The hip and knee joints are amazing. The human body can carry out a variety of activities from running and dancing to simply standing, thanks to the combination of strength and flexibility these joints provide. Our hips and knees provide stable support to the body, which allows us to walk. Since the hip and knee bear the weight of the body, they are more prone to developing arthritis. Arthritis is the breakdown of cartilage in the joints. The normal function of the cartilage is to provide a smooth gliding surface and to absorb shock. Without this, joint pain and stiffness can result. This pain can be severe and can limit activity.
Understanding Hip and Knee Pain
Understanding hip and knee pain is the initial step to guaranteeing that you get the right treatment for a prosperous recovery. Commonly, individuals will not seek advice for their pain for a few reasons; if the discomfort is minimal, folks might just concede that it is an aspect of aging. Others just hold on to find out if the ache will go away- but it is not suggested to overlook pain. If you do not exactly know what is causing the pain, you can make points even worse still. As a result, you might limit the activity/habits that worsen the pain and this may result in other complications and sufferings overtime. One more reason individuals hold off obtaining care is that they get conflicting info. Indeed in this time and age, the internet provides substantial helpful information, but with that it can lead individuals to derive to the wrong conclusions. In some cases, it is a last resort as people who suffer chronic pain can get down especially if it restricts activities that once were very easy to perform. E.g. Pain getting in and out of the car, using stairs, putting on socks and shoes, and eventually pain can affect usual daily duties. Prolonged pain can also affect your psychological state. These are frequent symptoms of individuals with osteoarthritis, an inflammatory condition of the joint. Patients can reach to a stage where they are willing to try anything to alleviate the pain, while others are uncertain and don’t want to undergo any major surgery.
Importance of Exploring Non-Surgical Treatment
It is important to fully explore non-surgical options before deciding on the most appropriate treatment for hip and knee pain. This is a consequence of several factors and should not be rushed into without considering many different variables. The first reason for you to consider is recent research that has told us that weight loss and exercise are effective interventions for preventing and treating hip and knee OA. Improved fitness and weight management have been proven to be cost-effective in avoiding and minimizing the impact of what is termed a debilitating disease. Weight loss is a particularly important self-management strategy with a proven track record of success. For instance, a reduction in body weight by 5 kg results in a 50% reduction in the load exerted on the knee per step. The lifestyle changes that contribute to weight loss and involve increasing physical activity have a corresponding effect on increased muscle strength. Strong thigh muscles are important in alleviating knee pain. It has also recently been shown that knee muscle strength can be increased in elderly people with symptomatic OA. This is an important finding in that muscle weakness is a common cause of disability in the elderly. It is a reasonable assumption to make that increasing muscle strength will improve physical function in older persons with knee pain due to OA.
Benefits of Non-Surgical Treatment Options
– Prevention of disease progression: Studies have shown that the degree of pain in arthritis is not always directly related to the amount of joint damage, and it is not uncommon for patients with severely arthritic joints to have few symptoms, while others with mild arthritis have severe pain. This suggests that the arthritic process is being modified by factors other than the mechanical damage to the joint, and in some cases it may be possible to slow or halt the progression of the disease, relieving symptoms without necessarily resorting to treatment of the joint itself.
– Protection from further damage to the joint: It is known that the longer a patient with arthritic pain can be kept away from joint replacement surgery, the better; as joint replacements have a limited life span and delaying the operation can therefore be very beneficial for both the patient and healthcare provider. For some patients, particularly younger ones, it may be desirable to avoid joint replacement altogether.
– Pain relief: This may seem an obvious reason for patients to seek treatment, but it should be remembered that chronic pain can have major effects on a patient’s psychological wellbeing, and addressing this may require treatments other than those directly targeting the painful area. In some cases, pain relief may be only partially achieved directly through treatment of the arthritic joint, and an important component of treatment will be to improve the function of the joint so that the pain is reduced.
Patients with hip and knee pain seek non-surgical treatments for a variety of reasons. We feel that the most important of these can be captured by the five following “P’s”:
Non-Surgical Treatment Methods for Hip Pain
Physical therapy is often one of the best starting points for those suffering with chronic hip pain. The goal of therapy is to restore strength and function to the hip and lower extremity. Individuals with hip pain treatment without surgery often alter their gait to avoid weight bearing on the affected side; this can lead to muscle weakness and a further decrease in joint stability. Weakness in the muscles around the hip can lead to increased pain and instability in the joint. Therapy can address the underlying muscular imbalances and weaknesses and improve the overall function of the hip. Many individuals with hip arthritis have been found to have weakness in the hip abductors and external rotator muscles. Specific exercises can target these muscles to improve their strength and help to stabilize the joint. In severe cases of arthritis, the cartilage loss can be so great that the ball and socket no longer have congruent surfaces. In cases such as this, therapy can only help to a certain extent. If therapy does not significantly improve hip pain after a trial of 3-6 months, a patient may be considered to be a candidate for a total hip replacement.
