Posted on: Saturday, July 31, 2004
PRESCRIPTIONS
Walking or cycling may help arthritic knee
By Dr. Landis Lum
Q. Is walking good or bad for my knee pain? What about surgery?
A. The May issue of the journal Arthritis & Rheumatism studied 316 older adults who on average weighed 202 pounds and were randomized into groups of people who lost only 10 to 11 pounds of weight, through either dieting or dieting plus exercise.
All had degenerative knee arthritis (osteoarthritis) apparent on X-ray. Those losing weight through dieting alone were not better 18 months later, while those losing weight through diet plus exercise not only had less knee pain but could walk longer distances faster. The exercise was three days a week of walking 15 minutes, then 15 minutes of resistance training such as repeated leg extensions and heel raises using cuff weights, then a final 15-minute walk. Stationary cycling and pool exercises can also improve knee pain.
So what's happening? The walking or cycling muscles that surround the knee help strengthen it — strengthening these muscles also helps with impact protection of the cartilage that coats the surface of the knee bones. Cartilage is actually alive, and "old" joint fluid is repetitively squeezed out of cartilage with walking or cycling, allowing fresh nutrients and oxygen to flow in. Too much exercise, however, can erode the cartilage. So listen to the wisdom of your body — reduce or stop exercise if you get undue knee pain or swelling.
Anti-inflammatories such as Motrin help but can cause bleeding ulcers if taken chronically. Acetaminophen (Tylenol) is safer, and doses up to 1,000 mg (with a full glass of water) four times a day may be needed for pain relief, but if you drink alcohol or beer regularly or have liver disease, then it can cause liver damage.
Capsaicin cream and glucosamine may be worth a try but may take two months to work. Drugs injected into the knee may give a few months of pain relief. However, if you continue to suffer bothersome knee pain, talk to your doctor about knee replacement surgery, which per a recent National Institutes of Health statement is a safe and very successful treatment, resulting in rapid and substantial improvement in pain and quality of life in 90 percent of patients; 85 percent of patients are satisfied with the results of surgery.
However, only one in 10 people who qualify for this surgery actually do it; the rest have reasons such as "I don't think I'm bad enough — I can go down stairs without going one at a time, but I can't come up" or "it hurts like heck, but then I'm fine for a couple of weeks."
Yes, any surgery has its risks, but don't lose the chance to live your remaining years in less misery and more independence.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
