Knee Pain Archives - Michigan Spine & Pain

Panacea Alert: Glucosamine, Chondroitin and Fish Oil

The scientific research, however, isn’t as effusive as the marketing copy on the back of the bottles. Here, we look at the evidence for when these supplements might help — and other pain management strategies to consider.

Omega-3 Supplements

Research suggests that high doses of fish oil, or other sources of omega-3 fatty acids, may help for one particular type of joint pain: rheumatoid arthritis. But its effect on most other types of joint pain, including osteoarthritis, is unclear.

For example, Consumer Reports cited analysis in The Journal of Pain that looked at 17 randomized controlled clinical trials which concluded that people with rheumatoid arthritis who took 1.7 to 9.6 grams of fish oil a day reported less joint pain, tenderness and stiffness. The investigation also found that people who took more than 2.7 g per day reported a greater improvement in morning stiffness and painful or tender joints than those who took lower doses.

But taking fish oil isn’t risk-free. “Even at doses below three grams per day, fish oil can cause side effects, including upset stomach, diarrhea, and a tendency to burp,” writes Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser, adding that with every incremental increase in dosage taken “…the more likely [one is] to experience gastrointestinal problems.”

Another sticking point that is often acknowledged but also given short shrift: dietary supplements aren’t regulated by the Food and Drug Administration the same way prescription or over-the-counter medications are — so there’s no guarantee the fish oil listed on the label is what’s actually in the bottle, or that it’s high quality, or even that it’s safe to take. According to the American College of Rheumatology: “Some fish oil supplements may contain high levels of mercury or vitamin A, which could be toxic.”

Glucosamine and Chondroitin Supplements

A 2010 trial of 662 people with knee osteoarthritis published in the Annals of the Rheumatic Diseases did find that these supplements relieved pain for some people — but over time were no more effective than a placebo. More recently, a study of 1,625 people published in the journal Arthritis & Rheumatology in 2015 found that using glucosamine and chondroitin over a four year period did not relieve knee pain or prevent cartilage loss in people with osteoarthritis any better than a placebo. In addition, The American Academy of Orthopaedic Surgeons does not recommend either of these supplements for osteoarthritis of the knee.

Got Knee Pain? What to Do Instead…

One step is to lose weight. Research suggests that for every pound of excess weight you shed, it can take approximately 4 lbs. of pressure off the knees when walking. Additionally, strength training can help build up the muscles that support the affected joint. As well, gentle, low-impact exercise such as swimming and walking can relieve dull knee pain by keeping the joints flexible and lubricated. And, for flare-ups, try over-the-counter anti-inflammatory medications like ibuprofen or naproxen, if your medical provider agrees that this is safe and recommended for you.

If you are experiencing joint pain, we suggest a thorough for proper diagnosis. To schedule an appointment, contact Michigan Spine and Pain online or by calling (800) 586-7992.

Top 11 Knee Pain Issues

Receiving an accurate diagnosis is vital in overcoming your knee pain, receiving the correct course of treatment and stopping it from returning. For example, if the knee is swollen you can treat the swelling with ice, but if you don’t treat the underlying cause, it will just keep coming back. The best way to receive an accurate knee pain diagnosis is to see your healthcare professional, but here is a guide to help you find out what your problem might be and some questions to think about:

Specific symptoms: What are the main symptoms associated with your pain (e.g. popping noises, locking, etc.)?
Location of the pain: where exactly is your knee pain (e.g. inner our outer knee)?
How did the pain start: the mechanism of injury (e.g. sudden twisting or gradual onset)?

Specific Symptoms

One of the most important parts of diagnosing knee pain is thinking about the specific symptoms that accompany the pain. These tend to be the most defining features in knee pain diagnosis, as the presence or absence of them quickly rule conditions/injuries in or out.

1) Knee Makes Unusual Noises

A sudden popping noise at the time of injury usually indicates a ligament injury or sometimes indicates a cartilage tear. Persistent clicking/grinding when the knee moves may indicate an ongoing knee problem affecting the joint surfaces or how the bones are moving such as chondromalacia patella.

