The young arthritic knee: do’s and don’ts - Dr Shreedhar Archik

Dr Shreedhar Archik - Orthopedic Surgeon Mumbai Dadar

ShalakaDeo a 33 year old mother of two recently visited me with pain in both her knees. She has been steadily putting on weight since the birth of her first son 8 years ago. She now weighs 85kgs and she is five feet four inches tall. She is otherwise healthy but started complaining of pain in both her knees while climbing stairs. Her younger son is 3 years old. She started finding it difficult to get up from the floor after playing with him for a while. Her x-ray showed early wear and tear which is not expected at this age.

I am seeing patients like Shalaka almost every alternate day. Osteoarthritis is an age related wear and tear of the joints which all of us undergo. Traditionally I see these patients in the age group of 55+. Young arthritis patients pose a different problem. If these young individual s do not take adequate care in the early stage they end up having a knee replacement surgery by the time they are in their late forties. I am used to doing knee replacement surgeries in elderly arthritic and the average age group id 65+.

Shalaka was very keen to get rid of her nagging knee pain and followed my instructions religiously. Shalaka now weighs 63 kgs and has no complaints whatsoever.

I would like to share our treatment plan with other young patients for obvious reasons.

The first important goal is to strengthen the muscles around the knee joint. My physiotherapist gave Shalaka a few exercises to strengthen her knee muscles. These are simple exercises which require no equipment and can easily be done at home. We asked Shalka to avoid unnecessary stair climbing and sitting on the floor. I gave her anti –inflammatory drugs for just 7 days and her pain settled. We then gradually started her with low impact aerobic exercises (Pilates). A dietician planned her diet properly. Shalaka was given a target of burning certain calories per day. She started Pilates and regular morning walks but what helped her was a lifestyle modification. She started parking her car at least a kilometer away from her destination and started walking. She used a free app available on the net to calculate how much distance she was walking and how many calories she burnt. Shalaka also started getting up from her couch while watching her favorite daily soap every time a commercial break came up. She used to walk in front of the TV for those 2 or 3 minutes. She set up an inactivity alarm on her smart phone which used to buzz every 15 minutes to remind her to move around. She slowly inculcated a habit of not sitting in one place for more than 30 minutes unless there was a valid reason. Many friends suggested her to take nutraceuticals like Glucosamine/ Chondroitin/ Green mussles extract but she refrained from trying medicines. Slimming tablets also were pushed by some friends. Shalaka asked me for any scientific evidence about the effectiveness of these drugs and when I told her there was none; she refused to take these tablets.Shalaka’s close friend had lost a lot of weight going for Zumba classes and she asked Shalaka to join her class. Zumba dancing is a very good exercise to burn calories but for knee pain cases it is classified as a high impact activity and hence should be avoided. Acupuncture and Acupressure are allowed but they have only a temporary pain reliving advantage. Both these modalities do not treat the basic cause.

Shalaka’s aunt from USA sent her a fancy knee brace called “unloader” (cost 26,000 indian rupees). These braces again are not useful for young arthritic patients.

So friends the take home message from Shalaka’s case study is important
1. Reduce your weight
2. Change your lifestyle
3. Strengthen the muscles around your knee
4. Eat sensibly
5. Avoid tablets of any kind especially to lose weight or for cartilage growth.
6. Customize your exercises after consulting your doctor, what is good for your friend may not be good for you!
7. Use your smartphone for tracking your calorie burn and workouts.
8. Avoid fancy braces/belts.
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