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Managing Your Arthritic Knee
Mild to moderate arthritis of the knee can often be managed without surgery.
Patients frequently ask “What can I do to minimize the pain and prolong the life of
my knee?” Here are some suggestions that have stood the test of time and have
For patients who are carrying extra weight, pain can often be managed with
losing a few extra kilos. Your knee is a transmission system for the smooth
transfer of energy. Like the transmission in your car, the less load placed on
your knee, the longer it wil last. For many patients with arthritis exercise can be
Non-Steroidal Anti-inflammatory Drugs.
Many patients wil already e familiar with the likes of Naprosyn, Voltaren,
Ibuprofen etc. The newer “COX2 inhibitors like Vioxx, Celebrex, Mobic and
Bextra were developed to lessen the unpleasant gut/ stomach side effects of the
Many patients do not like the idea of taking tablets every day for years on end.
Although there are few problems associated with this for most patients, others
choose to save the NSAID’s for days when they know they wil be more active
This is sold across the counter as “joint food” by chemists, health food shops and
supermarkets, often in combination with chondroitin sulphate. Careful y
control ed studies have shown that for some patients the pain-relieving effect is
similar to the NSAID’s. As this is a normal component of some foods there are
almost no side effects or long term problems associated with its use.
Glucosamine is a component of healthy cartilage and, although the mechanism
of action is unclear, most surgeons wil now advocate its use. Although it does
not reverse the arthritic process, it may prove to slow it down. The
Weight-bearing exercise that involves running or jarring is not encouraged.
Although running does not cause arthritis, it wil speed up the process in a
predisposed knee. Our genetic inheritance or previous injury are much more
important factors. It is as simple as wearing out the tires on your car: the more
miles you do, the sooner the tires wil wear through. It is difficult for a surgeon to
say “You must never run!” The final choice rests with the patient, as long as he
or she understands that an arthritic knee has a finite number of steps remaining
before being completely worn. It remains up to the individual to choose how and
Conversely, Non-weightbearing exercise can be beneficial. Swimming is ideal as
there is almost no load on the knee. To lessen the load even more it is possible
to swim with a “pul buoy”. This is a smal flotation device designed to rest
between the thighs, keeping the legs afloat without needing to kick. Most
patients do not have a problem with gentle kicking though.
Cycling is perhaps the best exercise of al . There are almost no “shear” forces
on the knee during the pedal stroke. Most people have access to a bicycle or an
exercycle. The biggest problem is that poor technique can actual y make the
knees hurt more. Here are a few suggestions
Bike Fit. A bicycle comes in multiple sizes and needs to fit the rider like a shoe
must comfortably fit our foot. Start with a reputable bike shop to be “sized” The
frame must be the right size as wel as the handlebar stem, seat post and cranks.
Seat Height. Many people ride with the seat too low. This wil place extra strain
on your kneecaps and quite possibly make you pain worse. The easiest way to
get it right is to sit square on the saddle and place the pedal at the very bottom of
the pedal stroke. You should just be able to “tip” the pedal with the heel of your
ful y-extended leg. You should then pedal with your FOREFOOT on the pedal.
The joint at the base of your big toe (the bump of a bunion) should line up with
Cadence. Most novice cyclists pedal with a very slow cadence (the number of
times per minute the pedal goes in a ful circle) of around 50 revolutions per
minute. This also puts a huge strain on the knee. It is much better to select an
easy gear with almost no resistance and spin your legs around at around 80 rpm.
Professional cyclists choose a cadence of around 90-100rpm! This feels strange
at first but wil quickly become second nature.
Road cycling verses the exercycle. It makes no difference whether you choose
to ride on the road, trails or in your living room on an exercycle. One of the
problems with the exercycle is boredom. It helps to distract yourself by watching
TV or a video, listen to music or read a book. If exercise is unpleasant or boring
it wil soon disappear from your schedule.
Intensity. The saying “no pain, no gain” does not apply here. You should be able
to carry out a conversation while exercising. If you are so breathless that al you
can manage is “yes” or “no” then you are going too hard. After 10 minutes or so
you should notice a deep, steady comfortable breathing rhythm and perhaps a
How Long? Start with 10 minutes per session. Build up to 30-45 minutes.
Twenty minutes should be a minimum. If you become enthusiastic there is no
reason why you cannot ride for one, two or more hours. Many cyclists have
found that their arthritic knee copes comfortably with ten or fifteen hours of riding
per week over many years with no worsening of symptoms.
How Often? Try for a minimum of three times per week. If you enjoy the activity
there is no (medical) reason why you cannot ride every day. Often having a rest
day at least once per week can keep you mental y fresh.
C. Prestación Farmacéutica 14/1/05 16:24 Página 44ANEXO B. FÓRMULAS MAXISTRAIS E PREPARADOS OFICINAISLISTA DE PRINCIPIOS ACTIVOS PARA FORMULACIÓN MAXISTRAL Comentario ¤ /gramo ou enfermidades asociadas segundo a clasificación ICM-9 ou enfermidades asociadas segundo a clasificación ICM-9 activos en procesos patóloxicos que requiran fotoprotecciónC. Prestación Farmacéutica 14/1
Ted Westmeier, RS, MPH Donald Lawrenchuk, MD, MPH Director Pertussis Immunization Update In October 2010 the Advisory Council on 1. Pertussis Immunization Update Immunization Practices (ACIP) voted to broaden 3. Children’s Special Health Care recommendations for the use of Tdap based on the current increases in pertussis cases in the US. In January 2011, the following new Tdap guideli