Knee Pain and Weight Management: Strategies for Singaporean Patients

Need to highlight that knee pain is important because it can help set agenda for public health priorities, and be a common cause of disability, and can be effectively managed with weight loss. This is important because it will help lead into the next section which talks about the effect of weight on knee pain.

Understanding the cause of knee pain is an important step in managing this condition. Weight is another issue. Being overweight increases the risk of developing knee arthritis. Research has shown that for every kilogram of weight lost, there is a 4kg reduction in load exerted on the knee for each step taken. Weight loss can be a very important part of the treatment plan for those with knee pain, since it is one of the most effective, non-drug measures for reducing pain and increasing function in overweight people.

Knee pain Singapore is a common complaint, affecting people of all ages. One survey estimated the prevalence of knee pain to be around 20% in those aged over 55. Knee pain reduces mobility and function, and impacts on social activities and mental health. In Singapore, knee pain is one of the leading causes of visits to the physician’s office or orthopaedic surgeon. It is also a major cause of disability, with more than half of those with knee arthritis not able to perform daily activities.

Understanding Knee Pain in Singapore

Knee pain is a common and potentially disabling ailment that is prevalent among any age group. It is estimated that up to a quarter of adults experience frequent knee pain. This statistic increases to 50% likelihood in a person’s lifetime. The structure and function of the knee are compromised when one is suffering from knee pain, thus impairing one’s mobility and strength. The knee is an intricate joint that is susceptible to a variety of injuries. These can be distinguished into acute injuries such as a ligament tear or a fractured bone, and overuse injuries such as patellar tendinitis. Osteoarthritis is also another common but potentially more serious cause of knee pain. It is a degenerative joint disease that affects mostly middle-aged and older people. Osteoarthritis of the knee can alter the shape and functionality of the cartilage and bone within joints. This could lead to pain, swelling, reduced range of motion, and at times a feeling that the knee is unstable. Recovery from traumatic injury to the knee may be painful and prolonged, while successful surgical repair is often followed by long periods of physical therapy and recovery. Knee pain has been established as an ailment that is often chronic and does not have a specific cure. Studies have pointed out that because of the changing and aging population in Singapore, chronic diseases will increase and orthopedic services will be in higher demand. This holds true for knee pain in Singapore as it is a common symptom in the adult population and it has been cited as the fourth most common disability. This is especially profound in the older generation of people above 60 years old, and it is estimated that 82.5% of people in this age group will have degenerative disease in their knees. Thus, understanding knee pain from different perspectives is important in attempts to alleviate this ailment in the local population.

The Impact of Weight on Knee Pain

This can also provide an explanation from the precise definition for knee OA described above. Knee pain manifests as aching or stiffness in and around the knee joint. It is not localized and is often of a daily nature but intermittent. Sometimes, knee pain can also cause the patient to lose sleep at night. Early morning stiffness in the knee joint lasting less than 30 minutes is also one of the symptoms. All of these knee pain symptoms will impact the patient in their everyday life. The young adult or older individual will have some difficulties in walking up stairs or rising from a sitting position. Also, they may have to decrease their activity, which results in weight gain, and with the increased weight, this will worsen the knee pain. This is a vicious cycle that the patient needs to be aware of. A qualitative study also found that individuals with knee OA considered that their weight was a key modifiable risk factor for either worsening or improving their knee pain. This is an important and positive message with respect to the prognosis quality for the patient.

This part of the content also focused very deeply on information for Singaporeans. It shows that in their knee pain study, they found that higher BMI was significantly associated with prevalent knee pain that was frequent, persistent, or severe. In the sample, nearly half of the subjects with knee OA were overweight and about one-fifth were obese. As weight increased, the risk of knee pain also increased. This relation was similar for men and women, and the possible biological basis behind the relation was that mechanical load on knee joints from the extra weight increased compressive forces and stress on the cartilage.

