A PAIN IN THE KNEE

A PAIN IN THE KNEE

If you’re having knee pain, from arthritis or osteoarthritis or any other kind of itis, the faculty of the Harvard Medical School says there are many treatments short of surgical replacement.

Sure. We all know knee pain, like back pain, is a prime example of pain caused by TMS and one or more of our repressed emotions. I am not a doctor, but I believe those at the Harvard Medical School that surgery is often not necessary, if ever.

I’m 83 and until just a few years ago, I never heard of anyone with an aching knee or hip getting a replacement. I saw those that did walking with a limp before the surgery and walking with a limp afterward.

The Harvard medics say that if your knees have become painful, tender, or swollen, are stiff first thing in the morning, or are making crackling noises, the probable cause is osteoarthritis. It affects more than two-thirds of women over age 60.

Osteoarthritis results from the breakdown of joint cartilage. That’s the tough, slippery tissue that protects the ends of bones. Eventually, the cartilage may wear away completely, permitting bone to rub painfully against bone.

The medics say that the goals of osteoarthritis treatment are to reduce pain and stiffness, limit the progression of joint damage, and maintain and improve knee function and mobility.
They report that about five percent of women in the United States over age 50 have had total knee replacement surgery. They say it is the recommended treatment when more conservative measures have failed and pain and disability are intolerable.

The number of these procedures has more than doubled over the past decade, according to research presented at last year’s annual meeting of the American Academy of Orthopedic Surgeons. This is partly because – they say -- knee replacement works.

According to their statistics, more than 80 percent of patients say they're satisfied with the results. But experts say it's also a sign that people aren't fully utilizing the many noninvasive strategies that evidence suggests should be tried first. Above all, weight loss and exercise.

Weight loss: Lightening the load

The Harvard medics say that every step you take exposes your knee joints to a force equal to three to five times your body weight. If you have osteoarthritis, a weight gain or loss of just five pounds can cause a noticeable difference in the amount of pain you feel.

One study of overweight or obese older adults who had knee osteoarthritis found that for every pound of weight they lost, the stress on their knees was reduced fourfold.

Obesity not only puts added stress on the knees, it also spurs the production of inflammatory proteins that may hasten cartilage degeneration. Weight loss can help preserve cartilage and reduce symptoms.

"People don't appreciate the strong connection between obesity osteoarthritis,” says Dr. Patience White, vice president for public health at the Arthritis Foundation. “If you lose ten percent of your body weight, you can reduce pain by 50 percent," The Academy of Orthopedic Surgeons recommends that overweight or obese women with knee osteoarthritis reduce their body weight at least five percent.

Exercise: Motion as medicine

Lack of exercise makes you more likely to develop knee osteoarthritis; the pain of osteoarthritis makes you avoid exercise; and avoiding exercise makes the arthritis worse. The key to breaking this cycle is exercise.

"People may find it surprising that a painful condition can be improved more by exercise than rest. There's good data that effective measures such as exercise are being underused," says Dr. Jeffrey Katz, professor of medicine and orthopedic surgery at Harvard Medical School and a rheumatologist at Boston's Brigham and Women's Hospital.

Steve Ozanich, author of The Great Pain Deception, knows the value of exercise. He was in extreme back pain for years, until he applied Dr. John Sarno’s principle that TMS caused his pain. When Steve didn’t think he could get out of bed, he got up and played golf. Sure, he hurt, but after a while, the more he exercised, the less pain he had until it finally went away.

Regular light to moderate exercise (during which you sweat lightly but can talk easily) can slow the arthritis disease process and reduce your pain. The exercise should be individually tailored to prevent injury, the Harvard medics say. So start with an evaluation by a clinician or physical therapist experienced in managing osteoarthritis.

A program to improve knee osteoarthritis may include the following:

Low-impact aerobic exercise. Swim, cycle, walk, or use an elliptical trainer (a machine that simulates walking or stair-climbing without stressing the joints) and gradually increase the time you spend doing it. Also, try to add more activity in your daily tasks—for example, park farther from your destination and walk, or use stairs instead of the elevator.

Quadriceps strengthening. Strengthening the thigh muscles will help protect the knee and improve pain, stiffness, and balance. (For exercises that work the quadriceps, see "Knee-strengthening exercises") If your joints are poorly aligned or the ligaments are overstretched, consult a physical therapist for safe strengthening exercises.

Flexibility. Muscle stiffness can limit knee-joint movement and lead to further pain. Stretching and range-of-motion exercises may help.

