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Keeping knees pain-free and flexible
By Janice Lloyd, USA TODAY Updated 09/26/2011 8:03 PM
If your knees start throbbing like those of post-game NFL players, remember all of your options — and not just the easy ones, health experts say.
Knee surgeries are expected to soar as baby boomers try to stay active longer, but self-care treatments can help with pain, restore mobility and delay or eliminate the need for surgery.
"Total knee replacement is an epidemic in our country," says Marj Albohm, president of the National Athletic Trainers' Association. "That circles back to the American way. Fix it. Give me an operation."
Replacement operations increased 100% over the past 10 years and are expected to rise 500% by 2030 , according to the American Academy of Orthopedic Surgeons. Traumatic injuries and osteoarthritis, which troubles 27 million American adults by damaging cartilage and bone and causing pain, stiffness and swelling, can lead to expensive surgeries.
Tried this? Think again
The American Academy of Orthopedic Surgeons developed the 2008 treatment guidelines for osteoarthritis of the knee to include only treatments less invasive than joint replacement. Not all the regimens are recommended because scientific evidence is lacking.
Not recommended:
Glucosamine and or chondrotin sulfate. “Most of the studies recommending it have been done by the industry,” says John Richmond, chair of the AAOS task force that drew up the guidelines. One study concluded no clinical benefits compared with a placebo. The report says the “best possible evidence does not support prescribing” them.
Can not recommend for or against:
Various braces. “These might help some individuals but overall we didn’t recommend them because they don’t work on overweight or obese people,” says Richmond.
Acupuncture. The guidelines cite conflicting studies and other studies on the “effects of acupuncture were not statistically significant.”
The best ways to slow down arthritis and help preserve cartilage cushioning knees and other joints are to follow the Arthritis Foundation's guidelines, says physician John Richmond, chairman of the group who wrote the AAOS 2008 guidelines for treatments less invasive than knee replacements. At the top of the list is losing weight.
What to take for pain:
Always check with a physician before taking over-the-counter analgesics for knee pain. Recommendations in the 2008 guidelines:
Patients with osteoarthritis of the knee should take acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). The guidelines state “NSAIDs appear to reduce pain significantly more than does acetaminophen. ... but they also have statistically significant increased risk of gastrointestinal complications.”
Patients with increased gastrointestinal risk should take acetaminophen, topical NSAIDS, oral NSAIDS with a gastroprotective agent, or COX-2 inhibitors.
Also encouraged: corti-costeroid shots for short-term pain relief.
Source: 2008 American Academy of Orthopedic Surgeons clinical pratice guideline summar
"The only treatment that actually slows down the progress of the disease is weight loss," says Richmond, chairman of New England Baptist Hospital's department of orthopedic surgery in Boston. "You might think restricting activity would help but it does not."
Among the Arthritis Foundation's strategies to combat pain and restore mobility:
•Lose weight: Every pound lost reduces the weight on your knees by 4 pounds, says Patience White, chief public health officer of the Arthritis Foundation, which funds research for treatments and a cure.
•Get exercising: Include regular, low-impact aerobic exercises (cycling, brisk walking, gardening, group exercise classes and dancing) in your workout routine. "We can't say this enough. Exercise helps with pain and is good for overall health,'' says White.
•Increase muscle: Work all the muscle groups twice a week. Stronger muscles can help support damaged joints.
But sometimes, a healthy routine won't help and people will opt for replacement surgery when pain restricts everyday activities. Surgeons consult X-rays to see if knees are severely damaged before deciding to replace the diseased or injured joint.
Athletic trainer Paul Ullucci, 43, is fighting that fate. He has had six surgeries on his right knee and is putting off replacement surgery as long as possible. He combines exercise with other routines to help his knees, and it's working, he says.
Among his drills: squats and bridges (lie on your back and push up your legs with a ball squeezed between them) are good exercises for both muscle groups.
"There's a lot of research showing proper exercise and stretching will actually prolong the knee's life," says Ullucci, a board member of the National Athletic Trainers' Association and president of the Ullucci Sports Medicine and Physical Therapy in Providence, R.I.
The 2008 AAOS guidelines state quality studies found quad strengthening helps "with pain and function." No published studies addressed the effects of flexibility exercises, but "based on expert opinion," the guidelines say "stretching is an option for patients." Sixteen orthopedic specialists combined on the guidelines by reviewing research and examing other work prepared for the Agency for Healthcare Quality and Research and done by the Osteoarthritis Research Society International .
One of Ullucci's treats many patients is a , including boomers and older people, who want to stay active even though they have knee trouble. One firefighter who was told by his doctor to give up his career.
"He's 53 and was told he needed knee replacement," says Ullucci. "We worked with him (instead) for 1½ months, and he went back on the job. He needed to strengthen and have everything balanced in his body. But he's going up and down ladders again."
Ullucci thinks Americans' biggest problem is "as a society, they aren't very patient. Certain injuries prevent you from working. But with proper treatment, you'll save or put off having your body from going through surgery."
