Knee Pain Management: Strategies for Long-term Relief with Singapore family Doctors
Injuries often occur when people do an activity using the muscles around the knee too much. This can occur with changes in training routines, having to stand for longer periods of time than usual, or increased activity over time. People often tear cartilages in the knee or sprain ligaments, which also cause pain around the knee joint. Each one of these injuries, if not given proper medical treatment, may cause long-lasting effects or pain in the long run. Understanding your injury will help you in relieving the pain.
The knee is the body’s largest joint and one of the most easily injured. It’s made up of the lower end of the thighbone (femur), which rotates on the upper end of the shinbone (tibia), and the kneecap (patella), which slides in a groove on the end of the femur. The knee is a hinge joint that allows your leg to bend and straighten. It also has a slight rotational motion. Because the knee supports nearly the entire weight of the body, it is vulnerable to both acute injuries and chronic wear and tear. These can cause pain and lead to severe arthritis.
We often do not seem to understand the severity of knee pain and what has caused it. Sometimes, with mild pain, we may pass it off as nothing serious. However, what caused the pain could be affecting you more than you realize it. To understand and be relieved of the pain, we must know what caused it.
Understanding Knee Pain
Knee pain can happen to anyone, whether they are engaging in regular physical activities or leading a sedentary life. There are three major common causes of knee pain: sudden injury, overuse, and an underlying condition, such as different types of arthritis. Injury is the most common cause of knee pain. Usually, significant pain or limited range of motion following a traumatic event, such as a fall or a sports injury, is a good indication that something is seriously wrong in the knee. Overuse is another very common cause of knee pain. High-intensity activities can cause stress fractures, inflammation of the patellar tendon, or the muscles which attach to the knee. These types of activities include jumping or running. The repetitive movements from stair climbing, biking, or rowing can also cause overuse problems. Finally, acute injuries or chronic conditions can cause the wearing down of the articular cartilage, which can eventually lead to arthritis. Osteoarthritis is the most common type and occurs frequently in middle-aged people as a result of the wearing down of the cartilage. Knee pain can be localized or diffused throughout the knee. Pain can also be accompanied by physical restriction, such as locking or buckling, which can be quite severe or can make movement virtually impossible. A feeling of instability or weakness can also be a consequence of knee pain. The exact cause of pain can usually be diagnosed by the location and severity of the pain and by the type of injury that preceded the pain. A medical professional should be able to pinpoint the cause of pain with a good degree of certainty after an examination and a few tests, such as an x-ray or MRI.
Importance of Seeking Professional Help
Another important reason for seeing a knee pain doctor Singapore is to screen for red flags. These are signs and symptoms that may indicate serious underlying conditions which, if left uninvestigated, can lead to further complications. For example, an older person with a history of cancer who develops new unexplained knee pain may need to see a doctor to rule out the possibility of bone metastases. In this case, the knee pain is not due to a musculoskeletal problem but is referred from the affected bone. Early diagnosis of such a condition is essential.
There are numerous reasons for this initial assessment by a healthcare professional. Identifying the real cause of knee pain is crucial in planning the right intervention. Certain conditions will require referral to a specialist. For instance, a patient may have a mechanical problem in the knee joint, which will ultimately require orthopedic consultation. Alternatively, an accurate diagnosis for a systemic condition such as gout or rheumatoid arthritis can be made by a doctor, and treatment involving medication and monitoring the condition may be initiated.
