Living with knee pain

I have a friend, in his 60s, who loves and owns many “World’s Best Grandpa” sweatshirts. He belongs to a softball team and – much to his adoring fans' delight and his wife’s chagrin – slides into bases.

His knees are knotty like cauliflower. I’m guessing with some certainty that his X-ray will show osteoarthritis: loss of cartilage and joint space, bony changes. But he’s never complained of knee pain (at least not within earshot of his wife). 

Knee pain and knee osteoarthritis are like kiwi and emu; these flightless birds are related but not that closely related. Osteoarthritis doesn’t necessarily mean knee pain.

Knee pain can occur at any age.

A 1994 Framingham study identified painful knee arthritis as one of seven leading causes of physical disability in the elderly, ranking right up there with heart failure and emphysema, right below hip fracture, stroke and depression.

For decades, we’ve injected steroids into joints for pain relief.

Steroids are powerful drugs. But it’s a bit like waging war to keep peace: Steroids suppress inflammation in one area, and inflict harm elsewhere. For one, it’s not an ally of cartilage.

A study that came out of JAMA this month questioned its wide use.

Patients with painful knee arthritis were divided into two groups: One group received steroid injections every three months and the other, normal saline (the control). The steroid-injection group didn’t have better pain relief – and, after two years, lost more cartilage volume on MRI.

This is worrisome because treatment for knee osteoarthritis is primarily intended to reduce pain and restore function. In this study, steroid injection didn’t relieve knee pain and potentially aged the knees even more.

I’ve shied away from prescribing joint injections for years. Now, I encourage two long-term solutions.

First, exercise. The pain haze makes you just want to ball up with a blanket, a hot water bottle and ibuprofen. But studies have shown that those who enroll in regular exercise have better pain relief and can walk longer. The effects are immediate and sustained months after the exercise program ends.

The problem with exercise programs is that too often people drop out.

Second, if applicable, lose weight. Knees are very sensitive to weight.

One pound of body weight puts four pounds of stress on knees. Squatting and going up and down stairs are particularly hard. 

On the bright side: Lose a pound, you instantly lose four pounds of compressive stress on your knees. According to a study of knee biomechanics published by the American College of Rheumatology, a 10-pound weight loss translates to “48,000 pounds less in compressive load per mile walked.”

In my experience, losing a few pounds of holiday weight combined with exercise goes a long way towards relieving knee pain.

These days when I get out of the car, bed, or up from writing this story, my knees snap, crack, click and moan – an innate Greek chorus warns: keep moving.

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Volume 9, Issue 11, Posted 10:17 AM, 06.06.2017