ARTHRITIC KNEES - DO YOU NEED SURGERY?

Long time ago, knee pain used to be an old age problem where people who suffered were very few and even lesser population getting knee replacement done. But now there is a dramatic shift in number of people facing the knee arthritis and number of surgeries being performed. Moreover, the age at which these arthritic changes occur has reduced. The changes in the knee seen at around or over 55 years of age are now been observed as low as at 30 years of age. 

I consider early knee arthritis similar to premature graying of your hair. Just imagine why do you get grey hair. The reasoning starts with you might be getting older but if it is early then you might be stressed, too much in the sun, not sleeping enough or not eating healthy and may be some genetics. 

Similarly, Osteo-Arthritis of knee is a term for inflammation of old age knees. But in early knee arthritis, overloading of joints (especially if your muscles are weak), stress, poor diet or disturbed sleep can disturb your metabolism to deplete calcium from the bones and put your knees under abnormal load and may result in early and faster degeneration. Rheumatism or gout can also eat up your knee joint and make it degenerate early. Last but not the least, a previous injury with unresolved inflammation or infection can lead to early arthritis. The only difference is it is not affected by your genes. Even reduced Vitamin D3 levels in blood can cause degeneration of the joints because it is linked to your bone strength. So either it is simply that you are getting older or you are causing it with bad lifestyle as mentioned above.

I feel this early arthritis of the knee is a major concern because with the speed we are replacing the knees, soon we will have a major population with metallic knees.  The world will soon have a workforce of "not so natural" knees.

Are the replaced knees good for your health? I think when your knees are damaged enough to make you stop enjoying life it becomes necessary to undergo knife chopping but only if it is a promising procedure. The question is not whether surgeries are good or bad, it is about whether you need it and if no then what can you do to avoid it.

Now carefully read this paragraph to know your answers. Knee arthritis means the pain and stiffness generated in your knee due to inflammation caused by loss of cartilage (Lubricant inside the knee) and wear-tear of joint surface as well. At early age when you show the signs of arthritis, there is loss of cartilage but doesn't mean its fully gone. The knee can become completely healthy as there is only some loss of lubrication that means your bones are still not touching each other directly. The reason behind your pain is something more than what your doctor told you or the X-Rays are showing there. 

The first thing I usually notice in knee pain is that within 72 hours of pain the muscles stop working efficiently and shows weakness on examination. And if your pain has now become chronic, you can easily judge how much your muscles have become weaker. And when you try walking with knee pain, there is subconcious adjustment in the way you walk to avoid pain, which may lead to abnormal functioning of your Lower Back, Hip or Ankles. So there is a gross weakness and imbalances in the whole body. All these changes may lead to more pressure on your affected knee causing more or unresolved pain. The knees are mainly survived by strong thigh muscles, ligaments and healthy cartilage along with healthy lower back and muscles of HIP and ANKLES. 

If only knee cartilage has got some injury there are many other structures to keep you moving pain free. All you need to do is following a suitable exercise regime supervised or crosschecked by a concerned health expert (in this case your Physiotherapist), working on healthy diet in order to control your weight and regular walks if or when you become painfree. This change will not only help your knee pain but also work on saving your knees from further damage. 

Remember, if you can prevent it you don't need to cure it. please feel free to comment here if there are related questions in your mind.

REMEDY FOR UNRESOLVED PAIN

Any pain lasting for more than 12 weeks is generally considered as Chronic Pain. This means whether the injury is traumatic or non traumatic, it should or must heal within 6-12 weeks at maximum. If you do not help yourself to get better within this time frame, you are basically channeling your nervous system to adapt to the painful sensation given by the local tissue damage.

Poor Diet, Lack of Sleep, Emotional or physical stress, lack of physical activity, your boss and colleagues, family and friends. all of this can affect your pain to become good or bad. Many things are not in our hands but anything from the list above which you can change to help your self should be tried. Hence, your lifestyle modification is a big term where you have to consider anything which influences your pain. Just remember self help is the better help. The change starts from YOU and the rest will follow. A doctor or Physiotherapist can give you the path to recovery but you need to proactively participate and reach to the goal of pain-free life.

Long standing pain generates a threat to your normal body movement and you start avoiding them which in turn makes the joints and muscles unhealthy. There is a sub-conscious fear in moving all the time and the brain and body kind of pre-decide that this particular movement will cause pain. Inability to move freely along with fear of pain increases the neural and chemical response in the brain to make you feel sick all the time. In such conditions, medicines usually don't work or mask your pain very temporarily.

What you need to do at this stage is to come out of threatening painful memory  through controlled pain-free movements (Pain free activities). Resting at this time is not a correct choice but being careful to not create too much pain is. I believe any activity or exercise causing pain more than 20 % is a good sign to step back or stop that activity. Doing ice compression as a therapy can work very well if and when pain increases. At times you need pain modulation procedures like Manual therapy, Massage, Dry Needling / Acupuncture or even taping to facilitate pain free movements. Once you get better with pain, simultaneously start loading your damaged tissues via exercises which mainly includes strengthening against gravity or resistance. 

In the beginning, you may find some discomfort in doing strengthening exercises but that is a normal response to tissue loading rather than any damage which you might think is happening. But tissue loading capacity will increase you will start feeling stronger and active with your earlier painful movements. In my opinion, it will take from 6 weeks to 6 months, where decent muscle strength will build up and you will reach to your pre-injury level of fitness.

Since, chronic pain involves memory of local tissue damage, nerves which conducts painful sensation to spinal chord and the brain at the center, there are social and psychological factors which can variate your pain on daily basis. I always tell my patients that the part of brain which responds to chronic pain is also responsible for your emotions. So, it is very natural for emotions to make you feel pain and vice a versa. You definitely feel emotionally stressed on the days when it is painful or when you are emotionally stressed your pain increases. Anything which disturbs the chemistry of your brain will disturb the pain also.