Strategies for Long-term Relief
When you age or when an injury occurs, you will face making lifestyle changes that may be difficult. Permanent lifestyle change may be necessary in the presence of joint pain or reduced mobility, and it is better to make changes before severe disability sets in. This is because, even though lifestyle modification can be beneficial, it can be difficult to accomplish if you wait until it is a necessity. An example of a necessary lifestyle change is weight loss. Obesity is a major risk factor for the development of osteoarthritis. Ischemic Patellar Tendinopathy is a common injury in jumping athletes and has been referred to as jumper’s knee. Weight must be reduced or activity decreased to accomplish relief from this activity related overuse tendon problem. Another example is decreasing activities that involve high forces on the knee or result in prolonged positions of knee bending. An individual with malalignment or a meniscus problem can have symptoms worsened by activities such as squatting, kneeling or heavy lifting. If alternatives are not available, measures to reduce forces and pressures through use of knee padding or external knee supports should be considered. In making lifestyle changes, it is important to maintain a level of general fitness to minimize other health problems that may further impact joint health or mobility. This may be achieved through activities that do not aggravate the specific knee problem, or through exercises that can be done in a modified manner to maintain strength and fitness of the rest of the body.
Medications may be useful to help manage knee pain. Simple pain relievers such as Tylenol or pain relieving prescription drugs including narcotics or anti-inflammatory medications may be prescribed. Narcotics are not usually recommended and are often used sparingly in short-term situations, such as immediately after an injury or a surgical procedure. It is not advisable to use narcotics for long-term management of chronic knee pain. Anti-inflammatory medications can be very helpful for joint pain and can be taken over prolonged periods, but these drugs have potential side effects, such as stomach irritation, ulcers, and impairment of kidney function. Be sure to discuss the relative risks and benefits of long-term use of over-the-counter or prescription anti-inflammatory medications with your physician if such drugs are prescribed for you. Injections of corticosteroids into the knee joint have been shown in studies to provide significant short-term benefit for joint pain.
Physical therapy is a way to keep the knee strong and flexible. It may delay the need for surgical intervention, or it may be necessary to relearn how to bear weight and ambulate safely if surgery is required. A physical therapist may instruct the individual in exercises to maintain or increase range of motion, as well as to strengthen the muscles of the thigh and lower leg. You should assure that you are receiving knee stabilization help before beginning exercises and/or range of motion activities. This can be done through knee taping or bracing. Your therapist will explain to you the relative value of taping as opposed to bracing for your particular knee problem.
There are many ways to manage knee pain. The best a person can do for themselves is to attempt to maintain strong and flexible knees. People who have a knee injury might be able to save themselves from surgery by going to physical therapy. Other people may find that surgery is the best way to get back in the game. Finally, exercises the muscles of the thigh and lower leg is needed to stabilize the knee and support an injured, aging, or worn out knee. Follow these strategies to help manage the pain.
Physical Therapy and Rehabilitation
Rehabilitation and exercise play a vital role in obtaining pain relief and making sure that an episode of knee pain does not become chronic. It is important to try and keep the quadriceps muscles strong as studies show that people with weak quadriceps are more likely to suffer from knee pain. The quadriceps muscle is most commonly weakened or inhibited after knee surgery, injury, or trauma. Straight leg raises and quadriceps contractions are effective exercises to help strengthen the quadriceps muscles. It is also important to make sure that the Vastus Medialis Obliquus (inner quadriceps muscle) is firing correctly as this has been shown to prevent and aid in the treatment of Patellofemoral Pain Syndrome and Patella Tendinopathy. This can be achieved by taping, electrical stimulation, or exercise therapy. High repetition exercises and low resistance strength training have been shown to improve function in people with knee pain. It also produces less stress on the joint because the patellofemoral joint forces are reduced. Specific exercise therapy should target the internal and external structures affected by the knee pain. A correct and accurate diagnosis is vital to make sure that the right exercise therapy is prescribed. For example, exercises to the VMO may be prescribed for patellofemoral knee pain and eccentric strengthening exercises for the hamstring origin tendinopathy. Swimming is an excellent form of exercise for people with knee pain because the buoyancy of the water reduces the joint stress. Finally, functional or proprioceptive exercise has a preventative effect on knee pain. Studies show that people who have neuromuscular or proprioceptive deficits are more likely to suffer from knee pain. Functional exercise can range from balance training to more sport-specific drills.
