Seniors: Knee pain in older adults – what works

Summer is here, and you want to get out and be more physically active. What if your knees are hurting? Knee pain due to Osteoarthritis (OA) is common with aging, affecting 40 per cent of adults over the age of 65 years. It is the primary cause of reduced physical activity or inactivity in older adults.

The World Health Organization ranks OA as the 4th cause of disability for women, and 8th cause of disability for men. In fact the risk of disability from OA is greater than that associated with heart disease, cardiovascular disease or any other disease.

What exactly is OA and how does it affect our knees? OA is a degenerative condition affecting joints. It starts affecting our knees when the cartilage, which acts as a cushion in our knee joint, starts breaking down slowly. This could result from an injury or trauma, high impact activities such as running, or due to wear and tear associated with aging.

When the cartilage thins away, the bones forming the joint start grinding against each other. This causes pain, swelling, and stiffness. OA also affects the quality of joint fluid in our knees, reducing its ability to lubricate the joint, thus making it harder to move it.

Symptoms tend to be worse in the morning, after activities, or after prolonged sitting.

How can we manage the symptoms and live well with OA? Medical literature describes over 50 different modalities for the treatment of symptoms of OA.

Total knee replacement is the most definitive treatment for disabling knee OA, unresponsive to conservative treatment. This is offered as the last treatment option after all other options have been exhausted.

Studies have shown that one in five patients (particularly, those younger than 70 years) who received total knee replacement experienced residual pain and stiffness and were not satisfied with the outcome.

Several non-surgical treatment options are available, ranging from lifestyle modifications to more invasive injectable therapies.

Weight loss decreases the strain on the knee joint, and when combined with low-impact aerobic exercise (swimming, elliptical training) can improve the mobility of the joint and improve symptoms. 1 Kg of weight loss correlates to a four-fold decrease in forces acting on the knee joint. Frequently, weight loss alone can relieve symptoms of OA.

Knee braces, taping, orthotic devices, acupuncture, transcutaneous electrical nerve stimulation (TENS), and nutritional supplements such as chondroitin sulphate are frequently suggested for improving symptoms. However, there is inconclusive evidence for all these interventions.

Physiotherapy to strengthen the quadriceps muscles in the front of the thigh can help reduce the load and stress on the joint. Several studies have shown that strengthening exercise programs either with a therapist or at home can result in significant improvements in pain, function and quality of life.

Topical NSAIDs, such as topical Diclofenac (Voltaren Gel) and ketoprofen have been found to be very effective in relieving pain and swelling, and being devoid of adverse effects, they have to be tried first before taking the pills.

NSAIDs (Advil, Naproxen etc.) taken orally are the most commonly prescribed treatment for OA. But daily use of these medications causes serious gastrointestinal, renal and cardiovascular adverse effects.

Studies to evaluate the commonly prescribed NSAIDs have identified Diclofenac 150 mg/day to be the most efficacious in relieving pain and improving physical function.

Injection of corticosteroid drugs (cortisone), into the joint can cause short-term pain relief. However, their repeated use may result in greater loss of cartilage volume.

Injection of hyaluronic acid — a naturally occurring shock absorber present in joint fluid — has been found to be more efficacious in improving symptoms than cortisone and NSAIDs.

Surgical treatments such as knee realignment procedures, arthroscopy to diagnose and treat damaged knees, and arthroplasty or knee replacement are available for OA unresponsive to conservative treatment.

Though many physicians follow a sequential treatment approach, a multidisciplinary approach including physiotherapy, lifestyle modifications and medical treatment seems to be the most sensible way to manage pain and improve quality of life of older adults with OA.

Therefore, it is beneficial to discuss all your options with your physician.

Padmaja Genesh, who holds a bachelor degree in medicine and surgery as well as a bachelor degree in Gerontology, has spent several years teaching and working with health care agencies. A past resident of Red Deer, and a past board member of Red Deer Golden Circle, she is now a Learning Specialist at the Alzheimer Society of Calgary. Please send your comments to padmajaganeshy@yahoo.ca

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