Knee pain is one of the most frequent types of pain among the general population. Using data derived from the Nottingham community, researchers highlight the prevalence of knee pain and its impact on the community. In this study, it is shown that in a sample of 1809 individuals, 41.1% reported experiencing some form of pain localized to the knee at some point in the previous month. This demonstrates that knee pain is a common problem, particularly in older individuals, and as far as overall joint pain is concerned, the knee is the most commonly cited site. This highlights a need for greater understanding of the impact and key factors affecting knee pain in the community as a whole. As pain in a specific area can be ascribed to a multitude of reasons, gaining a clear understanding of causation is paramount in developing the most effective treatment and prevention strategies. As we have seen, the increase in frequency of knee pain in older individuals is related to an increase in osteoarthritis of the knee. Data from the study has highlighted the prevalence of arthroalgia in osteoarthritic individuals, with 92% reporting pain that was strongly associated with atmospheric conditions. This shows that a greater understanding of cartilage response to various stimuli, such as atmospheric pressure change, will also be key in developing more targeted prevention strategies for knee pain.
Causes of Knee Pain
It is highly essential for patients to understand the cause of their knee pain in order to manage and cope with it. This involves understanding the anatomy of the knee and the physiological factors that cause pain in certain situations. Essentially, the knee is the joining of two leg bones held together by ligaments. These ligaments join the tibia to the fibula and the femur to the tibia. There are two types of ligaments in the knee: one type limits the movement of the joint, and the other type provides joint stability. The ends of each bone are covered with articular cartilage, which allows smooth and limited friction movement of the joint. Between the joints, there are muscles and tendons. There are also fluid-filled sacs called bursae, which are located at friction points between the bones, ligaments, and tendons where smooth movement is necessary. Any damage to these components can cause pain and restriction in the movement of the knee. Articular cartilage, the absence of which causes osteoarthritis, is of particular importance as damage to this area is irreversible and may cause further degeneration of the knee.
Relationship between Weather and Knee Pain
Multiple surveys and studies have shown that more than two-thirds of people with chronic joint pain have reported that their pain seems to get worse when it is cold and damp. A fact well known in colder climates, where people often say that they can feel a storm coming ‘in their bones’. The belief that weather influences pain is so widespread that it has even been suggested that this belief is an entity that influences pain itself. These ideas have been expressed in the following phrases: ‘rheumatism set in when I got soaked through’ and ‘I always know when it’s going to rain when my back starts playing up’. Despite evidence showing that people from countries all over the world believe that their pain is affected by the weather, and modern meteorology being able to provide accurate data on temperature, humidity, and air pressure changes, the role of weather as an influence of pain is poorly understood and rarely studied. An understanding of weather as a cause of pain is important for itself, and may provide information about other treatments for pain if it is found that pain and weather sensitivity is an entity. But the popular belief in weather as an influence of pain means that it is a potentially large factor in many people’s health and quality of life.
Coping Strategies for Singaporean Patients
It is now generally accepted that therapeutic exercise should form a core component of the management of OA. Exercise has a well-documented positive effect on reducing pain and improving physical function and should be promoted for patients with knee OA. Public health initiatives are necessary to overcome barriers to participation, and health professionals need to deliver a consistent message about the importance of exercise in both the prevention and treatment of OA.
Numerous coping strategies are available to help OA sufferers deal with their pain and regain control of their lives. Building muscle strength and flexibility through physical therapy and exercise is important to overall disease management. The role of exercise in managing OA is the best established of all non-drug treatments. Exercise is effective in reducing pain and improving function and physical performance. Exercise therapy has been reported to be effective in decreasing pain and disability for people with knee OA. In the short term, aquatic exercise relieves pain and improves daily performance for individuals with knee OA. For some patients, hip OA may cause changes in gait that can be corrected with a cane. Unloading the medial compartment of the knees through bracing in patients with knee OA is under investigation with a view to preventing progression of the disease. Successful weight loss can be achieved by a combination of diet and exercise. Weight loss is more effective in relieving pain in overweight individuals than in changing physical function. In the longer term, exercise therapy and diet were similarly effective in slowing radiographic progression. Exercise is effective in promoting weight loss and our data provide scientific evidence to inform decision making in the management of knee OA by overweight older adults.
Physical Therapy and Exercise
Tai Chi is a form of aerobic exercise that is slow and graceful and is mixed with deep breathing. It has been found to improve function and decrease pain for those with knee OA. Measures should be taken, however, to avoid flare-ups of increased joint pain during exercise. This can be achieved by applying ice to the joints post-exercise or taking pain relief medication.
Aerobic and fitness exercise is important for general health, mood, weight control, and to regain energy. Low-impact aerobic exercises are generally best for those with OA and will provide a suitable workout without stressing weight-bearing joints. It can be carried out using an exercise bike, a bicycle, or low-impact aerobics class. If done properly, exercise will not exacerbate OA and has been shown to be as effective as NSAIDs on pain relief.
Aquatic exercise has become a favorite among patients with OA as the buoyancy of water reduces forces through the joint, the warmth of the water helps relieve stiffness, and simple immersion to neck level results in 80% less body weight on lower limb joints. Studies have also shown that regular water walking improves knee strength while not increasing knee pain.