Physical Therapy and Rehabilitation
Physical therapy is usually one of the first treatments your doctor might recommend. It can be done at home, but is often done under the supervision of a qualified physical therapist. A qualified doctor therapist could give you any of several treatments including stretching exercises, massage, whirlpool baths, ultrasound, and applying heat to restore strength, mobility, and flexibility to your hip. A regular exercise program is beneficial for hip health. Exercise is good for strengthening the muscles around the hip and can help prevent further injury. Both of these things can be accomplished through flexibility and strength training programs, as well as aerobic conditioning. The best aerobic exercises for your hip are walking, stationary cycling, and swimming. Water provides resistance which strengthens muscles and yet reduces the impact on the joint, and therefore is the ideal environment for someone with hip issues. Other good exercise routines may include some low impact sports such as golf and doubles tennis, as well as using an elliptical trainer. Avoid sports like basketball, volleyball, and jogging as they involve high impact that can cause further problems for your hip. These exercises are ideal ways to recondition your hip; however, it is important to consult your doctor before beginning any exercise program. If your hip problem is an acute injury such as a muscle tear or hip fracture, your doctor therapist may suggest an activity modification initially, to avoid aggravating the injury. Complete avoidance of the aggravating activity may not be necessary and alternative methods of performing that same activity may be discovered depending on the nature of the issue. For instance, if the injury was sustained during a recreational sport, it can be discovered to what intensity the same muscles are used during the sport, and perhaps the patient can still participate in the sport at a lower intensity. In some cases, this strategy can be successful in pinpointing an alternative method until the patient is capable of resuming their regular activities. In severe cases, an assistive device such as a cane or crutches may be necessary to offload the weight from the affected hip. This issue will often prompt a discussion with your doctor about the possibility of a hip replacement.
Medications and Pain Management
Nsaids are a type of medication to help ease your pain. They are medications that are the non steroidal side of anti-inflammatory. Some nsaids need a prescription and some do not. These medications all work in the same kind of way and tend to relieve pain in a few weeks. They reduce the amount of prostaglandins in your body and therefore help to control the amount of inflammation you have. Once you have less inflammation there should be less pain and better mobility. You may have minor side effects with these medications such as indigestion and stomach aches, it is important you stop the medication and inform your GP if you get these symptoms. This is because nsaids can sometimes increase the chances of getting a stomach ulcer or making any existing diseases worse, such as asthma. If you are over 65 or have had a peptic ulcer then you should not take nsaids. E.g. Diclofenac, Ibuprofen Paracetamol, although not an nsaid, can also help to relieve pain and a high dose can provide anti-inflammatory effect. This again can improve pain and make you feel better. Although very safe and is rare to have side effects, taking large amounts can damage your liver, make sure you follow the packet instructions or consult your GP.
Alternative Therapies for Hip Pain
Glucosamine and chondroitin sulfate have recently become popular for the treatment of hip and knee pain. These are nutritional supplements that have been shown to help with mild to moderate osteoarthritis. Glucosamine is an amino sugar that is believed to promote the repair of cartilage and has an anti-inflammatory effect. Chondroitin is a complex carbohydrate that helps cartilage retain water. Both of these are necessary for maintaining healthy joints. These supplements have been shown to be more effective than placebo and are as effective as taking ibuprofen for pain relief. However, they take 2-3 months to take effect, and those who have an allergy to shellfish should avoid glucosamine as it is derived from this. The long-term effects and safety of these supplements are still unknown.
Some patients may be interested in exploring alternative therapies for their hip pain. There are numerous treatments available, but only a few have been studied for safety and effectiveness.
Non-Surgical Treatment Methods for Knee Pain
Knee pain can be a very debilitating and burdensome condition. With around 11 million visits to physicians’ offices a year, and an average annual budget of $3.5 billion for the initial treatment of chronic knee pain, knee pain is a fairly common ailment and can be caused by a wide variety of factors. It is of utmost importance that knee pain is properly diagnosed in order to direct the best course of treatment. With such a wide array of etiologies behind knee pain, it is quite common that in order to treat pain in the knee, multiple interventions are used in conjunction to obtain better results. This being said, there are a number of non-surgical treatment methods for knee pain that have been supported in the medical literature and have shown to be effective. This section will describe some of the treatment methods that can be employed and the received results from each of them.
