I coined the term POLITE Method for how I treat my patients. The ‘P’ is for improving posture and creating a plan of treatment.
The ‘OL’ is optimal loading. This means figuring out self-management activities for knee pain that are not too easy and not too difficult.
The ‘I’ in instruments that I use in the office for knee pain such as laser, DMS, and shockwave therapy that give effective short- and long-term pain relief benefits.
‘T’ is for taping the knee and I’ll teach you how to apply simple kinesio-tape to the knee for pain relief.
‘E’ is for education regarding the progressive nature of osteoarthritis (OA) and for pain management education; joint-sparing exercise advice including daily walking, balance tips, and falls prevention; and emotional and cognitive skills to improve quality of life; Eating for weight loss for those who are overweight or obese. Weight loss has been shown to improve mobility and reduce pain. For every one pound of weight lost, there is a 4-pound reduction in the load exerted on the knee for each step taken during daily activities. A weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.
A low-carbohydrate diet has been shown to reduce weight in obese patients by ?10% and lead to improvements in self-reported scores for overall progress and functional ability.
If you like my POLITE approach call 310-444-9393 for an appointment.
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.
ROME — Contrary to some earlier findings, obese patients with knee osteoarthritis who lost substantial weight showed signs of structural improvement in their damaged joints, according to two studies reported here. In 44 extremely obese patients whose…
full story http://www.medpagetoday.com/MeetingCoverage/EULAR/tb/20768
Repetitive exercises are another way to help arthritic knees:
•Use a skateboard. Sit down in a chair. Place your foot on the skateboard. Slide your foot back and forth.
•Use a furniture mover. Use these on carpeted surfaces. Do the same thing as with the skateboard.
•Use a rocking chair. Rocking chairs create small, light motions in the hip, knee and spine. They really work.
•Swing your legs in water while sitting on the edge of a pool. For this to work, you have to swing your legs very slowly. Otherwise, you’ll fatigue the muscles too fast.
•People often ask if they can use cycling as a way to improve their joint health and the answer is, it depends! It depends on how much motion you have in your knee, how irritable your knee is, and how easily you can control the resistance on the bike. Cycling can create body weight or higher loads on your knee so it’s usually not my first choice. But, it is an option. And, only on a stationary bike.
•I suggest ten-fifteen minutes per session and aim for three sessions per day. The key is to move slowly and feel very little fatigue in the muscles. The purpose is not to strengthen your muscles; it’s to improve the fluid in your knee.
Regarding Glucosamine, the original Italian studies circa 1988 were using 1200mg GluS04 and 600mg ChonS04 daily for 6 weeks. These studies claimed that people with osteoarthritic knees felt a 50% symptom reduction. Arthroscopy of that group revealed evidence of increased meniscal thickness. Histo revealed increased Chondrocyte size and histo density.
The JOG (Joints on Glucosamine) study used Glucosamine Hydrochloride at 1500 mg/day. Glucosamine hydrochloride has been shown to be ineffective in other studies. Glucosamine sulphate is the active form that is most helpful. My experience is that clients need to be on at least 3-4 grams/day for an initial 3 week dose to be effective. At week 4-6 they can take 2-3 grams daily. A maintaince dose is 1500 mg. I do like to change this supplement out every 10-12 weeks.
Using glucosamine hydrochloride has been a common theme of studies showing lack of benefit.
Ideal treatment for joint pain should include Pycnogenol, a pine bark extract with anti- inflammatory effects. Pycnogenol has been shown to help knee osteoarthritis, conditions that need enhanced blood flow, symptoms of menopause, and diabetics manage blood sugar levels.
Dr. Tucker recommends combining Pycnogenol (150 mg of Pycnogenol daily), glucosamine and chondroitin sulphate ( 1500 mg daily), with omega-3s( 2-3 grams daily) to reduce inflammation related to knee OA.