Strategies for Weight Management

Healthy eating habits are the most important strategy for weight management. Effective weight management involves making lifestyle changes, and as the habits that led to obesity develop over time, so it is necessary to reinforce new habits, but this requires time and effort. Fad diets don’t work, so a good way to start is by assessing your daily food intake and looking for areas where you can make easy changes, for example, by cutting out unhealthy snacks for healthier options. This way you are more likely to make changes that you’ll keep to. The next step is to set achievable goals, aiming for steady weight loss of around 0.5-1kg a week. It is important to set a realistic goal, for example, it can be very daunting to someone who has lost and regained weight many times over, to set an ideal weight that is 20kg less than their current weight. A smaller short-term goal such as 5-10% of your current weight is more achievable. The American Council on Exercise provides a daily calorie needs calculator which is a useful tool to work out achievable weight loss goals. Finally, it is important to support your changes with a healthy and balanced diet. This doesn’t mean going on a diet, as this implies a temporary change to achieve a desired result. Changing to a healthy diet means making a permanent change to your eating habits. Many Singaporeans have dietary habits that come from cultural or social influences, and the types and quantities of food consumed can be difficult to change. A diet history and assessing eating habits over a week can help to identify areas that can be changed to improve a person’s diet. This is something that may be best done working with a dietitian to develop a plan that makes small changes over time to improve eating habits.

Healthy Eating Habits

Stage 1 is known as the ‘relapse prevention’ stage, where the individual plans to make a change in diet to eat healthier, with consideration into the effects his/her actions will have on his/her knees. Stage 2 requires the individual to realize the specific benefits of healthy eating and stage 3 entails weighing the benefits against the costs and cons of healthy eating. The final stage is implementation of a plan or specific guidelines, to bring about a permanent change in eating habits. An easy and effective method of managing a diet intake would be to document the food consumed in a ‘food diary’. The four stages of change may be individual to the different person, but it is important to remember the basic concepts and that healthy eating does not mean ‘bland’ eating. A healthy diet for arthritis is the same as a healthy diet for anyone. The key is to eat a variety of foods, the aim being to get a mix of the various nutrients needed for good health.

Healthy eating is not about going on a diet, staying unrealistically thin, or depriving yourself of the foods you love. Rather, it’s about feeling good, having more energy, and keeping yourself as healthy as possible, all of which can be achieved by more effective management of conditions such as diabetes, heart disease, and arthritis. Its importance is especially underscored in the case of knee pain where having a healthy diet can translate to reduced weight, and in turn alleviate pressure on knees. The key to healthy eating is not to restrict usage of certain types of food but rather to look at the food being consumed as a whole. Making the promise to improve eating habits can be done by utilizing the four stages of change to successfully change a diet intake.

Regular Physical Activity

To achieve any health benefits from physical activity, more is better. It is not a case of no pain, no gain; it is simply a matter of the more you do, the more you benefit. Ideally, aiming for 60 minutes a day is recommended. However, it is fine to start off with small bouts (e.g. 10 minutes) of activity and gradually increase this. In fact, activity as short as 10 minutes adds up to health benefits.

To those patients who have never engaged in regular physical activity or are not currently doing so, it may seem like a daunting task. However, the key to success is to start off slowly and gradually increase the duration and intensity of your activity. This may help reduce the incidence of flare-ups if you currently have knee pain.

Regular physical activity is an essential part of a healthy lifestyle. It is important in managing your weight and preventing weight gain. In addition to helping you burn calories, physical activity has several other benefits. It can help elevate your mood, manage stress, and prevent injuries. It is recommended that overweight patients with knee pain engage in regular aerobic activity. It will also make your heart and circulatory system more efficient, increase your energy levels, and has the added benefit of lowering your blood pressure and cholesterol. Studies have found that aerobic activity is beneficial for knee pain.

Seeking Professional Guidance

Professional advice and support from experts in weight management can be sought from several sources. Hospital-based outpatient clinics may have specific programs for weight management tailored to the needs of patients with chronic conditions. Patients may be referred by their knee pain specialist to see a dietitian or weight management specialist with expertise in the management of overweight patients or those with obesity and related health conditions. Caution is needed in seeking advice from unqualified practitioners or from various sources advocating special diets or remedies for weight loss, as these may be potentially harmful to health or not effective for weight management, and some may impact existing medical conditions and treatments.