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Knee Injections and Joint Fluid Therapy
Injections in the knee: Injecting corticosteroid (a powerful anti-inflammatory agent) into the joint is one of the most effective methods of reducing inflammation and pain in the knee. These injections are frequently used for patients with osteoarthritis. Relief from a single injection may be sustained for several weeks, months, or even longer. An injection can also act as a quick solution for acute inflammation and pain. Although there is no definitive evidence, it is thought that repeat injections can decrease the benefits of the previous injection, so it is generally advised to keep them as infrequent as possible. Other types of injections into the knee include those with viscosupplements and Platelet-Rich-Plasma (PRP). Viscosupplement injections are a type of joint fluid therapy – a treatment that aims to replace damaged synovial fluid in the joint with viscosupplements. Viscosupplements are injected directly into the joint and aim to lubricate the joint, act as a shock absorber, and provide relief from pain. It is believed that they achieve this by providing an environment for chondrocytes to produce molecules which repair damaged tissue. Viscosupplementation has produced mixed results in studies, but there is some evidence to suggest it may be most effective in providing pain relief for patients with mild to moderate osteoarthritis in the knee. It is usually less expensive than most other long-term treatments for knee osteoarthritis.
Bracing and Supportive Devices
The use of an ‘unloader’ brace is frequently recommended for patients with knee osteoarthritis and varus or valgus malalignment. These are custom-made or off-the-shelf functional braces, which attempt to shift load away from the damaged or affected area of the knee to the more preserved compartment. The concept is that by doing this, pain will be reduced, function increased, and disease progression slowed. There has been considerable research in this area over the past ten years. A recent Cochrane review of unloader braces for knee osteoarthritis found 11 studies of various methodologies. Unfortunately, the current conclusion is that there is limited evidence to support their use. At this stage, the authors recommended that unloader braces should only be used for patients with knee osteoarthritis who have significant varus or valgus malalignment, as a trial of the brace to determine clinical response. This is because an unloader brace may cause further pain and discomfort for patients who do not have significant malalignment. If this is the case, the brace can be adjusted, but if there is no significant improvement then it should be discarded.
Bracing and supportive devices for the knee are prescribed to patients for several reasons. The two most common indications are to reduce pain, provide stability, or to reduce the risk of re-injury. Considerable evidence exists to support the use of a simple knee sleeve for patients with knee osteoarthritis. One randomized study has shown a decrease in pain and an increase in functional ability when a neoprene sleeve was worn. Another study has shown that a sleeve was as effective as using an NSAID. Despite this evidence, a survey of orthopedic surgeons found that sleeves are often overlooked as a way to manage knee OA. This is unfortunate, given that the evidence suggests a relatively low-cost intervention which has a significant functional impact for some patients. It may be that some clinicians simply prefer to use a more expensive brace for their patients, whether there is good evidence for its use or not.
Exercise and Strengthening Programs
Exercise and strengthening programs are an essential part of recovery and can significantly reduce pain as well as improve function and mobility. A well-rounded exercise routine will include a cardiovascular, strength, and flexibility component. Exercises to improve balance are also beneficial for patients with knee pain. Water-based exercises (i.e., Aquafit) put less stress on the knee and are ideal for patients with knee pain or osteoarthritis. Patients with knee pain should choose shoes with good support and cushioning. Orthotics or shoe insoles can improve the alignment of the foot and leg and reduce stress on the knee joint. Bracing is a proven method to reduce pain and improve stability in a knee with ligamentous damage. An “unloader” brace can relieve pain from osteoarthritis by shifting weight away from the affected part of the knee. These braces are custom-fitted for the patient and are typically used in conjunction with exercises to strengthen the affected knee.
Lifestyle Changes and Preventive Measures
Joint injuries can occur from a variety of activities, but some activities put a higher load on the joints than others. High-impact activities such as running or jumping stress the joints more and can cause acute trauma or speed up degeneration of the joint. Athletes frequently involved in these types of activities may want to consider switching to a less traumatic activity to preserve their joints in the long run.
Poor posture and improper body mechanics can also be blamed for much of joint pain. Whether sitting, standing or working, there are right and wrong ways to perform these activities. When done right, there is less stress on the joints, which can prevent pain or dysfunction in the future. For example, when lifting objects, bending at the knees is the correct way because it puts less force on the hips. Good posture is more or less a continual practice of using the right body mechanics while performing activities.
There is no one sure way to prevent knee and hip pain, but there are certain steps that can be taken to decrease the likelihood. Lifestyle changes and preventive measures tend to be the most effective for individuals in all age groups due to these tips typically being free or low-cost. Weight management and proper body mechanics are just two examples of lifestyle changes that help prevent joint pain. Staying active and exercising is important for overall health and can have added benefits for joints, increasing strength and stability. Low-impact activities, such as swimming or cycling, can help sustain an active lifestyle. Strengthening the muscles around the joint will decrease the load on the joint, which can avoid or lessen symptoms of pain. All of these practices help to achieve and maintain a healthy weight, which is crucial in preventing joint pain. Excess weight adds stress to the joint, particularly knees, and can cause the deterioration of cartilage. This often leads to the onset of osteoarthritis, so reducing even a small amount of weight can have a significant impact on joint pain.