As osteoarthritis is a degenerative joint disease, the aim of physiotherapy is to strengthen the surrounding muscles to take the load off the affected joint. Patients with knee OA can benefit from a series of strengthening and range of motion exercises to improve the strength and function of the affected joint. Strong muscles help absorb shock and take the pressure off the joints. Range of motion exercises will improve the ability to move the joint.
Medications and Pain Management
People need to be aware of the side effects of taking any medications. All drugs can have negative effects on the body, and some may negatively interact with other medications. It is important to ask a knee pain specialist or pharmacist about what possible side effects the drugs may have and report any negative changes in health to a doctor. This way, the doctor can confirm whether the drugs are related to the negative health change and determine whether the drugs should be continued. A person can weigh the benefits of the drugs against the side effects of each drug to determine what is the best form of pain management for them.
Many patients use pain medication to help manage their knee pain. They take over-the-counter drugs, such as acetaminophen or aspirin, to relieve pain and reduce inflammation. Others take prescription drugs such as muscle relaxants or narcotics. Narcotic drugs are not recommended for long-term use but can be a great short-term pain relief if used under the supervision of a physician.
Lifestyle Modifications
When considering the patient’s existing or potential occupational demands and needs in relation to knee pain and weather sensitivity, a thorough assessment is required. This assessment should consider both physical and behavioral facets. Occupational and environmental demands have a strong influence on behavior and lifestyle and often detract from functional activities that may aggravate knee pain and injury. An optimal situation would involve a change to less demanding occupations that reduce knee stress and the risk of further damage. This often necessitates early retirement or long-term disability. As discussed in an earlier article, total knee walkthrough arthroplasty is becoming increasingly common in many elderly patients with debilitating knee OA. Aged workers in Singapore with knee pain showed significant improvement in physical function and reduction in bodily pain by changing to a less physically demanding job.
The individual can live more comfortably with less pain due to changes in lifestyle. Obesity increases stress on the body and is linked to arthritis of the knee, hip, and lower back. Weight loss will help prevent degenerative diseases from getting worse or repeat injuries, resulting in less pain and increased function. Weight loss is achieved through a combination of diet and exercise programs. Reducing caloric intake and increasing exercise is often more effective than simple dieting. Dietary caloric restriction alone often results in a reduction of lean body mass and a relative increase in fat mass. Weight reduction has been proven to markedly decrease pressure on the knee. For every pound lost, there is a four-pound reduction in load per joint. This means that a five-pound weight loss would result in a twenty-pound reduction in knee pressure. A weight loss program should, therefore, be a high priority for obese patients with knee OA. The importance of this will need to be effectively communicated to the patient, with emphasis on how altered weight distribution is detrimental to the ailment. In addition to general health benefits, weight loss will also help prevent the onset of systemic osteoarthritis.
Alternative Therapies
These options of therapy are more varied and depend on the person and are often tried in search of a method of pain reduction before moving on to more severe forms of treatment. The most popular options are analgesic balms and/or patches and herbal supplements. The analgesic balms are used to provide instant relief of pain when the effect of medication has worn off. These are commonly found in sport shops, with the most well-known products being Tiger Balm and Rheuma salve. Herbal supplements are also a popular choice and are said to have an effect on joint pain reduction. The most commonly used supplement is glucosamine, which is thought to improve the knee cartilage and increase fluid retention in the joints. This treatment is usually paired with chondroitin, which has similar qualities. This method is, in fact, the closest alternative treatment to medical treatment, and there have been many sought-after clinical trials by patients. A 2001 American study concluded that the use of glucosamine sulfate was effective at reducing the symptoms of knee osteoarthritis and was well tolerated. The length for which these patients continued to take the treatment was not known. With little risk involved, it is no wonder this method is so popular.
There are several alternative types of treatment often used by patients who would rather not spend thousands of dollars on surgery. These options are usually self-administered and practiced from home. There are many types of alternative treatments, and it is difficult to discern whether they truly have an effect on deteriorating knees in correlation to weather changes. The effectiveness of these methods is even more dependent on the person. Different approaches to alternative methods are seen in elders from different cultures. For instance, Japanese elders are often more open to trying out non-traditional alternative treatments such as magnetic therapy and copper jewelry. These two items are thought to have a significant effect on pain reduction. This stems from traditional Chinese medicine and is a practice that has been ongoing for centuries. Magnetic therapy is also commonly practiced in the United States and Europe. German elders have been said to use Germanium bracelets, which also possess similar qualities to that of copper jewelry. Copper jewelry and magnets are thought to increase blood circulation and therefore increase the efficiency of transferring nutrients to tissues, thus decreasing inflammation and pain. These methods have no scientific evidence to prove the effectiveness but are said to provide relief after extended use. Other methods of alternative treatment are methods more focused on the mental/spiritual state of mind. This can be anything that relaxes the person and brings them relief mentally. A sample is music therapy. This method is said to provide relaxation and comfort and provides a positive mental state, which can indirectly decrease stress on the knee joints. Others include activities such as yoga and tai chi, which can increase flexibility and muscle strength. Although not directly proven, these methods have a positive effect on knee reduction and are highly recommended.