2) Pain When Kneeling

Kneeling puts pressure through the front of the knee and primarily aggravates three conditions:

Housemaids Knee: inflammation of the prepatellar bursa (fluid filled sac) at the front of the knee. It is a common problem for people who spend long periods kneeling (e.g. carpet layers)
Osgood Schlatters: common in adolescents, particularly after a growth spurt. Tension on the tendon just below the kneecap damages the bone, often resulting in a hard lump on the front of the shin
Arthritis: changes in the bone caused by wear and tear or sometimes inflammation. Most common over the age of 50

3) Locking (knee gets stuck)

This happens when something gets wedged in the joint, stopping you from moving the knee. You generally have to wiggle the knee around before it will then move. The most common cause of locking is a Meniscus Tear (a tear in the cartilage that lines the joint.) It can be caused by sudden twisting or a force through the knee, or can come on gradually due to wear and tear.

A less common cause of locking is Osteochondritis Dissecans, a condition where poor blood supply causes small bits of bone and cartilage to break off at the joint.

4) Running Knee Pain

Knee pain from running is hardly surprising when forces up to 550% of one’s body weight go through the joint when running. Running knee pain is usually due to either training errors or poor biomechanics.

5) Knee Gives Way

This is when the knee buckles underneath you without you being able to control it. The most common cause of this is a ligament injury, usually an ACL tear or sometimes a PCL injury. They are usually caused by sudden twisting, a force through the knee or the knee bending backwards the wrong way. Only 20% of ACL tears are caused by direct contact. It may be accompanied by a popping sound, swelling and extreme pain.

Meniscus tears often make the knee feel unstable and can occasionally cause the knee to give way, but this is much less common.

6) Pain When Bending The Knee

A great deal of force goes through the knee when we do any activities with a bent knee. For example, squatting down places a force seven times body weight through the knee. It may be caused by a problem inside the knee, such as a cartilage tear or arthritis, or one of the surrounding structures, such as a ligament tear or inflammation of the bursa.

7) Pain When Sitting for Long Periods

It is not just activity that aggravates knee pain. Some conditions tend to get worse with prolonged inactivity (e.g. office workers sitting for long periods.) The pain may start while you’re sitting or when you first get up. The most common causes are:

Runners Knee: a problem in how the kneecap moves that causes pain and stiffness at the front of the knee
Arthritis: changes in the bone caused by wear and tear or sometimes inflammation
Osgood Schlatters: common in adolescents, particularly after a growth spurt. Tight muscles irritate the bone causing pain just below the knee

8) Pain Going Down Stairs

This usually indicates a problem with the kneecap, as the force going through the kneecap when you come down stairs is 3.5 times bodyweight.

9) Swelling

If the swelling begins immediately or within the first 48 hours, it usually indicates a ligament or cartilage injury. If it comes on gradually with no specific cause, it usually indicates an underlying knee problem such as bursitis. If there is moderate to severe swelling, you should see your doctor immediately.

10) Stiffness

Knee stiffness may develop as a result of an injury or a medical condition. It may develop suddenly or gradually, and often fluctuates. Stiffness when you first wake up that settles once you’re moving about is a classic feature of Osteoarthritis, which is most common in people over age 50.

11) Bony Lump at Front of Knee

This is a classic sign of Osgood Schlatters, which is common in teenagers and young adults, particularly after a growth spurt. Tension on the tendon just below the kneecap damages the bone, often resulting in a hard lump on the front of the shin.

Remember, the best way to get an accurate knee pain diagnosis is to see your doctor. Contact Michigan Spine and Pain for an appointment to receive a proper diagnosis.

Exercising (Exorcising?) Your Pain Away

photo by Rudolph A. Furtado

Exercise is good for everybody, even people who struggle with pain. Exercise helps build strength, improves balance, contributes to feelings of well-being through the creation of endorphins and is a significant factor in maintaining appropriate body weight.

Researchers in pain management are circling around three exercises that show promise in contributing to a healthy lifestyle: Pilates, Yoga and Tai Chi.

All three exercise groups are beneficial because:

They include slow, controlled movements.
They don’t involve any sudden movements or jolts, meaning they are low-impact.
They encourage strengthening core muscles, including the trunk as well as limbs.
They help patients focus on breathing.
They often include quiet meditation.

Before you embark on any exercise program, check with your health care team. They will recommend the best practitioners and will also tell you what exercises and positions to avoid, like flexing your back or neck or certain positions that might put too much pressure on hip or knee joints.

Go visit a class or watch a video if you are going to exercise from home. See if the motions look doable to you. Meet with the instructor prior to attending and discuss your exact needs.

