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knee osteoarthritis

Common Knee Osteoarthritis Symptom Treatment Fails Again

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knee osteoarthritis symptoms
Knee arthritis and steroid injections

 

Knee osteoarthritis symptoms. For some, it seems like the diagnosis is pretty much the same as saying that surgery is inevitable.

There are times when I think that more information is a bad thing.  There have been countless times in my practice where someone gets hooked on imaging findings (whether they are MRI, CT scans or X-rays) and focuses on what damage is present rather then what is reality.

Whether it’s a shoulder, low back, neck or knee imaging study, there have been multiple studies pointing out two very important problems.  First, there is very little correlation between imaging findings and symptoms.  In other words, if someone has “stuff” wrong on a MRI, it does NOT mean this person is going to have pain.  You cannot look at a MRI and state that this patient will or will not have pain.

This misconception then leads to the second problem.  There is a large chunk of the surgical field that is devoted to doing procedures based on stuff we find on imaging.  Got a disc bulge?  Cut it out.  Have knee osteoarthritis?  Replace the knee.  Torn rotator cuff?  Surgical repair of the shoulder.

This particular study highlights just how wrong this approach is.  In yet another study on the relationship between arthroscopic surgery of the knee for arthritis found on imaging and beneficial outcomes of the surgery, researchers looked at the results across 9 different medical trials.  Specifically, these middle aged and older patients with knee pain and degenerative knee disease underwent knee arthroscopic surgery.  Here’s what they found after an average of 2 years had passed after the surgeries:

  • There was a very small benefit to surgery in patients’ pain levels (basically, a benefit of 2.4 mm on a 0-100 mm scale).
  • There was no significant benefit on physical function.
  • Harms included symptomatic deep venous thrombosis, pulmonary embolism, infection, and death.

The bottom line is that, going in for surgery just to “clean out” the knee has virtually no benefit but a list of risks.  This is a procedure that, frankly, should no longer be done except in rare cases (and I don’t know exactly what these cases might look like…).

So what can you do instead of surgery?

  1. Move.  Not exercising is one of the worst possible things you can do for knee arthritis.  Hiking, swimming, weights, stationary bike, whole body vibration–there are lots of things you can do to strengthen your knees.
  2. Find a chiropractic who can competently treat the soft tissues of the knees–look for those that do Graston, ART, NMR, fascial manipulation.
  3. Consider a TENS unit to control the pain in the short run.
  4. Consider a joint support formula with glucosamine in it.
  5. Add vitamin D to your supplement list.
  6. Get down to your ideal body weight.

By using these tools to help manage your knee osteoarthritis symptoms, you won’t ever need to worry about whether or not the risks of surgery outweigh the miniscule benefits.

 

Markers of bone, cartilage, and synovial tissue w/ knee osteoarthritis – (06-21-01)

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Markers of bone, cartilage, and synovial tissue w/ knee osteoarthritis

More and more, a new theory of osteoarthritis is emerging–one which views OA as a systemic condition affecting the nutrition of the joints surfaces themselves. This could drastically change the way we treat OA. Current Western therapies focus only on the reduction of overall inflammation in an attempt to control pain in the joint and does absolutely nothing to affect the nutrition of the joint surfaces themselves. Besides nutritional therapies to support health cartilage function, chiropractic physicians for years have known that manipulation increases the exchange of fluids out of and into the avascular joint surfaces.

Ann Rheum Dis — Abstracts: Garnero et al. 60 (6): 619

Read entire article here

Static postural sway, proprioception with knee osteoarthritis – (06-07-01)

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Static postural sway, proprioception with knee osteoarthritis

This article reveals that, in patients with knee OA they have reduced ability to balance themselves. This is the classic case where manipulative therapy shines–the adjustment actually works by firing off proprioceptors surrounding the joint–sort of a “breaking the cobwebs free” concept. Research has shown that these receptors surrounding the joint send a burst during the manipulation–thereby waking up the joint and restoring or improving joint proprioception.

