Osteoarthritis (OA) is the leading reason for functional disability in older adults, and it disables 10% of Americans over the age of 60 years. The most common joint affected by OA is the knee joint. Find out about the top 10 nonoperative knee pain therapies.
For simple knee sprains and overuse injuries, RICE (rest, ice, compression, elevation) will help. The patient rests the affected leg for several days, applies ice in 20-minute intervals, uses a compression wrap (ACE bandage), and elevates the knee to decrease swelling.
Orthotics and Footwear
To treat knee pain associated with OA with varus deformity, special lateral-wedged insoles are used. Two recent randomized controlled trials found that these orthotics decrease patient consumption of knee pain. Elevated joint load is associated with progression of knee OA, so experts recommend a specially designed flexible, flat shoe for walking.
External bracing of the knees alleviates knee pain. Commonly used devices include rest braces, un-loading knee braces, patellar taping, and knee sleeves. Rest braces are made of stiff composite material that is specifically designed for joint immobilization. In a recent study, simple neoprene knees sleeves decreased pain, improved function, and improved quality of light. These are often used for varus malalignment of the knee due to OA progression. Un-loading knee braces can improve balance and stabilize the joint. In addition, patellar taping is done using adhesive, rigid tape that is positioned to the patella. In a large review of studies, patellar taping of the knee produced significant reduction of pain.
Many cases of knee pain can be alleviated using physical therapy. Prolonged inactivity of the knee joints can result in deconditioned muscles and periarticular stiffness. Physical therapy exercises improves muscle function and relieves pain. In a longitudinal study involving 2,000 patients, improving knee extensor strength with physical therapy lowered the incidence of symptomatic knee OA. In the Fitness Arthritis and Seniors Trial (FAST), PT improved function, pain, and disability in adults aged 60 years and older.
Knee pain can often be treated using medications. Commonly prescribed agents include:
- Acetaminophen – Tylenol has both anti-pyretic and analgesic actions, and it is recommended for mild knee OA.
- NSAIDs – Nonsteroidal anti-inflammatory drugs can reduce inflammation, swelling, and joint stiffness. Many studies confirm these agents are effective for knee pain.
- Tramadol – This is an atypical analgesic that is proven in many clinical studies to relieve knee pain.
- Opiates – Narcotic analgesics can be used when other medications do not help. In a large meta-analysis involving over 6,000 patients, opiates were found superior to other medicines for OA pain.
Topical agents are include topical Capsaicin, topical NSAIDs, lidocaine patches, and Aspercreme. These medications penetrate the skin and work directly at the site of pain. In a recent study, Voltaren gel used for 8 weeks lowered patients’ pain scores by 45%.
Corticosteroid Joint Injections
OA knee pain can be treated using a corticosteroid agent, which is injected into the knee joint. A few studies have shown that corticosteroid knee injections offers long-term effects, but most studies show benefits lasting between 3 and 6 weeks. The doctor first cleans the skin of the knee using an antiseptic, and then inserts the needle into the joint. If excessive fluid is present, the doctor can aspirate it before injecting the medication.
Hyaluronic Acid Joint Injections
Common name brands of hyaluronic acid include Hyalgan, Synvisc, Orthovisc, and Euflexxa. These agents are administered as a series, given weekly for 3-5 weeks, or given once every 3-6 months. Hyaluronic acid mimics normal joint fluid, which is often depleted with knee OA and injury.
Alternative Agents and Nutraceuticals
Herbal and nutritional supplements have been reported to decrease arthritis pain. These agents include methylsulfonylmethane (MSM), s-adenosylmethionine (SAM-e), ginger extracts, and avocado-soybean unsaponifiables (ASUs). Glucosamine is a substance many people take to improve physical function and stiffness. In the glucosamine sulfate unum in die efficacy (GUIDE) trial, researchers compared glucosamine sulfate to acetaminophen and a placebo. They found that glucosamine demonstrated better pain relief than the Tylenol.
Chiropractic treatment aims to reduce pain and joint inflammation by using supportive devices, icing the area, and using ultrasound to promote soft tissue healing. Specific chiropractic manipulation techniques are applied to areas of restricted movement in the knee joint, which can improve overall knee function.
Al-Hakim W, Jaiswal PK, Khan W, & Johnstone D (2012). The Non-Operative Treatment of Anterior Knee Pain. Open Orthop J, 6, 320-326.
Mushtaq S, Choudhary R, & Scanzello CR (2011). Non-surgical treatment of osteoarthritis-related pain in the elderly. Curr Rev Musculoskelet Med, 4(3), 113-122.