The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries. Knee problems may arise if any of these structures are injured by overuse or suddenly during sports activities. Injuries to the knee can be caused by degenerative disease such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair mobility as well as the quality of life of the patients. All of these conditions require appropriate treatment, either surgical or non-surgical, to return the patient to normal activities. The non-operative orthopaedic treatment options include non-pharmacological and pharmacological interventions and are aimed at providing symptomatic relief and improving the quality of life of the patients. They can be used as a treatment option to treat certain conditions or to decrease pain as well as promote proper functioning and quality of life after surgical treatment.
Non- pharmacological intervention
Non-pharmacological interventions may range from simple lifestyle modification or the physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:
- Weight reduction and physical exercise -The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of knee conditions.
The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered over weight and BMI over 30 is considered as obese.
Rigorous exercise is not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.
- Transcutaneous electrical nerve stimulation –The transcutaneous electrical nerve stimulation (TENS) method involves the use of low-voltage electric impulses to relieve the pain. It is believed to provide pain relief by inhibiting the conduction of pain impulses to reach the receptors in the brain and spinal cord. The patient wears a device which generates electrical impulses providing pain relief to the patient. The frequency of the impulses, duration of treatment and location of the electrical electrodes on the body are decided by your physician based on the severity of your condition as well as the response of the patient. It should not be used by patients having a pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.
- Thermotherapy – Thermotherapy involves application of hot or cold packs to the affected area. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.
- Acupuncture –This method involves insertion of sterile needles into specific acupuncture points or pressure points. It is believed that insertion of needles at specific points restore the flow of “qi”, a form of energy and thereby relieves the pain. A modification in acupuncture is electro-acupuncture where the needles are stimulated by an electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and can offer pain relief.
- Patellar taping – Patellar taping is used as a short term treatment particularly when performing normal activities deteriorates the knee condition. The principle behind the treatment is stabilization of the knee joint by altering the distribution of stress and joint pressure. The response depends on the taping technique used and length of time worn.
- Massage therapy – It is one of the oldest methods of treatment and can help reduce pain by increasing the circulation of blood and lymph and reduce muscle tension.
Pharmacological interventions include management of pain using medicinal preparations such as pain relieving capsules or injections.
- Non-steroidal anti-inflammatory drugs – These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the hip. Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must take extreme care while using them. They can cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.
- Steroid Injections:These injections of steroids are given directly into the affected joint for severe pain when use of NSAIDs does not bring much relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.
- Weak and strong opioids –Opioids are prescribed when use of analgesic medications or NSAIDs does not offer symptomatic pain relief, if other treatments have intolerable side effects or when surgery is delayed or contraindicated. Though they offer better pain relief than NSAID’s they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise it can cause withdrawal effects. Opioids are also known for addiction and should be used short term as directed.
- Disease modifying anti-rheumatic drugs and biological agents – Disease modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of disease and offer symptomatic relief. Biological agents are the antibodies against the disease causing agents manufactured using genetic engineering technology. These agents are recommended in individuals with severe disease conditions.
- Other treatments – Your physician may recommend the use of braces and orthoses, prescribe chondroitin sulphate, electromagnetic therapy, vitamin supplements, herbal and other dietary therapies.
Discuss with your physician about these therapeutic options before initiating the treatment.