ultrasound therapy. Occupational therapists, on the other hand, will help you to employ joint protection strategies, as well as the correct way of moving the knees while performing your daily activities. Exercise on the knee is also a good way to help to reduce knee pain, although many people are reluctant to exercise their knees. Exercise has a 3-fold benefit: improving fitness level, reducing friction in the long run, and reducing body weight – thus reducing the impact on joints. Like muscles, joints should be exercised and will become more robust with appropriate use as supporting structures are reinforced. Similarly, overuse can be detrimental, although this is less common in older adults.
Worse comes to worst, when the cartilage is gone, the bones rub against each other, and you end up with pain, stiffness, and swelling, surgery is one of the options. However, it varies depending on the pathology.
Therefore, do not let knee pain or the threat of it interrupts your life. By employing some of the following strategies, you can help keep your knees as young as you feel.