Patients with knee pain may need guidance and support from healthcare providers and professionals to develop a weight management program that is suitable for their medical condition and lifestyle. Healthcare providers such as family physicians, internists, and orthopaedic surgeons, and allied health professionals such as dietitians, physiotherapists, occupational therapists, or weight management specialists can work together with patients to devise an overall strategy that combines medical treatments for knee osteoarthritis with weight management. In this regard, primary care practitioners and rheumatologists are in a key position to manage knee osteoarthritis and its related conditions and coordinate with allied health professionals in providing optimum care. Overweight patients with knee pain need to seek long-term programs that result in weight loss over a period of time to reduce the impact of the excess load on their knee joints.

Exercise and Rehabilitation for Knee Pain

The patient with knee pain should generally avoid exercises which load the knee joint and cause pain, at least in the short term. There is evidence that strength and endurance of the quadriceps muscle are reduced in people with knee OA, therefore improving the strength of this muscle has been a focus of many studies and expert opinions, with the rationale that stronger quadriceps muscles will better stabilize the knee joint and absorb load through the joint, thus reducing symptoms of OA. A recent review has shown that ‘closed chain’ exercises to strengthen the quadriceps such as leg presses are more effective at reducing pain than ‘open chain’ exercises where the foot is not weight bearing, e.g. knee extensions. In spite of the potential benefits, there may be an initial period where quadriceps strengthening exercises cause muscle soreness in unconditioned individuals, and the patient will need to be advised whether to persist with these exercises or to back off if symptoms are aggravated.

The best exercise program for people with knee pain is one that is individualized to the person’s specific condition, and one that is chosen to promote a good balance between the different components of the exercise prescription: strength, endurance, and flexibility. It is generally better to use exercise to correct or modify a particular physical problem or abnormality rather than to attempt to improve overall fitness. For example, an effective exercise for someone with a malaligned patella (knee cap) might be to strengthen the inner portion of the quadriceps muscle, whereas an appropriate exercise for someone with an arthritic knee might be to improve the range of motion in the knee joint. Overall fitness or weight loss can be the secondary result of a well-chosen exercise program.

Low-Impact Exercises for Knee Pain

Switching from high-impact exercises to lower-impact ones will allow you to adopt a less stressful, more forgiving exercise regimen. Remember, though, that when you take the emphasis off the affected muscle groups, you must then use other muscles to assure the stability of the knees. For example, if you are used to running, try walking instead of a kilter location such as a shopping mall. Instead of an aerobics class, take a beginners’ yoga class. The idea is to lessen the impact on the knees by choosing activities involving less vertical and forward motion. At yoga or tai chi you can increase the intensity as you get stronger. If you’re a stationary bicyclist, you could try a recumbent bike which has a larger seat and backrest. Swimming and water aerobics are great knee exercises because the water buoyancy reduces impact on the joints and muscles are in action from the resistance provided by water. And finally, upper body weight training is a good way to keep the rest of the body fit while sparing the knees. Remember to avoid any exercises that cause residual pain or swelling in the knees.

Strengthening Exercises for Knee Support

Squats Stand with your feet shoulder width apart. Slowly bend your knees and hold your arms out level with your shoulders. Try to squat to a 90-degree angle at the knees (essentially in a sitting position) and hold for 6 seconds. 15 repetitions doing 90-degree angles are ideal.

Long arcs Sit in a chair with a backrest. At the beginning of this exercise, you want to tighten the muscles on top of your affected thigh. Slowly straighten your knee and raise your leg until it is parallel to the floor. Slowly lower your foot back down. Do 15 repetitions.

Short arcs Lay flat on your back. Place a roll (about 6 inches in height) under your affected knee so that it is supported in a slightly bent position. At the beginning of this exercise, you want to tighten the muscles on top of your thigh and then straighten your knee and raise your heel off the floor. Slowly lower back down. Aim for 15 repetitions.

Straight leg raises Lie on your back on the floor or bed with the affected knee bent and the other leg flat. Tighten the top thigh muscle of your affected leg and lift your leg several inches off the floor. Hold it for about 6 seconds and then slowly lower it back down. Do 10 repetitions.

Quadriceps sets Sit with your legs straight and supported on the floor or a bed. Tighten the muscle on the top of your thigh of the affected leg and straighten the knee, pushing the back of your knee toward the floor. Hold for about 6 seconds and then relax. Repeat this exercise between 10 and 15 times.

