Recommendations for chronic and severe knee pain

January 3, 2023 11:12 AM

My partner's arthritic knee has been giving her grief for the past several (5+) years, I'd like to hear your suggestions re: knee brace technology, medical intervention, diet, exercise (more inside).

Up until the past two years, she has not really let it get her down, but lately she does as much as she can to stay off her left knee. A vigorous dog walk can make her want to stay off the knee for 2-3 days. She wears a simple brace, she gets turmeric in her diet every day (usually), and she is a busy person. She is not swimming or biking or doing regular exercise, just generally keeps busy up till the past year where the pain is definitely keeping her on her back more often, there is weight gain, I'm thinking the load on the knee is exacerbating things.

She got a gel injection earlier in 2022 and that helped for a while, I believe she needs to push to have knee surgery (Canadians know what I mean here). They keep telling her to hold off but I don't see the trade-off benefit of prolonging, given the past year especially.

Do you have any advice? And this Stoko athletic brace popped onto my radar, is this thing any good? I am pretty sure she bought the brace she currently wears at the local (small town) drug store, it's a stretchy thing with some rigidity built in, kind of a pain in the ass to get on/off from what I can tell.

posted by elkevelvet to Health & Fitness (18 answers total)

Does she know what kind of knee injury she has? Some are fixable with physical therapy and some are not. Figuring out which she has will help her decide if she needs to push for surgery or can rehab the knee with appropriate guidance.
posted by jeoc at 11:17 AM on January 3, 2023 [3 favorites]

Have she tried physical therapy? Has she gotten a diagnosis? Pushing for surgery does seem like the last step after trying lots of other things, and physical therapy should be first on the list. The PT will help figure out what's going on and come up with a series of recommended movements to help her learn to restrengthen her knee. She's at the point where she probably has some habits based on years of avoiding pain, and she is going to need to learn to walk and move differently.
posted by bluedaisy at 11:22 AM on January 3, 2023 [1 favorite]

Response by poster: No PT recently though she did have visits a couple of years ago.. I'd say some stubbornness and fatalism have combined to result in discontinuing regular PT treatment.. the arthritis is worsening in the knee and (from what she describes) she is losing the cushioning in the joint over time.
posted by elkevelvet at 11:38 AM on January 3, 2023 [1 favorite]

on the physio tip -- something I've noticed recently is that some people have tried one physiotherapist, didn't get good results, then sworn off the whole idea.

I get it. There are some dubious physios out there. But if I'd gone that route, I imagine my last thirty plus years would've had been way different (ie: more painful). Because yeah, my first physio was pretty much useless -- he had lots of equipment, a nice big facility but I got zero results. I went back to my doctor and wondered if surgery was my only other option and he said, "Not until you've tried a different physiotherapist." Long story short, the second one was way better. Less equipment, way more about me committing to a regime of stretching and strengthening. And yes, within a month or two, I could walk properly again.

And the same thing has happened since with different injuries. Only once have I landed at the right place the first time. I don't think it's even that there are so many bad physios out there -- more that some are better with certain injuries than others (more experience probably).

For the record, my last affliction involved some crippling leg-knee-hip pain this past spring-summer. The first physio gave me a few stretches etc, but I got no results. The second one reviewed what I was doing, tweaked it a bit, added one or two other moves and ... voila! Within a week, I was seeing serious results.

Hope this helps.

And on review --

I'd say some stubbornness and fatalism have combined to result in discontinuing regular PT treatment..

even if she does opt for surgery, physiotherapy will be part of her recovery process.
posted by philip-random at 11:43 AM on January 3, 2023 [2 favorites]

You asked for diet advice, so I'm going to give it. If you want to get rid of "old age joint pain" get rid of wheat/gluten. Before I got rid of wheat in my mid 40s I regularly had joint pain and other inflammatory issues. I am 56 now and not only do I have zero joint issues, my eczema has gone away and my night vision has come back. It's a tough sacrifice, getting rid of gluten, but I can think of no smarter decision for anyone. That shit's toxic, a slow poison.
posted by seanmpuckett at 12:25 PM on January 3, 2023 [2 favorites]

Try quitting dairy for a month? Dairy has been shown to cause and exacerbate inflammation. Folks with inflammatory complaints including rheumatoid arthritis have anecdotally reported substantial relief from quitting dairy. Won't cure any damage but may provide some relief.

Hope she finds something that works, sounds very frustrating.
posted by Glinn at 12:27 PM on January 3, 2023

Vitamin and mineral guide for arthritis - if it's worse in winter, check vitamin D levels.
posted by aniola at 12:38 PM on January 3, 2023 [1 favorite]

I got a full year of relief from debilitating pain in my severely arthritic hip with the drug meloxicam. I ultimately had the hip replaced because I didn't want to be talking any med long term. The meloxicam, for me, was miraculous in its ability to relieve my pain.
posted by Dolley at 12:40 PM on January 3, 2023 [3 favorites]

Gel injections only work for a while but if that helped she should keep up with it, it’s worth saving for even on a budget if that applies.

