We are all living longer in general. This is thanks to better living conditions, improved public health and nutrition. We are also more active, participating in sporting hobbies and working longer than previous generations. Mobility is crucial for all these changes to happen. Knee pain is a common ailment that affects a large proportion of our population. In this article, we discuss the common ways to manage knee pain so that we may all continue to be active and pain-free.
Most knee pain improve with simple lifestyle changes. We tend to get better with some rest, refraining from strenuous activities and then resuming our activities slowly. If the knee is swollen, some compression and icing may help improve the symptoms.
Physical therapy is also important not only to prevent knee injuries and knee pain, but also to help recover from it if you’re already experiencing it. Aerobic exercises like walking, cycling and jogging help to build up muscle strength, improves flexibility and range of motion of the knee. Cycling is also a low-impact exercise that helps to improve cardiovascular health and burn away calories. Lifting light to moderate weights at the gym is a great way to enhance bone density and promotes healthy weight management. The trainers at the gyn are there to motivate you and also teach you to use the available equipment in an effective and safe way.
If these conservative techniques are not sufficient in managing knee pain, simple medication may be required. Some analgesia such as paracetamol and anti-inflammatories (NSAIDS) such as ibuprofen may be obtained over the counter. Stronger NSAIDS such as Arcoxia or Diclofenac may be prescribed by a doctor. There are also some muscle relaxants that may be taken as an oral tablet or a topical gel which can be massaged around the painful joint.
For middle-aged patients with difficulty walking, the use of walking aids is essential for general mobility and safety. If there is a risk of falls, these walking aids help patients to maintain balance and improve their confidence level. They may also be more independent in their daily activities with the use of walking aids. With more mobility and confidence, these patients are more likely to leave their home to carry out their daily errands or continue with their usual employment. There are many modern walking aids that have dual purposes, such as the ‘walking seat stick’ that can be used as a walking stick but also converted to a small seat for resting.
Some of these patients may also require some modifications to their home to facilitate their mobility in safe way. Modifications such as grab bars, railings, elevated seating and non-slip mats are just some to name a few. An occupational therapist can visit your home and assess what you may need.
For patients who have had surgery for their knee, they will experience some discomfort. The extent of the pain or discomfort will depend on the type of surgery received, the pain threshold of the patient and the type of post operative pain killers given,
In sports related surgeries like meniscus repairs and ACL reconstruction, the key-hole or minimally invasive techniques help to reduce the pain patients feel post op. Analgesia such as NSAIDS and muscle relaxants are generally enough to keep patients comfortable. After a knee replacement surgery, patients may require stronger pain killers that contain opioids. These include codeine, tramadol, targin and oxynorm. These opioid medication may be given as oral tables, intravenous medications. Some may be given as an infusion pump so that patients do not need to ask for painkillers when they experience it. The medication is given as a slow dose intravenously.
It is quite common to experience some swelling after surgery. This can be managed with compression and icing on a regular basis.
Physical therapy and physiotherapy are important aspects of any patients’ rehab. Rehab may be given in several phases. The initial phase is often focused on maintaining muscle strength and reducing swelling around the joint. The second focus in mobility with or without a walking aid. The third step is functional mobility, stability and return to sports or daily function. These sessions may be done in an outpatient setting and is more customised to the individual patient.
As mentioned above, rehabilitation is a crucial aspect of any surgery patients undergo. No matter how good the operation was, the final outcome won’t be optimal if patients do not go through a robust rehab program.
Physiotherapy sessions should be regular, perhaps two or three times a week to allow the therapist to keep a close eye on the patient’s journey and make changes along the way as needed. Continuous encouragement and positive feedback is also important to keep patients engaged and motivated.
There is no fixed time for physiotherapy sessions to start or end. Each patient may have different outcome goals and may require different amount of time and techniques to achieve these goals. Physiotherapists are all well trained but they may have different philosophies when they treat patients. Some may focus more on physical massage, others more on stretching and strengthening. Some physios use dry needling while others use ultrasound machines to help their patients. What is most important is the continuous communication and sharing between patients and physios to get the best outcome from their efforts!
Patients should expect their use of NSAIDS and other painkillers should gradually reduce over time as they go through their rehab. The dose and frequency of their medication will drop as they get physically stronger and more mobile. Their dependence on mobility aids such as walking frames and walking sticks should also reduce as they work their way to unaided mobility!
I think the key to mobility is keeping your muscles strong and flexible. Even animals who do not walk around much will get fat infiltration into their muscles. This fatty muscles is actually what we order as WAGYU STEAKS in restaurants! Yes they might be tasty but we do not want fat infiltration in our own muscles. As we grow older, strong muscles will keep is walking and also stable on our feet. We want to avoid falls as best as we can as this has other repercussions.
It is not a bad idea to arrange regular check-ups to monitoring your progress with your doctor or surgeon if you are experiencing some pain or weakness. There are minor intervention that we can make such as injections to manage pain and weakness.
Regardless of how wealthy we may or may not be, health is still the most important investment we can make for ourselves. I do encourage my patients to participate in regular exercises and events. Sometimes it may be difficult to motivate yourself if you are exercising alone. Several ways to get around this is to exercise with friends or family members, or sign up to be part of a gym which organises many different types of activities such as Zumba, boxing and pilates. It is also a great way to meet like-minded people.
No matter how much we exercise, we should also focus on what we eat and drink. A popular phrase is ‘a 6-pack is made in the kitchen’. We should be mindful of the amount of calories we consume and burn off on a daily bases to ensure we maintain a healthy weight. Less additional weight means less stress around our knees and other joints.
We may live longer but we should also strive to live a happy and meaningful life. Keep your muscles strong and your joints flexible to enjoy a healthy and active life! You are not alone on this journey. Exercise with your loved ones and visit the gym to get in shape and live your best life!