During any class or demonstration, follow your doctor’s orders. There is no longer any support for “no pain no gain” exercise regimens. If you are in pain, stop the movement; ask the teacher for some sort of modification or just sit quietly until the group moves on to the next task. On the other hand, do not shy away from a little exertion or a bit of a stretch. It is okay to break a sweat (less likely in Tai Chi, however.)

If you were an exercise lover before your pain episodes, these three exercise types may or may not be a perfect fit for you. For some, Yoga, Pilates and Tai Chi feel slow or contemplative. The music is quiet, but not peppy, and the pace can feel cumbersome. But taking a slow route back to health and wellness is a reasonable detour, before making your way fully back into more vigorous cardiovascular workouts or even weight-bearing strength routines, both of which are crucial components to a lifetime of physical fitness.

The Knee Pain Problem: Exercising When Your Knees Hurt

It’s a real problem. Knee pain affects millions of Americans. At highest risk are the elderly and the overweight. Seniors face greater knee problems typically due to osteoarthritis, although other factors may also play a part, like injuries.

The overweight population has another issue. Their knees are bearing more of a load than they should. Clearly, the best practice for overweight individuals is to lose weight.

Unfortunately, those who suffer knee pain often are in too much discomfort to exercise.

What should you do?

Engage your health care team, especially your physical therapist. They will work to give you a list of approved exercises and modifications that will increase your range of motion and decrease your pain.
Find what works. Don’t give up and just go sit on the couch. Continue to try small amounts of physical activity to see what you can tolerate.
Build up your endurance. If you feel good after walking for 15 minutes, build up more each day. Try to be at 30 minutes within a week, and add 5 minutes each week after that.
Always choose the low-impact option. Jumping jacks and running in place will be too jarring on your knees. Your physical therapist can show you low-impact modifications where you never jump, but still build up muscles. Fitnessblender.com has thousands of fitness videos, which typically contain modifications for low-impact.
Pay attention to all of the muscles that support the function of the knee. Stretch them before and after your work out. Roll your ankles, point and flex your toes, bicycle your quadriceps, do some calf lifts, stretch your iliotibial band (which is a tendon that runs along the outer portion of your hip and leg).
Get those thighs moving. The front of the thighs (quadriceps) and the back of the thighs (hamstrings) need to be very, very strong to give your knees a break. Any exercise that utilizes these muscles that you can tolerate will be beneficial. Women, in particular, can benefit from exercises that strengthen the hamstring, as weak hamstrings contribute to a higher percentage of knee issues in women than in men. Bridges and weighted hamstring lifts are two such exercises.
Be wary of certain exercises that can exacerbate knee problems, like squats, burpees and excessive jumping.

Your knees are complex and yet fragile. Preserve them for as long as possible by getting to and maintaining an ideal weight and staying physically active.

Avoiding Overuse Injuries

Sometimes our body aches because of the presence of disease, like arthritis or fibromyalgia or various headaches, like migraines. Sometimes, we are in pain because of injuries to the bones or muscles.

There are several common injuries that are typically the result of overuse, either from athletic pursuits, work routines or regular daily life activities. Overuse kind of sneaks up on you. It may start off as a twinge that goes away and over time develops into more constant or consistent pain associated with specific activities.

Frequently occurring overuse injuries are:

Shin Splints (Leg pain which worsens with running or walking)
Tennis Elbow/Golfer’s Elbow (weakness and/or pain inside or outside the elbow)
Runner’s Knee (pain behind the kneecap, made worse with running, walking, jumping, cycling and ascending or descending steps)
Rotator cuff tendinitis (shoulder pain felt when lifting the arms straight up or in a circular motion like a swimming stroke)
Plantar Fascitis (usually felt in the feet and ankles upon first waking up)
Achilles Tendinitis (typically presents as ankle pain)

Overuse injuries are the result of too much exertion, combined with muscle weakness. The major ways to prevent the above injuries include babying yourself a little bit by not hitting the same muscles day after day. When you work out, be sure to warm up before true exertion. Most importantly, after exercising or after a long period of working, take time to stretch and cool down. Be sure you are moving appropriately. Contact a coach or trainer to check your form or consult with a physical therapist to demonstrate what hurts and learn compensating exercising to increase strength, flexibility and reduce pain.

If you are trying to increase exertion or activity, do so gradually, not all in one spurt of activity. If you’ve led a sedentary life, you can’t go from sitting on the couch to running a marathon. Start by adding 15 minutes of exertion and add a maximum of 10 minutes per day.

