Arthritis: Don’t be a knee jerk

Most of the damage to the knee is our own doing. Take steps now to prevent it immobilising you

The human knee is an engineering wonder. It endures years of constant walking, running, sporting activity, squatting, climbing stairs and carrying loads. The knee comprises the thigh bone or femur, the leg bone and the knee cap held together by strong rope-like structures called ligaments. The knee has excellent shock absorbers called menisci. These shock absorbers protect the joint surface or the cartilage. The key to knee health is the integrity of the articular [relating to or affecting the joints] cartilage. If the cartilage is damaged or worn out, the knee joint is labelled arthritic. Such arthritis is known as osteoarthritis.

Common types of arthritis

Other than osteoarthritis—the one that affects the knees—rheumatoid arthritis, septic arthritis and gouty arthritis are commonly found.

Rheumatoid Arthritis usually affects multiple joints. It causes inflammation and destruction of joints and could start as early as in your 20s. There is no known way to prevent rheumatoid arthritis because the exact cause of the disease is not yet known.

Septic arthritis is bacterial in origin and leads to infection in the joints. The most commonly affected joint is the knee followed by the hip. The infection travels through the bloodstream, causing high fever, pain, redness and swelling.

Gouty arthritis is an uncommon form of the disease. Here the crystals of uric acid accumulate in the joints. The affected areas are usually toes, knees, feet, ankles and wrists.

Anti-arthritis strategy

Preventive measures can delay the onset or slow down the progress of arthritis in the knees. Some of them are listed below:

Knee exercises

To protect the knee, engage in low-impact exercises like swimming [swimming is a good exercise for other joints as well], cycling and walking. Running is a double- edged weapon. For the light-bodied and lean people, it is a great source of fitness and fun.

However, once the knee starts to wear, running can accelerate the damage. This is true for most racket sports and field games like football. The knee joint benefits from thigh muscle building exercises in the gym. Strong quadriceps and hamstring muscles can be beneficial for the knee joint.

Optimum body weight

The role of a light body cannot be over-emphasised in preventing knee damage. A high body mass index [BMI] weighs heavily on the joint structures and causes rapid slide of knee health. If you shed all your excess weight by your thirties, your chances of developing osteoarthritis [which is one of the most common types of arthritis] in the 60s drop significantly.

Better lifestyle

Walking on uneven ground, climbing or descending stairs, use of low seats, squatting while doing activities like gardening, high-impact exercises like running and skipping can cause repetitive stresses on a joint prone to develop osteoarthritis. These activities could hasten the progress of osteoarthritis and aggravate the wear and tear inside the joint.

I advise my patients with early changes of degeneration in their knees to keep the above activities to the minimum. Several of my patients have modified their furniture and some have even changed accommodation to avoid climbing and descending stairs.

Good footwear

Good quality shoes go a long way in preventing wear and tear of joints of the lower body, especially the knee. A pair of cushioned shoes may help reduce the stress on the joints. Let the shoe do all the shock absorption rather than your knee. Customised shoes with wedged insoles help by shifting weight off the affected part of the joint.

Remedial steps

A knee injury in the early years can contribute to osteoarthritis. A torn ligament, if not treated correctly can cause an internal derangement of the knee, leading to osteoarthritis. Arthroscopic surgery can play a major role here.

A keyhole operation performed on the injured tissues of the knee can help restore knee biomechanics and prevent degeneration in the future. With arthroscopy, tissues can be trimmed, ligaments reconstructed and knee cap realigned. With tools like radio frequency cold ablation, the procedure can be performed more precisely and in quick time. Following a proper post-operative exercise protocol can help strengthen knee muscles and help them return to full function.

Calm mind

A relaxed attitude and calm mind can improve our joints. A constantly stressed individual is in a state of excessive tension in the muscles, which worsens the posture. Techniques like progressive muscle relaxation [PMR] can help improve our posture and wellbeing. Music, meditation, positive affirmation and creative visualisation can help us to holistically maintain our knees.

In a nutshell, our knees can be kept healthy by resorting to a knee-friendly lifestyle, enhancing our fitness and taking the proverbial stitch in time.

From the doctor's diary

On the topic of coping with knee problems, I remember twocases distinctly, one who could cope and one who could not. The first case isthat of Jamshed, a 40-year-old slightly-overweight tennis player. He had suddenonset pain in his knee. On investigation, I found a tear in his knee meniscusor shock absorber. I performed an arthroscopic surgery and I advised Jamshed tolose weight with cycling and swimming and build his thigh muscles beforeresuming tennis.

In the second case, Sunder, a 45-year-old weekend runnercame to me with pain and swelling in his knee. It was found that he had ameniscus tear. So, Sunder underwent an arthroscopic meniscus operation.Sunder's knee surgery too was successful and his pain and swelling vanishedpost operatively. He was advised weight reduction with low-impact activitieslike cycling.

At the time of arthroscopy, both Jamshed and Sunder had onething in common—early degeneration of the joint surface. To prevent furtherdeterioration of their knees an exercise and lifestyle protocol was prescribedto them.

Cut to present-day scenario

15 years later, I saw both these persons in my clinic again.Jamshed came for a routine knee evaluation and maintenance programme. 10kglighter, Jamshed plays tennis twice a week, swims and visits the gym on theother days. He is hale and hearty, with no problem in his knee.

Sunder on the other hand is scheduled for a knee replacementoperation. After his keyhole surgery, Sunder did not heed the advice of losingweight or resorting to low-impact workouts. He continued running after the painsubsided, which further damaged his knee. Today, Sunder's knee joint hascompletely degenerated and is awaiting replacement.

Where did Sunder go wrong?

Sunder continued to impact his knee with his weekendrunning. The joint surface, which was slightly damaged before arthroscopy, wascompletely ruined by his running. The added weight did not help at all. LikeJamshed, if Sunder had lost weight with swimming or cycling, strengthened hismuscles in the gym and then taken up running, his would have been a differentstory.

Ayurveda says

According to Ayurveda, joint pain with throbbing sensation is due the increase of vatta dosha. The vatta dosha mostly augments at night. Such joint pain related to an increase of vatta dosha is severe if the constitution of the person is vatta type; the pain is severe in rainy season. On the other hand, joint pain with burning sensation is due to increase of pitta dosha, which increases at day time.

Osteoarthritis can be controlled by adequate consumption of:

  • Calcium with vitamin D3
  • Essential amino acids
  • Omega-3 fatty acids and minerals like magnesium, zinc and selenium
  • Ayurvedic medicines

Panchakarma treatments like Basti [enema of medicines and medicated oil] give good results in all types of joint pains.

Consumption of sesame [til] oil in diet and its application over the affected joints helps reduce pain. Including more onion, garlic, ginger in your food is also beneficial in controlling pain. It is important to ensure a proper intake of calcium, as it eases the pain and facilitates movements.

Avoid eating cold food products, curd, mixing non-vegetarian food with milk. Eating fruits with milk should be avoided to reduce arthritis.

If the patient has joint pain due to excessive weight on joints, then the condition can be reversed by reducing weight in a healthy way. Such people should consume a diet rich in proteins, calcium, omega-3 fatty acids and also follow a strict exercise regime [take up stretching exercises like yoga].

Shelly Khera is a dietician, nutritionist, slimming expert and a world-renowned Yogacharya.

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Dilip Nadkarni
Dilip Nadkarni is a leading orthopaedic surgeon based in Mumbai. He has written books like Knee Problem No Problem, REAL Fitness and Calm Sutra, the Art of Relaxation. He performs advanced Arthroscopic knee surgery at Lilavati Hospital.

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