Rehabilitation Techniques for Pain Relief

The aims and methodology of physiotherapy in Singapore do not differ greatly from that of other developed countries, although access to facilities and their availability does. One study ascertained that patellofemoral pain sufferers prefer to receive physiotherapy administered in a hospital setting, on a one-to-one basis with sessions lasting approximately 30 minutes. 27 Considering the effectiveness of patellofemoral taping on this particular condition, a randomised controlled trial has been carried out comparing it to quadriceps exercise and placebo taping. The subjects were ten females with patellofemoral pain, with six of them being randomised to a treatment order which included patellofemoral taping and a final follow-up assessment, and the remaining four having the assessments at the beginning of the data collection process, and four weeks later with the same taping sequence but no taping in between. These conditions enable comparisons to be made between patellofemoral taping and a control, and also to a repeated measures taping condition. Measures taken were subjective pain, quadriceps strength and functional status. A comparison of the two forms of taping revealed significant improvements in pain reduction and a trend for increased function with less pain. When compared to the control, significant improvements were found in all variables measured, and a comparison between the two taping conditions revealed no differences in any variable. This research indicates that patellofemoral taping is effective in providing pain relief and improving function and is no more effective in a short term period when combined with quadriceps exercise. The immediate and short-term effects of patellofemoral taping and exercise on pain and neuromuscular performance in females with patellofemoral pain have also been examined. Measures taken were visual analogue scale for pain, electromyographic activity and isokinetic fatigue tests of the quadriceps. This study will collaborate with a similar study on patellofemoral taping in males with patellofemoral pain mentioned later. In exploring the only study to our knowledge comparing the symptomatic effects of a vastus medialis obliquus exercise programme with patellofemoral taping, visual analogue scale for anterior knee and retropatellar pain will be compared. Measures of muscle activity timing and onset will be identified using intramuscular electrodes in 30% and 60% MVIC step up manoeuvres, with a similar investigation carried out on pain-free subjects to serve as normative data.

Lifestyle Changes for Long-Term Relief

Make time for at least 10 to 20 minutes of low-impact aerobic activity, such as walking or swimming, most days of the week. Even though it may seem difficult to start, regular exercise often is very helpful for relieving pain and breaking the cycle of pain-avoidance-further pain. Some exercises may need to be modified with the goal of not causing pain afterwards or the next day. For example, you may need to do swimming instead of bike riding if it causes more discomfort on your knee. Specially designed exercise programs taught by a qualified instructor can be helpful. These programs can be carried out in a professional setting, such as a physical therapy facility, or other healthcare setting. Supervised exercise is especially necessary for those with muscle weakness around the knee (especially the quadriceps) who have an increased likelihood of worsening of their arthritis. These patients should not assume that high muscle or aerobic fitness will guarantee protection against worsening of arthritis. Exercises to strengthen the quadriceps are very important and have numerous benefits for men and women of all ages. Strengthening the quadriceps has been shown to lead to a greater chance of symptom reduction in knee osteoarthritis and a lower risk of functional limitation in overweight men who are at higher risk for osteoarthritis in the knees. Weight loss is also very helpful for symptomatic relief of knee osteoarthritis, but it requires a greater magnitude of weight loss than usually assumed. High-impact weight aerobic exercise and regular vigorous physical activity can cause an increased chance of injury and will negate beneficial effects of normal physical activity.