Weight Management and Nutrition
Weight management helps to ease the load on the hip or knee. It can be as simple as losing a few extra pounds. For example, each pound of weight loss is equivalent to 3-4 pounds of pressure taken off a knee. Nutrition and portion control can contribute to effective weight management. There are many resources including community programs and dietitians that can help with meal planning and nutrition goals. An example of a community program geared towards those with joint pain is the Stanford Health Care’s “Weight Management for People with Arthritis”, or you can ask your health provider for a referral to a dietitian. An increase in weight can affect the pain in a hip or knee as it increases the load on the joint, and has been shown to increase the risk of developing osteoarthritis. Obesity is a major risk factor for the development of osteoarthritis as it increases the risk 2-4 times, because the excess load can cause damage to the joints. Losing a moderate amount of weight has been shown to decrease the risk of osteoarthritis in women. High quality trials have shown that a combination of weight loss and exercise is more effective in reducing pain and disability in those with osteoarthritis in the knee, than exercise alone.
Proper Body Mechanics and Posture
Proper body mechanics refer to the way we move as we carry out our day, whether it is sitting, standing, lifting, or walking. Often times, body mechanics can be the cause of back and joint pain, muscle strain, and other injuries. Poor body mechanics are the commonest reason for low back pain. Healthcare providers or physical therapists with training in ergonomics can give advice on how to modify the way you perform daily activities to protect your back. Body mechanics training can help prevent pain, provide relief and ease of movement, and thus promote healing and prevent reinjury. A physical therapist can help improvise individual body postures to confirm that the joints are not being put through excessive movement near the end range, which may lead to extra stress and increased pain. A trainer or physical therapist often uses video or digital analysis to help improve posture and body mechanics.
Avoiding High-Impact Activities
For patients with osteoarthritis who have constant hip and knee pain, lowering the amount of high impact activities can be a difficult lifestyle modification to accomplish. Although it is difficult to stop most high impact activities and therefore it is hard to change the biomechanics in the hip and knee joints, even a small reduction in high impact activities can have significant benefit. For the elderly, switching to a low impact exercise such as swimming or water aerobics can still have aerobic benefits while causing less pain from the osteoarthritis. For others, it may be as simple as modifying the activity which causes the most pain. An example can be seen in someone who has knee pain that is exacerbated by playing basketball. This patient may decide to stop playing basketball and take up a new sport that is less demanding on the knee, such as playing tennis. Older adults among the study’s more than 38,000 participants who were overweight and sedentary at the start of the study benefited most from exercise and diet. Intensive diet and exercise or diet alone maximum weight loss with dieting and exercise with a simple liraglutide cost saved in information about liraglutide helped the participants maintain their mobility. Over four years, diet and exercise reduced the risk of losing mobility, defined as being unable to walk a quarter of a mile, by 27 percent, while diet alone by 18 percent.
Knee Surgery in Singapore: A Modern Medical Hub in Southeast Asia
Singapore boasts a sophisticated healthcare infrastructure with state-of-the-art hospitals and clinics equipped with advanced technology. Renowned surgeons with international qualifications and extensive experience in minimally invasive techniques like arthroscopy perform knee surgeries. These minimally invasive procedures allow for faster recovery times, reduced pain, and smaller scars compared to traditional open surgeries.
Another factor driving Singapore’s popularity for knee surgery is its focus on patient-centered care. Hospitals offer personalized treatment plans, with a high standard of service and communication throughout the process. Additionally, Singapore’s multicultural environment ensures patients from all backgrounds feel welcome and comfortable.
Common knee surgery Singapore include arthroscopy for meniscus repair or ACL reconstruction, knee replacement surgery for severe arthritis, and high tibial osteotomy for realignment in younger patients. Singaporean hospitals are known for their expertise in robotic-assisted knee surgery, offering enhanced precision and potentially faster recovery times.
Considering treatment in Singapore can be advantageous for several reasons. The high success rates and focus on minimally invasive techniques can lead to quicker recovery and a shorter hospital stay. Additionally, Singapore’s geographical location makes it easily accessible from many Asian countries.
However, it’s important to acknowledge cost factors. While Singapore may offer competitive medical costs compared to Western nations, it’s generally more expensive than treatment in neighboring countries.
In conclusion, Singapore has positioned itself as a leader in knee surgery within Southeast Asia. Advanced medical facilities, highly skilled surgeons, and a patient-centric approach contribute to its reputation. While costs may be a consideration, the potential benefits of high success rates, minimally invasive techniques, and a focus on patient care make Singapore an attractive option for those seeking knee surgery.