All Posts tagged Knee

Knee Osteoarthritis

2007-2009. For men and women, the prevalence of age-adjusted arthritis increased significantly with increasing BMI (P <.001 for trend). The age-adjusted prevalence of OA among people who were obese (25.2% for men and 33.8% for women) was nearly double that of people who are underweight/normal weight (13.8% for men and 18.9% for women). Source: CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation— United States, 2007-2009. MMWR. 2010;59(39):1261-1265.

Treatment options for OA

In patients with knee OA, my approach tends include shoe inserts. These  are good adjuncts to supplements, laser, Deep Muscle Stimulation (DMS), injectables, taping, and exercise therapy. I recommend swimming, recumbent bicycles, rowing machines and elliptical trainers. I teacgh my clients a lot of low load, easy to do stretches and strenghtening exercises. Weight loss is really important here. 

On laser therapy for treating patients with knee OA:  It depends on the patient and the severity of his or her OA. For example, if the patient is older and has a severely arthritic knee, a total knee replacement will probably be necessary. If a patient has OA and joint effusion, I might recommend laser, aspiration and corticosteroid injection.

If I have a patient with symptoms of OA who may have incurred an injury such as an ACL tear, I will use warm laser and DMS. 

If you have undergone an arthroscopic procedure, but not yet fully out of pain, I will use laser. 

I often use glucosamine and chondroitin sulfate with high dose omega 3’s.

I like topical menthol products such as BioFreeze. These have evidence of efficacy.

There are dangers of using cortisone, which has been administered for years as an injection in the joints. If any of my patients ask for cortisone because it worked when administered to them 10 years ago, I would educate them on safer long-term options. The most common recommendation I have for most of my patients is to eat less carbs and exercise more. I love the anti-inflammatory diet coupled with UltraInflamX by Metyagenics and high dose omega 3 fish oils. Through weight reduction and a low-impact exercise program, many patients will achieve dramatic improvements in their arthritis pain.

My goal for patients is to decrease pain and inflammation, maintain or improve function and retard disease progression if possible. In this regard, preventing damage to subchondral bone, cartilage, joint space narrowing and osteophyte formation is the goal. 

The contraindications for NSAIDs include gastrointestinal (GI) bleeding or adverse effects to the kidneys or liver. Some patients worry about taking a glucosamine product because they have diabetes, but I inform them no data support this concern. 

I might recommend UltraInflamX by Metagenics alot. I like garlic, ginseng and gingko — but these affect bleeding time. If used in conjunction with NSAIDs, the risk of GI problems increases.

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Patellar tendinitis

Patellar tendinitis is the most common knee disorder found among competitive athletes. Known as ‘jumper’s knee’, it is most likely to affect you if you play high impact sports involving bursts of intense or repeated stress, notably basketball and volleyball (these sports demand twisting on the spot, deep knee bends and sprinting).

However, anyone from the casual jogger to contact sport players may develop the condition – all too often with far-reaching consequences. One study has estimated that more than half of athletes diagnosed with patellar tendinitis were forced to retire from their sporting activity.

Classically patellar tendinitis has been explained as chronic inflammation of the tendon connecting the kneecap (patella) to the main shin bone (tibia), at the point of connection to the kneecap. Recent research has, however, revised our understanding of the condition.

Both intrinsic (specific to the individual) and extrinsic (environmental) factors can be contributing factors to patellar tendinitis. 

Treatment involves corrective exercise (with proper exercises you can avoid the need for surgery). Partellar tendinosis is also very responsive to warm laser therapy and nutritional recommendations.

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Thera-Band® exercise program for total knee replacement featured in Lower Extremity Review

Ongoing research at the University of Louisville and Bellarmine University is investigating the effectiveness of Thera-Band® resistance band exercises before surgery for total knee arthroplasty (TKA). “Prehabilitation” consistshttp://lowerextremityreview.com/wordpress/wp-content/uploads/2010/03/Resistance-Training-Excerises-2.pdf of pre-operative exercises that are meant to improve strength and functional levels before surgery with the expectation of better rehabilitation and a faster recovery after surgery.

The TKA Prehab Program was featured in an article in the March 2010 edition of Lower Extremity Review. The program utilizes Thera-Band resistance bands, step-up exercises, and stretching exercises.  A full-color printable handout of the program is available online.

Reference: Brown K et al. 2010. Preoperative exercise boosts TKA outcomes. Lower Extremity Review: March 2010.

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