Being more active is a great goal. Being safe and avoiding overuse injuries should also be a concurrent objective.

Your Knees Need You to Lose Weight Now

If you’re trying to get motivated to lose weight, think about your knees.

The sheer numbers of knee replacement surgery have skyrocketed. In fact, the number of knee replacements has doubled in the past decade. More worrisome is that the number of knee replacement surgeries on patients younger than 65 has tripled in the same time frame.

There are some possibilities as to why this is occurring, including aging baby boomers as well as positive word of mouth and advertising regarding the surgeries.

But experts are circling around this theory: the increased obesity rate of middle age adults is driving the deterioration of our knees.

In a database called Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR), information is accumulated regarding total joint replacement surgeries from orthopedic surgeons in 22 states.

The latest data from FORCE-TJR revealed that younger patients were more likely to be obese than patients over age 65 who underwent knee replacement surgery. In fact, the average body mass index (BMI) of the middle age patients in the study was 33. A BMI of 33 falls into the obese range. Furthermore, this is the average BMI which means that roughly half of the participants have an even higher BMI.

Being overweight puts stress on all joints and can exacerbate osteoarthritis. Excess weight can cause an erosion of cartilage surrounding the knee. In addition, fat cells are believed to produce inflammatory cytokines that contribute to arthritis.

Overweight patients are particularly vulnerable to anterior knee pain, which is knee pain at the front of the knee. Anterior knee pain can include pain upon waking up, pain when walking after a sedentary period, difficulty walking up and down stairs, stiffness and soreness around the knee area and a general sensation of instability when standing upright.

Overweight patients may have other disease processes that can make a knee replacement surgery more complicated like diabetes, poor circulation and cardiovascular issues. Perhaps most troubling, some surgeons will not perform knee replacement surgery on morbidly obese patients, whose BMI is over 40.

Losing weight, even a fairly minimal amount can drastically reduce knee pain. An osteoarthritis study (the Framingham Study) showed that a 5% drop in weight among the participants improved joint pain by 18%.

One of the components to effective weight loss, of course, is increased exercise. Unfortunately for many patients with painful knees, some forms of exercise can be impossible. Physicians recommend swimming and water aerobics for these patients, as these exercises put far less stress on aching joints.

Please consult your health care team about any knee pain issues that you have and before you start any exercise regimen to alleviate them.

Not the stairs!

If you’re trying to stay fit and walk more, you have probably heard multiple messages about parking far away to force yourself to walk and foregoing the elevator in favor of the stairs. Whether it’s steps to the beach, the steps to the basement laundry, Rome’s Spanish Steps, or steps onto the bleachers at your favorite baseball field, sometimes you just can’t avoid the steps. But what if it hurts to climb or descend stairs?

Climbing Stairs:

Typically, people who suffer discomfort from climbing stairs have weakened leg muscles, especially the quadriceps muscles in their thighs. This, combined with poor cardiovascular conditioning often causes people to be short of breath or plain tired when they climb the stairs.

The good news: if climbing stairs wears you out, keep doing it. For most people, the repetitive exercise of stair climbing will actually build up your quadriceps, increase your endurance and improve your cardiovascular conditioning. We don’t recommend that you go from a totally sedentary lifestyle to running up the stairs of your nearest skyscraper, but certainly climbing several flights of stairs a day can only be beneficial, if your medical condition allows such exercise.

Descending Stairs:

Going down stairs uses your muscles in a different way. In addition, even a minimal amount of arthritis in the knee will often evidence itself as you descend the stairs. There are a few remedies that you can try to make your climbing down stairs less painful.

· Build up your quadriceps. If your quadriceps are weak, then the downward movement of your legs puts more pressure on your knees. You can build up your quadriceps through climbing stairs as well as other exercises, including leg lifts lying on your back.

· Move around a bit more. If you are quite sedentary, you can become stiff in lots of joints, and your knees are quite susceptible to this.

· Turn it around. Now we don’t mean go up the down staircase. But what we do mean is to face backwards and descend the stairs that way. You have to be holding onto the rail and you have to scan your surroundings beforehand to be sure this is a safe move (and we don’t recommend it in crowded stairways), but walking down the stairs backwards puts far less stress on your knees.

Please consult your health care team regarding the stairs in your life. You may be able to utilize physical therapy or occupational therapy to conquer the stairs.

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