Non-surgical treatments

   

BEWARE! … there are some people out there making quite whacky and ridiculous claims about being able to ‘cure’ all forms of knee pain with silly unscientific treatments such as sticking bits of bobbly rubber to the soles of your shoes!

If you are actually gullible enough to believe this kind of rubbish, then perhaps (according to Darwin’s principles of natural selection) you might just simply be well suited to it?!?! … and the same applies to other non-scientific, non-evidence based bunkum such as homeopathy, naturopathy, reflexology, aromatherapy etc. … and if these comments upset you then fine – this website’s simply not for you … just go away!

‘Knee Pain’ is a symptom, and one cannot talk about treatments until one has first got a clear and precise diagnosis! This means seeing a proper specialist and having whatever potential specialist investigations might be required – and the only proper true ‘knee specialist’ is a Consultant Orthopaedic Surgeon specializing in Knee Surgery.

I’m a knee surgeon, and it drives me crazy when some people suggest that all I do is ‘just’ operate! – only about 25% of the patients that I see in clinic actually end up needing surgery on their knee. The first part of my role (without which everything else is simply wrong) is to work out what the specific diagnosis is before then discussing with the patient what the various appropriate potential treatments for them and their knee might actually be. Sometimes it’s surgery, but many times it’s not …

The different potential non-surgical treatments available for knee pain include:-

   




Rest, ice, compression & elevation


This is the classic ‘RICE’ advice, and it applies specifically to acute knee injuries, where the knee is painful and swollen. This is simple first aid, but it is useful to help patients early on, in the initial stages after any knee injury.

If with time your knee then simply settles down, then great! However, if not – then that is when you should get further advice from an appropriate healthcare professional.

   

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Painkillers and Anti-inflammatories   

   

Painkillers (such as Paracetamol, Codydramol, Tramadol etc) and anti-inflammatories (such as Nurofen/Ibuprofen, Voltarol/Diclofenac etc) simply help by masking the pain from whatever problem there is in the knee.

If a patient has early mild arthritis, and if all they need is the occasional anti-inflammatory after they’ve done exercise or been for a long walk, then this may well be enough, and all that the patient needs at that stage. Likewise, if there has been a specific injury to the knee but if there is nothing significant ‘structurally’ damaged inside the joint (such as a meniscal cartilage tear or an ACL tear), then resting the knee and taking painkillers whilst the damage hopefully heals up can be entirely appropriate.

One should remember, however, that pain is a symptom – and taking painkillers or anti-inflammatories simply masks that pain. Generally speaking, for muscle strength and cardiovascular fitness, the saying ‘No Pain No Gain’ is right. However, for joints, pain is in some respects actually your friend, as it’s your body’s way of telling you that there’s a problem, and if you simply ignore that problem (or just mask it with painkillers) then it could potentially simply get worse. Therefore, with any kind of major or persistent joint pain, the sensible thing is to get an actual proper diagnosis.


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Knee Braces

   

Simple knee supports (like a neoprene sock that pulls up over your knee, often with a hole at the front for the patella) do little more than just keep your knee warm! The pressure that they exert on the skin does make you more aware of your knee and can potentially help with proprioceptive feedback (your sense of joint position and movement). However, they provide no actual mechanical support.

There are 3 general types of knee brace that can genuinely help, in certain specific situations:-

  • Knee braces that restrict the joints range of bending (flexion) - in some knee injuries or after some kinds of surgical repair in the knee, it is sometimes useful or even important to stop the knee from bending too much, e.g. after a meniscal repair. These braces strap onto the knee and have metal hinges either side, with mechanisms that allow the hinge to be locked within a certain range.
  • Knee braces that compensate for ligament deficiency
  • Knee braces that help offload weight from one side of the joint if one particular side of the knee is arthritic
  • Knee braces that help prevent patellar maltracking/instability

If you have an MCL injury and if the knee needs to be protected for 6 weeks whilst the ligament heals, then a cheap and simple brace with side supports is generally all that is required.

If, however, you are trying to provide stability to the joint and compensate for a ligament tear/rupture (such as with an ACL tear that has not been reconstructed) then what you really need is a decent proper dedicated ligament brace, such as the Don Joy Fourcepoint brace. Anything less than this just isn’t worth having.

CLICK HERE for further information about ligament braces

If you have arthritis in one side of your knee and if you need to offload that side of the knee to reduce pain, then what you need is a medial or lateral offloading OA brace. These offload about 15% of the weight from the affected side of the knee (medial/inner or lateral/outer), thereby reducing pain. 

CLICK HERE for further information about OA braces

If you are suffering from patellar maltracking and anterior knee pain, or patellar instability/dislocations, then a special patellar brace can provide support support/pressure on the lateral (outer) side of the patella to improve tracking/stability.

CLICK HERE for further information about patellar braces

   

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Walking Aids

   

Crutches can be very useful for even vital for offloading a joint after an injury or during recovery after surgery. If a walking aid is required longer-term, for example with an arthritic knee, then generally a proper walking stick tends to be more comfortable – accepting that many people really don’t like the ‘stigma’ of having to resort to a walking stick … but in some instances they really can help, even if it’s just a temporary thing whilst waiting for proper definitive treatment such as surgery.

   

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Physiotherapy

   

Physiotherapy is a science-based healthcare profession that views movement as central to health and well being. Physiotherapists aim to identify and make the most of movement ability by health promotion, preventive advice, treatment and rehabilitation, using skills such as manual therapy, postural correction and therapeutic exercise.


CLICK HERE for further information

   

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Kneease

   

The Kneease device is a registered medical device that works like a TENS machine. The device is strapped to the front of the knee and it emits precise frequency vibration that effectively scrambles the signals in the nerve fibres, thereby blocking pain signals from the joint.

The Kneease was developed by Mr Ranjan Vhadra, Consultant Orthopaedic Surgeon in Guernsey, and its safety and efficacy has been tested in clinical trials, which have shown that 78% of patients rated their pain relief from the Kneease as ‘very good’ to ‘excellent’, with 2/3 of patients being able to reduce their reliance on anti-inflammatory medications.

CLICK HERE for further information

    

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Intra-articular injections


There are two main things that can be injected into (inside) a knee joint - steroid (cortisone) and hyaluronic acid. In addition, steroid can sometimes be injected around a knee joint - i.e. not into the inside of the joint itself, but into or around the various structures surrounding the knee, such as bursae or tendon sheaths. The indications for a joint injection are very specific. It is vital to be aware of the fact that even though injections into a joint may reduce symptoms, they rarely actually 'cure' the underlying problem - instead, they often simply mask knee pain ... and this can be an issue if there is any actual mechanical/structural damage inside the joint.


CLICK HERE for further information

   

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