Stress Management and Sleep

Mind-body connections emphasize the necessity of understanding the relationship that exists between the state of one’s mental health and the physically perceptive sensations of pain and discomfort. Both stress and anxiety have the potential to significantly worsen a patient’s condition, by inexplicably intensifying pain irrespective of its source. As treatments for knee pain often focus mainly on the affected joint, little emphasis is given to the impact of mental health – yet changes can still be made in mental attitude as well as the emotions of the patient. It is important to use cognitive therapies to adjust maladaptive behavioral responses to pain, for example, a patient with knee pain may avoid using the stairs whenever possible due to fear of increasing pain. This results in decreased function of the knee joint and weakened musculature; strategies to encourage an increase in activity with coping tactics for the pain would be more beneficial for the patient. Relaxation and positive thinking strategies can be employed to lower stress and subsequently decrease pain levels, for when a patient is relaxed the pain will in turn feel less intense. This can be done through various techniques from meditation and breathing exercises, to engaging in activities the patient enjoys to take their mind off their pain. It is vital to address the issue of whether the patient is stuck in maladaptive patterns of pain behavior, and if so how these strategies can be implemented helpfully. Sleep makes a surprising yet integral contribution to the state of mental health and pain; with studies showing even minor sleep deprivation leading to increased pain sensitivity. This can be a difficult area to tackle for someone with chronic pain, yet making steps to improve the quality of sleep in any way can lead to feeling more refreshed and increased ability to handle pain and its emotional effects the next day.

Joint Protection Techniques

Prepare food up the stairs, you’ll need it before long. Join a wellness class for individuals with knee pain designed to show legitimate position, use of knee joints, and what exercises to keep away from. A section on strength exercises will be posted soon. This article addresses these strategies for people with knee pain and which exercises are best and which to avoid. Avoiding exercises that may exacerbate the condition is self-evident, but what does genuine position and use of the knee joint mean? For someone with knee pain, it is likely that they do not stand with their knees straight. Usually, there will be excessive bending of the knees. This is sometimes to try to alleviate pain by avoiding fully straightening the knee, but this also places more load on the joint. Research has shown that in normal walking, the loads on the knee joint are approximately 3-4 times a person’s body weight. This is even higher in stair negotiation, deep squatting, kneeling, and sitting. Making sure that the knee is positioned over the second toe in activities that involve bending will help reduce the load on the knee. This may feel awkward at first for anyone who has had a lot of pain and swelling in their knee, and they may be used to letting the knee roll inwards. Ideal positioning of the knee is important in that it distributes the load as evenly as possible on the joint and reduces the risk of further damage to the knee. An assessment of gait (manner of walking) by a physiotherapist would be beneficial for anyone with knee pain to identify any potentially harmful movement patterns.

Alternative Therapies for Pain Management

Homeopathic medication may be the most varied and interesting of all. A recent experimental clinical trial by Bell et al. on Rhus toxicodendron has shown some interesting results. Rhus toxicodendron is believed to be a homeopathic remedy for people who suffer from arthritis, relieving symptoms of stiffness and alleviating joint pain. The clinical trial conducted on 100 patients with osteoarthritis showed that patients who consumed Rhus toxicodendron in 6c potency compared to placebo had a significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). This study has interesting results indeed and may spark new interest in the efficacy of homeopathic remedies for osteoarthritis patients.

Glucosamine and chondroitin are two other natural substances that have been heavily marketed in the past. Manufacturers claim that they increase joint mobility and flexibility, repair cartilage, and slow down osteoarthritis progression. However, studies on their efficacy have shown mixed results, making it difficult to determine if they are viable long-term alternatives for osteoarthritis patients.

Alternative natural medications are numerous, and some have shown credible evidence in pain management for osteoarthritis patients. One of these is avocado-soybean unsaponifiables, a vegetable extract derived from soybean oil and avocado oil. This supplement has been reported to slow down the progression of osteoarthritis and effectively reduce pain. A clinical trial conducted by Maheau et al. resulted in a reduced Lequesne’s pain functional index and a reduced requirement for additional analgesics in patients consuming avocado-soybean unsaponifiables. This drug has the potential to be a long-term alternative for osteoarthritis patients, but further research needs to be done to confirm its effectiveness and long-term safety.

There are three types of alternative medication available: herbal, natural, and homeopathic. An example of herbal drugs is the long-term use of ginger extract. Ginger has been shown to reduce inflammation in the body, making it a good alternative to ibuprofen. In an experimental in-vitro research done by Grzanna et al., ginger was found to be as effective as ibuprofen. A study conducted by Altman et al. also showed positive effects of ginger extract in patients with osteoarthritis. Despite the difficulty in assessing the quality and quantity of the active ingredient in each ginger product, it is generally safe to consume with minimal side effects, making it a viable long-term alternative for osteoarthritis patients.

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