Sunday, 27 September 2015

Knee Caps & Braces in Knee Osteoarthritis

Almost everyone with knee arthritis is wearing some sort of a contraption or the other for relieving their pain. These externally worn aids are called by various names, knee caps, braces etc. Do they really help? Let's find out.

Types of knee braces
  1. Soft knee braces, like knee cap
  2. Hard knee braces, like hinged knee brace
  3. Offloading knee braces

Theoretically a brace should offload the diseased portion of the knee, in order for pain relief. It is therefore obvious that all soft knee braces like the knee cap are ineffective in doing so. Let's face it, something slightly thicker than socks cannot protect your knees. However they do bring about pain relief from a different mechanism. They tightly encircle the knee & the user's brain gets the feedback that my knee is tight or something is supporting my knee. What actually happens is that their wearing either takes away or distracts the brain from the knee pain or induces a reflex contraction of the thigh muscle (the quadriceps) that gives a feeling of having a stable knee. Pain after all is an unpleasant sensation conveyed by the nerves to the brain & diverting the brain's attention is the main way by which all the anti-inflammatory creams work. Most of them contain an irritant that sets up a minor pain sensation around the overlying skin, that diverts the brain's attention away from the bigger pain smouldering inside! It is a widely held myth that they actually penetrate through the intact skin & heal the hurt.

The rigid knee brace or the hinged knee brace is used in case there is injury to the collateral ligaments of the knee joint. The knee has 2 sets of ligaments called the collateral ligaments that run along the inner & outer side of the knee respectively. They usually get injured in a fall & depending on the direction of the fall either the inner (medial collateral ligament) or the outer (lateral collateral ligament) gets injured. These hinged braces are useful in helping these injured ligaments heal. They have absolutely no role in knee osteoarthritis, unless there is diagnosed ligament instability by a clinical examination.

The offloading braces are a whole new species of knee braces. These braces are designed so that once worn, they offload a certain portion of the knee & transfer that load to the other portion, something like Robin-hood (steal from rich & give to poor). They are very useful in moderate to mild stages of arthritis (decided by the x ray) in which one expects one half of the knee (usually the inner half) to be diseased & the other half of the knee (usually the outer half) to be healthy. In advanced arthritis (again decided by the x ray), wherein both sides of the knee are diseased, they have no role!

Do you need a brace?

Yes & no. You certainly don't need a knee cap or a hinged brace for arthritis. You are much better off & much more comfortable doing exercises & making subtle changes in your lifestyle (refer to my earlier blog post). If you have end stage knee arthritis, then also you won't benefit from any brace, you may be better off getting a knee replacement. 

If your doctor is able to diagnose isolated arthritis of one half of the knee, then you will benefit from an offloading brace. The problem with the offloading brace is that it also offloads your purse! Most such braces come upwards of 30000₹ per brace. Another problem is that you need to wear them throughout the day, which may be a challenge in our mostly tropical climate & if you are fond of tight clothing. Sometimes these braces simply don't fit us Indians as they are designed for Caucasians, we sometimes have a great discrepancy in the thigh & leg diameters & that causes the brace to lift off the skin in some places. An ill fitting brace will not work for you & might actually be counterproductive by constantly rubbing against the skin & eventually ulcerating it!

How soon will the brace start having its effect?

We are all in a terrible hurry to see results, especially after spending a fortune on the offloading brace. Results in term of pain relief takes time. Initially just like a new shoe, the knee may feel sore. Some people don't obtain that much relief in pain, but their mobility & joint flexibility improves. In a nutshell it is unrealistic to expect magic from the brace. Be prepared to wait out a few weeks for its effects to kick in.

Are offloading braces available in India?

Yes, but only on a doctor's prescription. All the braces available off the shelf are mostly ineffective as far as knee osteoarthritis is concerned.

Actionable advice:
  1. Kick off your knee caps & exercise instead.
  2. Adopt simple lifestyle changing measures (ref, my earlier post) to get relief from the pain.
  3. Consult your orthopaedic surgeon to see if offloading braces will be useful to you.

Content copyright of Dr Raju Easwaran

Wednesday, 9 September 2015

Knee Osteoarthritis Treatment in India

Knee osteoarthritis is sometimes not considered to be a disease, it is simply a normal manifestation of ageing, like grey hair. Everyone will develop arthritis one day or the other, we are just genetically programmed to get it at different ages. Some develop it early, some develop it late. Knee arthritis is not the end of the road in terms of living an active lifestyle. With these suggested lifestyle modifications, you can delay or prevent the eventual manifestations of the disease.

Swim, swim, swim. It is a well known fact that in water we feel lighter due to the Archimedes principle. Stiff & painful joints ease up like magic in the water. If you don't know how to swim, simply walk across the length & breadth of the shallow section of the pool, or immerse your feet in the water, sitting on the edge. If you know how to swim, it is a great advantage. You know what, it is never too late to learn. If you also suffer from backache, it will improve with swimming. Another silent advantage is the amount of Vit D you make during an hour's swim with your body exposed to the sun!

Best Knee Osteoarthritis Treatment in India
Aerobic exercises for 30-60 minutes a day will keep you & your knees healthy. Brisk walking is one of the best forms of aerobic exercise. There is a lot of confusion regarding whether people with knee pain should do a regular morning walk or not. It is recommended that you walk on soft surfaces like grass or artificial turf or a high end treadmill with built in shock absorbing properties. Walking or running on hard concrete & similar surfaces can aggravate your knee pain. In case of confusion remember that apart from the knee you have a heart & a pair of lungs. They demand aerobic exercise & brisk walking is the best form of that. Exercise done properly didn't do anyone harm!

Resistance training or weight training done 2 times a week keeps your bones strong. You should do one type of exercise for the upper body like dumbbell curls & one variant for the lower body like the leg press. 8-12 repetitions should be targeted with 60-70% of the weight you can lift maximally. For example if you can do a biceps curl with 20 pounds, pick 12 pounds instead.

Let's face it. Orthopedic exercise is boring. We forget to do it often enough. One of the biggest challenges is to remember when to exercise. If we set target oriented goals like doing a set of exercises immediately before breakfast, lunch & dinner, then we are more likely to remember to do the prescribed orthopaedic exercises.

Say no to certain things, like squatting, cross legged sitting. If you have a lift don't use stairs. If you don't have a lift, use the stairs as sparingly as possible. 

Watch this space for more relevant information that may help your sore knees. Till then get up & exercise!
Know More about : Best Osteoarthritis Treatment in India
Know More : Knee Arthroscopy , Knee replacement surgery , Knee Ligament Injuries