Written by Phillip Parr, M.D.
Living with the Degenerative Knee
As the population gets older, doctors are placing more emphasis on a healthy lifestyle to slow down the ravages of time. Proper diet and exercise help prevent high blood pressure, high cholesterol and obesity that lead to heart disease, diabetes and stroke, the leading causes of death in our society.
Unfortunately, many of the exercise programs used to maintain good health put direct stress on our joints, particularly the weight bearing joints of the hips and knees. The knees, especially, are susceptible to the stresses of repetitive exercise.
Factors that cause malalignment of the knee such as bowlegs or knock-knees, as well as athletic injuries in our youth frequently result in degenerative arthritis as we get older. Some of the exercises we do to stay healthy aggravate the arthritic condition. Resulting pain frustrates many who are trying to lose weight and stay fit.
Fortunately, there are ways to stay aerobically fit, lose weight and remain lean and strong, even with arthritic joints.
This is the conservative regimen I recommend to my patients with arthritic knees before they resort to surgery:
1. Change your lifestyle to accommodate your joint
Avoid high impact loading exercises, such as running and jumping. Forego sports such as basketball and tennis, which also aggravate arthritic joints. Many of my patients are ex-football players who have put on a great deal of weight since their playing days. Others are obese for other reasons. It is essential that those carrying extra weight take some measures to decrease the load on their weight bearing joints. This always involves changing dietary habits. Most of us eat far more calories than we actually need and do not pay enough attention to the carbohydrate content of our meals. Fad diets almost never work. The most reliable regimen for losing fat is a combination of burning a few more calories a day through exercise and consuming a few less calories, particularly fat and carbohydrates, in our diet.
2. Exercise
A. Strength training
As we age, we tend to lose lean body mass, or muscle tissue. Although our weight may remain stable, we may be getting fatter simply by losing our muscle and increasing our percentage of fat. The fad diets that promise weight loss in a short period of time usually are based upon losing water for a few days and then losing muscle mass rather than fat. Doing some sort of resistance training is essential to keep one’s lean body content. This may be accomplished by various machines found at local health clubs and gyms, use of free weights and simple exercises using one’s own body weight, such as push-ups, sit-ups or partial squats, all of which can be done in one’s home. A membership in a health club, if it is used, may be one of the best investments you will ever make to insure good health. Since muscle is more metabolicly active and consumes more calories than fat, it not only makes you stronger but promotes and maintains weight loss.
B. Aerobics
Aerobic exercise helps weight loss, promotes cardiovascular fitness and decreases some of the factors related to heart disease, such as high blood pressure and cholesterol levels. High impact exercises, such as jogging or running are stressful to the knee, and definitely aggravate degenerative arthritis.
The bicycle, either stationary or road bike, is the best aerobic exercise for those with arthritic knees. You are sitting and non-weight bearing, and it is a smooth non-jarring motion. You should select a resistance level that is comfortable for your knees. Increase the RPMs rather than the resistance on the pedals if you want to work harder.
Swimming or running in water with a floatation devise are both excellent aerobic exercises, and there is very little stress on the knees. However, because the water is supporting your body it is not the best type of exercise if weight loss is your primary goal. The elliptical machines, ski machines and rowing machines found in most health clubs are also excellent devices for cardiovascular training without undue stress on the knees. They are not quite as effective as the bicycle because they are weightbearing.
C. Walking
While it is a relatively safe way to exercise and burn calories, it is detrimental to arthritic knees because it involves repetitious loading of the joint. For patients who like to walk for exercise, I recommend that they alternate their walking with a bicycle, swimming or some other aerobic activity that does not repetitively stress the joint.
The general principle of aerobic exercise is that one burns 100 calories per mile of activity, regardless of how slow or fast one walks. Two and a half miles of cycling is equivalent to one mile of walking.
3. Braces
Some individuals get support from the knee sleeves that are available in most stores. Those with arthritis confined to primarily one compartment, either medial or lateral, can benefit from an unloader brace that can be prescribed by any orthopaedist. The unloader brace is Designed to unload the arthritic compartment and move the weight bearing stress to the other compartment. The brace is more effective for those with medial compartment disease (bowlegs) rather than lateral compartment disease. However, it works to some degree for either. It is used only when involved in athletic activities, such as tennis or walking. It does not have to be worn when lifting weights. It is one fairly simple measure that may allow one to extend their recreational activities in racquet sports and skiing.
4. Medications
Almost everyone with degenerative arthritis of any joint is taking some sort of nonsteroidal anti-inflammatory agent. The best over-the-counter medications are Aleve and Ibuprofen. Both are generally effective as anti-inflammatories but can cause some gastrointestinal problems, such as ulcers, if taken over an extended period of time. The Cox-2 inhibitors Vioxx, Celebrex, Bextra and Mobic are currently popular because they produce fewer GI problems.
However, they are more expensive and their anti-inflammatory properties are no better than older medications, such as Motrin and Naprosyn. Many insurance plans now will not pay for the Cox-2 inhibitors unless the individual has shown serious side effects from the sue of the less expensive nonsteriodals.
Keep in mind that these medications do not alter the progression of the arthritic process. Although you may have less pain, your arthritis may be getting worse.
5. Supplements
Several supplements are available at any health food store, grocery or pharmacy that may decrease arthritic pain or slow the arthritic process. The most widely known is Glucosamine Chondroitin Sulfate. These substances are part of the building blocks of articular cartilage. There is some scientific evidence that they may actually retard the arthritic process. They can be bought separately but work better when used together. This supplement is generally well tolerated by the stomach, although the Glucosamine has been known to increase one’s resistance to Insulin. The best brand name is Cosamine DS, because it is pharmaceutically pure and is the brand that is being used in all the medical studies.
Glucosamine Chondroitin is not a quick fix. It most be taken approximately two months before any decrease in pain is noted.
MSM is another supplement found in most health food stores that decreases arthritic symptoms. It is included now in combination with the Glucosamine Chondroitin products.
Omega 3 Oils are also readily available and effective for a multitude of reasons, both to decrease heart disease and joint pain.
6. Injections
Hyaluronic Acid (Trade names: Synvisc and Hyalgan) is a high molecular weight dextran that may relieve arthritic joint pain. Three injections into the joint over a two week period are felt to work by increasing the viscosity of the synovial flulid making it more slippery, as well as having some anti-inflammatory effect. It is moderately expensive and can be used every six months if it is effective. As with other medications, Synvisc and Hyalgan are more effective when the arthritis is not too advanced.
Cortisone is a powerful anti-inflammatory injected by physicians into painful arthritic joints. It is effective in helping relieve an acute flare-up of a degenerative process, particularly when there is synovitis or water on the knee. It is generally best not to inject a single joint more than three to four times in a year.
Conclusion
The healthy lifestyle, including exercise and diet, while not curing degenerative arthritis, will at least help you cope with it.
