Evidence-based treatment for knee osteoarthritis.

Knee osteoarthritis is the most common form of arthritis (365 million people worldwide).

It can be a debilitating disease, causing pain, joint stiffness, and limitations in overall mobility, such as squatting, walking, and exercising.

Many believe that arthritis is a death sentence - the cartilage in the joint will continue to wear down until eventually you’ll need a joint replacement. I wrote about this a bit in a previous email. However, that’s not necessarily the case. While we haven’t figured out how to grow the cartilage back yet, there are several treatments and strategies we have at our disposal.

My colleague Dr. Peng recently put together a table of all the common treatments for osteoarthritis and ranked them:

I love frameworks like this. Being able to see all the options in one place.

It’s easy to get caught up in the “doom and gloom” that comes with progressive diseases such as arthritis and forget that there’s so many options we can still consider to combat them.

Dr. Peng does a great job laying out the different treatments by benefit, risk, cost, and recommendation. If I were you, I’d save the image to my phone. Being able to discuss these options with a physician, PT, or someone like myself can be invaluable and help you, or someone you know, find the relief you need.

I have few thoughts as I like through the treatments:

Agreements:

• Weight management and exercise therapy should be at the top of the list. I’d argue this is true for most painful conditions. Keep moving, modify as needed, find painful triggers, calm stuff down, build it back up, address weaknesses and limitations. That’s the recipe.

• Turmeric / Boswelia are low-risk, potential high-reward supplements. I commonly recommend them through my dispensary and have seen a lot of improvement in those with joint pain.

• Arthroscopies (scopes) are NOT low-risk. Doctors will tell you they are - minimally invasive, outpatient, no rehab required, easy peasy - but they’re not. The research is clear that they can cause or progress arthritis in a joint. I mean, you’re literally cutting the cartilage out of the joint. Not great. STAY AWAY.

Disagreements:

• He recommends cortisone injections on a limited use basis. I’d argue they should never be used. Will they maybe help in the short-term? Yes. But do they also drastically progress the arthritis? Oh yea. Again, this is another “duh” sort of treatment for me. You’re injecting a steroid that has been shown to eat away at the cartilage and tissue. I could never recommend a treatment that I know is going to make something worse in the long-term but that’s just me.

• Wearing knee braces can have some side effects. I only mention this because he has them as “none” in his table and that’s not necessarily true. Knee braces offer support and stability to the joint. This can help decrease pain, especially when someone’s on their feet for extended periods of time i.e. going to the zoo, long hikes, working as a nurse, etc. However, the brace is doing a couple things we don’t necessarily want. 1 - it’s limiting your ROM and you can’t bend the knee as much. In any joint, motion is lotion. We want to keep moving the joint as much as possible, pumping synovial fluid in and out, maintaining the health of the tissues surrounding it. No bending, no bueno. 2 - the brace is doing what your muscles and tendons are supposed to be doing, which is providing stability to the joint. Over time, this can lead to weakness and weakness leads to further deterioration and limited functional mobility. Use braces as little as possible and only as needed.

That’s it. As I said, these types of frameworks can really be invaluable for when you’re dealing with something like arthritis.

Look through the treatments and options, weigh out the risk vs rewards, and create a plan that’s best for you.

As always, if you’d like to discuss those options with me, you can always book a Discovery Call by using the link HERE.

Until next time,

-Ryan

***

Share it

Thanks always for taking the time to read this.

If you’ve enjoyed this volume of The Movement, please spread the love and tell your friends! You can share this newsletter using the link below:

https://the-movement.beehiiv.com/subscribe

Do you have any suggestions for The Movement? Reply directly to this email or shoot me a message on Instagram.