By Janice Lloyd, USA TODAY Updated 09/26/2011 8:03 PM
If your knees start throbbing like those of post-game NFL players, remember all of your options — and not just the easy ones, health experts say.
Knee surgeries are expected to soar as baby boomers try to stay active longer, but self-care treatments can help with pain, restore mobility and delay or eliminate the need for surgery.
"Total knee replacement is an epidemic in our country," says Marj Albohm, president of the National Athletic Trainers' Association. "That circles back to the American way. Fix it. Give me an operation."
Replacement operations increased 100% over the past 10 years and are expected to rise 500% by 2030 , according to the American Academy of Orthopedic Surgeons. Traumatic injuries and osteoarthritis, which troubles 27 million American adults by damaging cartilage and bone and causing pain, stiffness and swelling, can lead to expensive surgeries.
Tried this? Think again
The American Academy of Orthopedic Surgeons developed the 2008 treatment guidelines for osteoarthritis of the knee to include only treatments less invasive than joint replacement. Not all the regimens are recommended because scientific evidence is lacking.
Not recommended:
Glucosamine and or chondrotin sulfate. “Most of the studies recommending it have been done by the industry,” says John Richmond, chair of the AAOS task force that drew up the guidelines. One study concluded no clinical benefits compared with a placebo. The report says the “best possible evidence does not support prescribing” them.
Can not recommend for or against:
Various braces. “These might help some individuals but overall we didn’t recommend them because they don’t work on overweight or obese people,” says Richmond.
Acupuncture. The guidelines cite conflicting studies and other studies on the “effects of acupuncture were not statistically significant.”
The best ways to slow down arthritis and help preserve cartilage cushioning knees and other joints are to follow the Arthritis Foundation's guidelines, says physician John Richmond, chairman of the group who wrote the AAOS 2008 guidelines for treatments less invasive than knee replacements. At the top of the list is losing weight.
What to take for pain:
Always check with a physician before taking over-the-counter analgesics for knee pain. Recommendations in the 2008 guidelines:
Patients with osteoarthritis of the knee should take acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). The guidelines state “NSAIDs appear to reduce pain significantly more than does acetaminophen. ... but they also have statistically significant increased risk of gastrointestinal complications.”
Patients with increased gastrointestinal risk should take acetaminophen, topical NSAIDS, oral NSAIDS with a gastroprotective agent, or COX-2 inhibitors.
Also encouraged: corti-costeroid shots for short-term pain relief.
Source: 2008 American Academy of Orthopedic Surgeons clinical pratice guideline summar
"The only treatment that actually slows down the progress of the disease is weight loss," says Richmond, chairman of New England Baptist Hospital's department of orthopedic surgery in Boston. "You might think restricting activity would help but it does not."
Among the Arthritis Foundation's strategies to combat pain and restore mobility:
•Lose weight: Every pound lost reduces the weight on your knees by 4 pounds, says Patience White, chief public health officer of the Arthritis Foundation, which funds research for treatments and a cure.
•Get exercising: Include regular, low-impact aerobic exercises (cycling, brisk walking, gardening, group exercise classes and dancing) in your workout routine. "We can't say this enough. Exercise helps with pain and is good for overall health,'' says White.
•Increase muscle: Work all the muscle groups twice a week. Stronger muscles can help support damaged joints.
But sometimes, a healthy routine won't help and people will opt for replacement surgery when pain restricts everyday activities. Surgeons consult X-rays to see if knees are severely damaged before deciding to replace the diseased or injured joint.
Athletic trainer Paul Ullucci, 43, is fighting that fate. He has had six surgeries on his right knee and is putting off replacement surgery as long as possible. He combines exercise with other routines to help his knees, and it's working, he says.
Among his drills: squats and bridges (lie on your back and push up your legs with a ball squeezed between them) are good exercises for both muscle groups.
"There's a lot of research showing proper exercise and stretching will actually prolong the knee's life," says Ullucci, a board member of the National Athletic Trainers' Association and president of the Ullucci Sports Medicine and Physical Therapy in Providence, R.I.
The 2008 AAOS guidelines state quality studies found quad strengthening helps "with pain and function." No published studies addressed the effects of flexibility exercises, but "based on expert opinion," the guidelines say "stretching is an option for patients." Sixteen orthopedic specialists combined on the guidelines by reviewing research and examing other work prepared for the Agency for Healthcare Quality and Research and done by the Osteoarthritis Research Society International .
One of Ullucci's treats many patients is a , including boomers and older people, who want to stay active even though they have knee trouble. One firefighter who was told by his doctor to give up his career.
"He's 53 and was told he needed knee replacement," says Ullucci. "We worked with him (instead) for 1½ months, and he went back on the job. He needed to strengthen and have everything balanced in his body. But he's going up and down ladders again."
Ullucci thinks Americans' biggest problem is "as a society, they aren't very patient. Certain injuries prevent you from working. But with proper treatment, you'll save or put off having your body from going through surgery."
