Sore knees are more than just a nuisance – they make physical activity uncomfortable, which has implications for preventing and managing all sorts of conditions, including heart disease and type 2 diabetes as well as a healthy mindset. As the largest joint in our body and one of the most complicated, it’s no wonder our body’s shock-absorption system is prone to aches and pains.
Fortunately, there is a lot you can do – and it’s almost as easy as a walk in the park (literally). According to Professor of Medicine and rheumatology clinician researcher David Hunter, of the University of Sydney and Royal North Shore Hospital in Australia, there are many steps to try before going under the knife for knee pain or osteoarthritis (OA), which occurs when the protective cartilage cushioning the ends of the bones wears down over time.
“There’s a lot that can be done,” he says. The three big areas of early intervention: stay active, stay strong and keep your weight down. And don’t resign yourself to thinking that with age comes pain. Here, leading experts share the latest advice on how to keep your knees healthy and strong.
“The benefits of early intervention are that you have the potential of breaking the cycle of knee pain, increased weakness of the muscles around the knee, and more frequent episodes of pain,” explains Professor Flavia Cicuttini, the Head of Rheumatology, Alfred Hospital, Melbourne and Head of the Musculoskeletal Unit, Monash University, noting that in general, people tend to ignore the early signs of pain.
“They believe it’s a sign of getting older and they just have to live with it,” she says. But if you leave it, this may put strain on other joints including your ankle, hip, lower back and other leg, says Justine Trethewey, the principal physiotherapist at Macquarie Street Physiotherapy Australia.
“You also might start to avoid various activities which have social and general health implications, avoiding stairs, hills, walking with friends, or going to the gym, due to pain,” she says.
A better plan: be proactive and book an appointment with a physiotherapist or check in with your GP to get to the bottom of why you feel pain.
“One of the most important risk factors for knee pain is carrying too much weight,” says Professor Cicuttini. “What many people don’t realise is that across the adult years, most people gain about half a kilogram per year and this weight gain tends to make knee pain worse.”
Interestingly, while losing weight is important, it’s even more crucial to stop gaining weight. According to Professor Cicuttini, excess weight affects joints by not only loading them, but also leading to low-grade inflammation caused by inflammatory chemicals produced by fat.
“Carrying an extra 10kg of weight has a double whammy effect on the knee, as it increases loading on an inflamed joint,” she says. Stopping or slowing the gradual weight gain that happens over the years will mean your joints stay healthier.
According to Professor Hunter, every additional kilo you gain means an additional 4kg load across your knees. The good news, however, is that reduce your by just 5 per cent, and your odds of developing OA are down by 30 per cent.
“Losing weight has an immediate impact,” he says.
The experts are unanimous: staying active helps painful knees, and with manageable pain, it’s better to do something than nothing at all. “Cartilage is kept healthy by a moderate amount of dynamic load going through it, for example walking,” says Justine.
“Under-exercising can result in cartilage degeneration just as overloading the cartilage can. An acutely injured or very painful, swollen knee should be rested, but otherwise gentle exercise is usually better than complete rest.”
A common concern among those with sore knees is knowing when to rest. Physiotherapist Dr Andrea Bruder has a helpful strategy to work out if you’re overstepping the line.
“Our body gives us information about when it’s time to do more or less,” says Dr Bruder, noting that a 10-point pain-rating scale can help us rate how hard or painful an activity is.
For example, he says, after a 10-minute moderate-intensity walk, ask yourself: On a scale of 0-10, how much pain am I experiencing in my knee? If the pain is 2 out of 10 and returns to pre-activity pain levels within a day, it’s probably safe to add a little more time or distance to your walk.
To help decide how much more to add, stick to the rule of no more than 10 per cent. So, for a 10-minute walk, don’t add more than another minute at a time, and always monitor your symptoms.
“A physiotherapist can design a tailored, progressive exercise program for you,” says Dr Bruder.
The message is stay active, whatever your age, and you can delay the onset of OA and more frequent episodes, and possibly even surgery. “Current evidence shows that simple, targeted exercises, for example the physiotherapist-run GLA:D program, can delay or prevent the need for surgery,” says Justine.
“Often people don’t think there’s anything that can be done except surgery, but getting good advice about strength, alignment, possibly orthotics to support the feet, and general exercise allows people to manage these problems as independently as possible.”
As a general rule, staying strong from an early age supports all the joints of the body.
“It’s a common perception that OA happens in older adults, but two-thirds of people who present with it are under 65,” says Professor Hunter. As we age, the quality and elasticity of collagen decreases, cartilage in the knee wears more easily, but you don’t necessarily have to do a huge amount to make a difference.
“Just because we get older doesn’t mean we will experience more knee pain,” says Dr Bruder. “An active older person with knee OA who is educated in symptom management, strong, socially engaged and supported, who maintains a healthy body weight, may have only a little pain or impact on daily activity.”
The experts agree – there isn’t enough evidence to show glucosamine assists with OA pain, though physio Tom Sheehan, of Northside Sports Physiotherapy, says some patients found it helpful.
“About 50 per cent of OA patients take glucosamine, spending about $50 per month that would be better spent on something more effective, like a strength program,” suggests Professor Hunter.
In their review, Professor Hunter and his colleagues found supplements Boswellia, Pycnogenol, MSM and curcumin “appear to have a modest effect”, but the quality of trials isn’t great so far.
Text: bauersyndication.com.au