Ann Rheum Dis — Abstracts: Hassan et al. 60 (6): 612

Read entire article here

Efficacy of intra-articular sodium hyaluronate in knee osteoarthritis – (05-20-03)

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Efficacy of intra-articular sodium hyaluronate in knee osteoarthritis

I still believe that this type of therapy and also future advances in cartilage transplants do hold strong hopes for the future of many advanced cases of OA. Patients in my office who have had the procedure done have had mixed results. I do think that advances in the makeup of the injection will lead to better results in the future. Hyaluronic acid the water-holding component of cartilage that keeps it springy and resilient.

SpringerLink: Clinical Rheumatology – Abstract Volume 22 Issue 2 (2003) pp 112-117

Read entire article here

Glucosamine Sulfate Use Delays Progression of Knee Osteoarthritis – (10-17-02)

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Glucosamine Sulfate Use Delays Progression of Knee Osteoarthritis

While this is probably not a surprise to many, I thought I would include this. For the amount of evidence supporting its safety and effectiveness, this nutrient is still not used to the full extent it should be. Interesting that there are no huge news releases from major orthopedic associations such as “glucosamine use should be expanded to include patients with these indicators…” such as we see frequently with pharmaceutical drugs such as cholesterol lowering meds.

Read entire article here

Knee Osteoarthritis Symptoms: MRI Images of Knee of Little Benefit

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Everyone wants an MRI. It’s cool to take a peek inside your body without the downsides of autopsy. But for knee osteoarthritis symptoms does an MRI help anything?

Regular readers of the Rantings know how I feel about ordering imaging before it’s necessary. It doesn’t matter what region of the body it’s in; sometimes TOO much information is not a good thing.

We have already seen studies suggesting that the rates of knee replacements are increasing, but there has been no change in the amount of knee osteoarthritis seen on imaging. What this strongly suggests is that knee osteoarthritis may not be the problem in a large chunk of the cases of knee pain.

For those providers that treat the soft tissues (and no–I’m not talking about exercises and electric stim here–these techniques do NOT treat the soft tissues), this comes as no surprise at all.

I firmly believe, based on the research and my own clinical experience, that most knee pain does not come from arthritis, but rather from pain being created in the soft tissues (muscles, ligaments, tendons, fascia) surrounding the knee joint as well as the imbalance and altered stress placed upon the joint by these damaged soft tissues.

This particular study adds weight to my thought process. Researchers looked at a group of patients who were older than 50 and had no signs of knee osteoarthritis on X-rays. They then examined this group using MRI images of knee and looked for findings that are consistent with osteoarthritis. These included:

  • osteophytes (also known as bone spurs)
  • cartilage damage
  • bone marrow lesions
  • subchondral cysts
  • meniscal lesions (usually described as a torn meniscus)
  • synovitis
  • attrition (a wearing down of the joint surface)
  • ligament lesions

What they were basically doing was looking at MRI as a tool to see how well findings on an MRI compared with what the patient was experiencing.  Here’s what they found:

  1. 89% of the group had at least one abnormality noted above (osteophytes were the most commonly found at 74%,  followed by cartilage damage in 69% and bone marrow lesions in 52%.
  2. As expected, the higher the age, the higher the prevalence of abnormalities.
  3. The likelihood of at least one type of abnormality was high in both painful (97%) and painless (88%) joints.

The last point being the most important. Basically, over the age of 50, a MRI becomes less and less important, and may actually lead the unsuspecting physician to recommend a more invasive procedure (injection or worse–knee replacement).

The bottom line is that just because you have something wrong on your MRI, particularly as you get older, does not really mean anything. If you have knee pain, my biased opinion would be to find a chiropractor that specializes in soft tissue treatment (Graston, Nimmo / Trigger point, NMR, Active Release, Fascial Manipulation, etc…) before you do anything else.

It is always worth trying this approach first. If it does not help, you can still opt for more invasive procedures. But the reverse doesn’t work so well…

If you had a knee replacement, was soft tissue treatment recommended to you before the surgery?