Surgery - not sure which province you’re in. For Ontario, OHIP will only cover a total knee replacement which only buys a certain number of years, after which a revision is needed. Revisions are always worse.

There are many more options in the US.
posted by cotton dress sock at 12:54 PM on January 3, 2023 [1 favorite]

In terms of framing things to your partner, perhaps she would like to find a good physiotherapist before surgery. I can't speak to how Canada does things, but it's possible that knee replacement surgery will have some "recommended" prehab exercises. So PT or PT type exercises will show up eventually.

Regarding diet/ supplements, here's a chart for Scientific evidence for popular health supplements (check the musculoskeletal box).
posted by oceano at 12:55 PM on January 3, 2023 [1 favorite]

I'm 56, I have knee arthritis and I've had to rehab for various injuries as I age. I've had injections and I've been told I will eventually need a knee replacement.

Here's my anecdote:

I tweaked something early on in the pandemic, it hurt like hell, and I didn't want to see a doctor (because COVID), so I got one of those drugstore knee braces and wore it for two months. My knee wasn't getting better. I could ride a bike, but on foot, I could barely keep up with my then 84-year-old Dad. It hurt.

Eventually, I sucked it up and went to see the sports doctor. The first thing he said was to stop wearing the brace. The brace was too supportive - the muscle in my leg had atrophied. A weak leg muscle means no knee support. The second thing was sending me to the physiotherapist, who I saw a couple of times a week, then weekly, then monthly, then in for the occasional adjustment to my strengthening routine.

Currently, I ski, I curl, I ride my bike and I'm running three times a week. The daily physio exercises are key, not just for recovery, but for maintaining strength. Strong leg and core muscles support the knee. It's night and day.

I watched my mother age. She was a dietician and she tried every diet intervention under the sun. She never did a squat or a lunge, though (she didn't like physical discomfort) she had a knee replacement she never really recovered from (because she didn't do the physio) and she spent the last five years of her life bedbound. That's my motivation when I feel like skipping my daily 15 minutes of physio.
posted by TORunner at 1:29 PM on January 3, 2023 [5 favorites]

I'm almost 62 - (bday is in February) and I have arthritis.

I first discovered this in 2014 after running a 5k. When I came across the finish line and stepped on my left leg, pain shot through my knee. I made the rounds of various doctors before ending up at an orthopedic surgeon's office where he diagnosed severe arthritis and prescribed PT. I went to PT where they told me that a lot of knee and back pain is caused by weak hip and butt muscles. I did a lot of clamshells and other exercises. I also decided that running wasn't my exercise of choice and took up weight lifting and also biking which is great cardio for folks with bum knees. (full range of motion without weight bearing).

Over time, the knee pain got worse, and I ended up having total knee replacement surgery on both knees in the fall of 2020. The surgery was successful, and I resumed my weight lifting and biking. However, my left arm started hurting. During a follow-up visit to my ortho in the spring of 2021, I asked my doc about it and he diagnosed shoulder arthritis.

That got worse, to the point I had shoulder replacement surgery in November which I'm recovering from now.

Going into my knee replacement surgery, I thought of it as the Fountain of Youth. It is helpful (I don't wake up in the night from pain, and I can stand for a while without being in agony), but the recovery is long. They say it takes a year to get back to 100% and that sounds about right. The first couple of weeks are really hard. My wife's support and the prescription pain meds were invaluable.

I was told to put off the surgery as long as possible (because the joint only lasts so long and revisions aren't as good as the original) but not too long (because if you lose strength and/or mobility, you may not regain it). I was prescribed PT post-surgery and have been fairly religious about it - I definitely make my appointments and usually do most of the at-home work.

Best wishes to you and your partner.
posted by elmay at 1:55 PM on January 3, 2023 [2 favorites]

After surgery for a torn meniscus that left my knee joint bone on bone, exacerbating existing arthritis, I had a total knee replacement at the age of 51. I work in the New Zealand health system (which I understand is similar to Canada’s) and was able to tap into great advice from my clinical colleagues. Here is what I learnt from my journey:

- An MRI provided a clear diagnosis - if she doesn’t already, your partner needs to know what she’s dealing with.
- Decisions for surgical treatment are typically based on Quality of Life scores. As your partner knows, severe knee pain impacts on activities of daily living and QOL. For example, how is her sleep? My knee would ache at night, limiting my sleep, which made life that bit harder.
- If your partner isn’t exercising, it’s likely her muscles will be deconditioning, which won’t be helping. Strong muscles help hold things in place and reduce the pain of arthritis.
- Non-weight bearing exercise made a huge difference to both body and spirit.
- I bought a recumbent exercycle. It’s big and takes up more room in our lounge than I’d like, but I use it almost every day. A recumbent is so much more comfortable than a standard exercycle. Hand on heart, I know I wouldn’t have been anywhere near as disciplined on a standard bike. Mine has a built in fan, which adds to the comfort level.
- Water walking/jogging is brilliant too. I especially love exercising in a very deep pool (where I can’t touch the bottom) with a floatation belt, as this makes it 100% non-weight bearing. Once my leg muscles grew stronger, I added ankle fins to increase resistance.
- Seeing a musculoskeletal physio who specialised in joints - and loved working with knees - was a game changer. Our brains will do incredible things to avoid pain, including switching muscles off. This means other muscles and joints end up working harder to try to compensate. My PT helped reactivate these muscles, lined things up correctly (and showed me how to too), gave me exercises, and recommended the right type of brace for my needs. She kept my orthopaedic surgeon informed about my treatment and this also played a part in his decision to go ahead with the knee replacement.
- Yes, losing weight makes a difference - even a small amount can help.
- My GP recommended supplements like turmeric and fish oil, and there are foods that help and hinder arthritis, so that’s worth looking into.

I hope this information helps. Wishing your partner all the best.
posted by MissyMonster at 2:23 PM on January 3, 2023 [4 favorites]

I know someone who got a lot of relief from these pants. Having said that, I think the concerns stated above regarding deconditioning muscles are valid.
posted by kate4914 at 3:50 PM on January 3, 2023 [1 favorite]

I am a health researcher working in orthopaedic surgery ie we do a lot of research on hip and knee replacements. 98% of people who have a knee replacement have it due to osteoarthritis (OA), which is an inflammatory, degenerative condition. Most of us develop OA as we age. For this reason, an MRI is likely unnecessary and overdiagnosis as it will most likely just show that your partner has OA and age-related degeneration of the joint.

An anti-inflammatory or Mediterranean diet has been shown to improve symptoms of OA. This is a diet with lots of whole grains, fruits and vegetables, beans & legumes, nuts and seeds, some fish, and light on processed foods, meat, dairy. Turmeric supplement - meh. No supplement will overcome a diet that is pro-inflammatory.

The worse your QoL scores are going in to a knee replacement, the better you do afterward. So if a person were to have a 'pre-emptive' knee replacement with the idea that the knee would need to be replaced at some point so why not do it now - even though the condition of the knee is not yet that bad - and get a jump on things...this would not necessarily lead to a good result. It sounds like your partner's situation has changed - possibly enough to warrant considering surgery. If you are in Canada, partner will likely be on a waitlist for a year or so, so it can't hurt to get the process started.

Most of the injections and etc are not evidence-based (or there is evidence that they don't really work) but are big money-makers for providers. Personally it's not a route I would pursue.

+++ to all the recommendations for physio above.

If you can find an Oxford Knee Score questionnaire for your partner to take online, marked as 0 (worst pain, poor to no function) to 48 (perfect function, no pain), people typically have a score of 15-18 going in, and end up with a score over 40 after knee replacement. [nb: some scales use a lowest score=12 and highest=60, in which case baseline score would be around 27-30]. That can give you an idea if she is in the ballpark where surgery would make sense.

Edited to add: IANAD, TINMA.
posted by lulu68 at 7:26 PM on January 3, 2023 [2 favorites]

Late fifties with knee arthritis here. I found that my pain levels were cut roughly in half after I started boron supplementation. It's a low-risk, low-cost intervention, and I started feeling the difference within a couple of weeks.
posted by timeo danaos at 5:38 AM on January 4, 2023 [1 favorite]

I was just visiting a friend last night who is recovering from knee replacement surgery, Just got the staples removed So about 2 weeks post surgery.
He's had the other knee done earlier this year.
Have a another friend who is still recovering from hip replacement. Still doing physio and has a nurse in every every couple of days. He's had a previous knee replacement as well.

I suppose it was easier to get the surgeries booked just before Christmas, as most would avoid surgery during that time. This is in Canada.

I know a couple of other people who have had the surgery as well
They all say I wish I had done it earlier.

The one friend has home visits from nurses and physio to help with recovery.
Both are looking forward to resume normal activity this summer.
(They want to go golfing lol)
They've been through it before and couldn't wait for the second surgery.
It just improves their quality of life.
posted by yyz at 7:56 AM on January 4, 2023 [1 favorite]

Response by poster: I will leave this up for the day, but just expressing appreciation for the responses. A combination of new information and stuff that reinforces stuff we kind of or really do know, it's all tremendously helpful. And the well wishes, a heartfelt thanks for that. She's a fighter, I think the extended pain is really getting to her but I think 2023 she will rally and meet this head on.
posted by elkevelvet at 9:32 AM on January 4, 2023 [1 favorite]