Medications and Pain Management Techniques
Another injectable medication frequently used for arthritis is a corticosteroid. Corticosteroid injections are effective at suppressing inflammation and immune responses. This treatment can provide quick relief of symptoms that can last anywhere from a few weeks to more than six months. However, there are limits to how many injections can be given in a one-year span due to possible adverse effects on the knee joint.
In severe cases of arthritis, an NSAID or other anti-inflammatory medication may be injected directly into the knee. This form of treatment has proven to be effective in that it acts only on the targeted area and can provide relief for several months. An alternative of the “COX-2 inhibitor” types of drugs is also available. COX-2 inhibitors have been engineered to have fewer gastrointestinal side effects than other NSAIDs. Although it is effective in reducing inflammation and pain, this type of medication may be associated with an increased risk of cardiovascular problems.
Medications for arthritis come in a number of forms. The most common form of medication used to treat arthritis is referred to as nonsteroidal anti-inflammatory drugs or “NSAIDs”. This type of medication works by blocking an inflammation-promoting enzyme and has been shown to ease pain and improve function of the knee for people suffering from arthritis. A commonly used over-the-counter NSAID is Ibuprofen. When used at the direction of a doctor, there are stronger NSAIDs available by prescription.
Medications are an appealing strategy to help manage knee pain, especially for those suffering from it. The effective use of medication can minimize pain and help get through slumps or flare-ups in the condition, for example, during changes in weather. There are many medication options available to help manage knee pain, although most medications are not without side effects. This is an in-depth review of medications that are used to treat knee pain.
Lifestyle Modifications for Knee Health
Physical therapy and rehabilitation therapy is beneficial for those suffering from knee problems. Physical therapists will analyze the problem and then prescribe a series of therapy exercises to help strengthen the knee and improve its function. This is beneficial as research has shown that using therapy and exercise in a weight-bearing knee is an effective treatment for osteoarthritis. A study showed that people with osteoarthritis of the knee who engage in physical activity to improve aerobic fitness and strength have significantly less pain and better physical function than those who do not. Those who can afford it might consider joining a gym. In a recent study, it showed an improvement of physical function in an older group of people who had a 4-month progressive strength training program. It also showed a decrease in pain in that group and demonstrated that strength training has a beneficial impact on knee osteoarthritis. Another research article found that self-reported exercise was associated with improved knee-specific symptoms and physical functional performance. Lastly, aquatic therapy is beneficial as it allows exercise with less pressure on the knee. This is useful for an individual who finds regular therapy or exercise too painful.
Finding the Right Singaporean Doctor
The majority of people who have knee pain feel they are under the control of their GP, who refers them on to a specialist. If you’re lucky, you might get a choice of which specialist to see, particularly if you have private health insurance. If you don’t have a choice, it is very important to ask your GP for a detailed background as to why he is referring you to a particular doctor and if this doctor has a special interest in knee conditions. If the GP is not very sure, it may be worth seeking a second opinion from another GP. Sometimes people feel that their GP is not taking their knee pain seriously and is merely trying to get rid of them. In these circumstances, it is perfectly acceptable to ask your GP to refer you to a specialist for a second opinion.
If you’re experiencing knee pain and looking for the right specialist to help alleviate it, you’ll want to find a doctor who fully understands the complexities of knee pain and who can provide the best advice and treatments. This can make a huge difference to your long-term pain relief and mobility. But finding the right medical professional can be a daunting task, particularly if you don’t know where to start or what you’re looking for.
Researching and Choosing a Specialist
Use the internet. Many websites have lists of orthopaedic surgeons who have registered on their site. While using the internet, it is important to be cautious about what sites are being visited and to cross-reference the information found on one site with another. Family members, friends, and other healthcare providers can also give recommendations.
Ask your primary care doctor for a referral. When being treated for a medical condition, it is important to have a primary care doctor who is a generalist to oversee the care. The primary doctor can help you decide which specialist is best for your needs and can also provide a referral to specific doctors or hospitals.
Contact the local, provincial or state medical society. Many have a service that provides the specialty and subspecialty interests of their member physicians.
In the initial stages of finding a doctor, you may want to ask people you know about doctors they see. Your orthopaedic surgeon may have a list of orthopaedists to recommend. Regardless of how you learn of a doctor, it is still important to do some research on your own. What is important to one person may not be important to another. Consider what is important to you in finding a doctor and write down questions that fit your needs. Below are some suggestions on how to go about gathering information on a particular doctor:
Consultation and Diagnosis Process
Dr. Lau agrees, adding that patients who seek an orthopaedic surgeon should consider factors such as the surgeon’s reputation and the amount of exposure he or she has had to specific knee problems. “In general, patients should try to obtain as much information about their doctors as possible,” he says.
When the decision is made to consult a specialist such as an orthopaedic surgeon or rheumatologist, the family doctor will generally provide a referral. Dr. Chong urges patients to do a little groundwork before making a choice. “There are a lot of orthopaedic surgeons around, but some have special interests and particular expertise in certain knee problems, such as sports injuries, ligament fractures, or osteoarthritis. Patients should try to find out a bit more about the specialist’s skills and experience before deciding on one,” he advises.
A family doctor or general practitioner often serves as the first stop for patients who have knee pain, says Dr. Chng. The initial consultation may include blood tests to rule out rheumatoid arthritis as well as osteoarthritis, says Dr. Lau. Patients should bring a list of their current medications, a description of how their knee pain began, and an outline of their daily activities, he adds. This information can be valuable in arriving at an accurate diagnosis.
Treatment Options and Ongoing Care
Finally, some patients use complementary and alternative medical therapies to treat chronic knee pain. The effectiveness of these therapies is largely unknown.
There are many surgical procedures that can be performed in an attempt to alleviate chronic knee pain. These include arthroscopy with various procedures, realignment osteotomy, and joint replacement. Arthroscopy, primarily used to treat osteoarthritis and meniscal tears, is the most commonly performed orthopaedic procedure. Although arthroscopy is associated with symptomatic relief, there is a lack of definitive evidence supporting its efficacy for osteoarthritis. A recent Cochrane review found little benefit from arthroscopic lavage or arthroscopic partial meniscectomy for patients with knee osteoarthritis and meniscal tears, but the study was inconclusive because of few patients and poor methodological quality of available trials. Randomized trials and lower-level evidence support that high tibial osteotomy is an effective treatment for knee pain associated with malalignment and compartment specific osteoarthritis. Joint replacement is a successful treatment for end-stage osteoarthritis, but the long-term durability and outcomes of this procedure in younger patients with symptomatic osteoarthritis remain uncertain.
High quality trials and limited data suggest that intra-articular corticosteroid and hyaluronate injections are modestly effective for short-term relief and are associated with little risk. However, these treatments are no more effective than a placebo injection for pain at 6 months and 1 year after the injection. Because of the expense and potential side effects, use of these treatments for chronic pain is not generally recommended.
Self-care, which is quite commonly used by patients with chronic knee pain, includes using pain relievers, staying off the affected knee, and reducing weight to lessen pressure on the knee. Physical therapy focused on exercise and strength training can improve function for older patients with osteoarthritis and is generally safe and effective. Exercise therapy is more intensive and often conducted under supervision. Weight loss reduces the risk of developing symptomatic knee osteoarthritis in older adults and can improve function for those that already have arthritis.
Patients with chronic knee pain have many options for treatment, including self-care, physical therapy, medication, exercise, weight loss, injections, surgery, and complementary medicine (Table 1). The comparative effectiveness of these therapies is not well established, but informed patient preference, comorbid conditions, and potential anatomic or mechanistic factors can guide the choice of a specific treatment.