Balance. Knee osteoarthritis can interfere with balance by impairing the capacity of receptors in your joints to detect the position of your body in space. You can improve your balance with strengthening exercises as well as specific balance exercises and activities such as tai chi.

For help in starting and maintaining an exercise program, the Harvard medics suggest contact your local Arthritis Foundation about their self-help program. Their web site is www.arthritis.org/programs. (www.arthritis.org/programs. The foundation also has a book based on the program.
Reduce pain with medications

Medications can't change the course of osteoarthritis, the Harvard medics tell us, but they can help ease pain and make it possible for you to exercise.

The Academy of Orthopedic Surgeons suggests using the following medications to control symptoms: acetaminophen (Tylenol), no more than 4 grams per day; nonsteroidal anti-inflammatory drugs (NSAIDs) combined or taken with agents to protect the stomach lining (NSAIDs should also be taken with food); cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex); or topical NSAIDs, such as diclofenac sodium (Voltaren Gel). These recommendations are designed to reduce the risk of gastrointestinal bleeding. Some guidelines also endorse the use of topical capsaicin, a pain-relieving substance found in chili peppers.

If you can't tolerate oral medications or need greater pain relief, your clinician may suggest a corticosteroid injection to reduce inflammation and improve joint function. The effects of a single corticosteroid injection may last for several weeks. (To avoid tissue weakening, corticosteroid injections are given no more often than once every three to four months.)

Another approach is viscosupplementation—injections of hyaluronic acid, a substance found in joint fluid, to provide added lubrication and cushioning in the knee joint. Several formulations of hyaluronic acid are available, approved by the FDA as medical devices rather than drugs. It's unclear how effective these products are in relieving pain or improving function; the AAOS is still reviewing the evidence.

Supportive aids

Depending on the location and severity of your osteoarthritis, you may walk more easily with mechanical support.

There's some evidence that therapeutic knee taping—the application of tape to better align the knee—can help relieve pain. It's not entirely clear how taping brings about pain relief, but it's thought that improved alignment reduces stress on surrounding soft tissues and may help in activating and strengthening the quadriceps muscles. A physical therapist can tape your knee and teach you how to do it yourself.

Although the AAOS endorses the use of tape, it does not recommend for or against the use of knee braces, because research on their effectiveness is limited. Some braces shift the load away from an affected part of the knee, while others support the entire knee. Wedges inserted into the shoes also change the forces acting on the knee, but randomized trials have not shown that this reduces pain or improves function.

Although canes have been used for thousands of years, the first controlled trial of canes for knee osteoarthritis was published just this year. In the two-month trial, cane users, compared with those not using canes, had less pain and better knee function and could walk significantly farther in six minutes. During the first month of the study, walking required more energy for cane users, but they soon adapted to the device. (Canes must be fitted properly and used correctly. To learn more, go to www.health.harvard.edu/womenextra.)

Alternative therapies

Certain alternative treatments may have benefits even though the medics say evidence has not been sufficient for their inclusion in professional guidelines. "A treatment might help you, even if it didn't help enough of the people in the studies that were reviewed," says Dr. White.

Your physician isn't likely to object if you want to give these a try:

Acupuncture. Trials comparing acupuncture with a sham procedure usually find only small short-term reductions in pain, although some individuals get a better response. Over several months, acupuncture plus exercise hasn't been found more effective than exercise alone.
I had acupuncture for my dog when it was twelve and had arthritis. It gave him three more years of active life.

Glucosamine and chondroitin. These popular supplements contain naturally occurring components of cartilage. Despite many studies, it's still not clear whether they can improve pain and knee function. Any benefit may take weeks or months. Dr. Katz suggests that you track your pain levels and function (such as walking ability) and discontinue the supplements after six months if they haven't helped.

I’ve been taking these two supplements daily for years and am not sure they’ve kept me from having knee pain. I may have avoided that just by walking my dog once or twice a day.
Glucosamine and chondroitin are unlikely to do you any harm, the Harvard medics say, but beware of miracle "cures" and other therapies with little or no supporting evidence. Stick with unbiased information sources, such as the Arthritis Foundation and the American Academy of Orthopedic Surgeons.

Surgical approaches

If osteoarthritis is severe and noninvasive therapies fail, several surgical options are available. When only one area of the knee joint is affected, a surgeon can perform an osteotomy. (No, not a head lobotomy!) An osteotomy involves cutting and realigning the bones to take pressure off the most arthritic parts of the joint.

Partial knee replacement is another way to treat osteoarthritis in just one part of the knee. The surgeon removes the damaged cartilage and covers the affected areas with metal or plastic parts. Bone and ligaments are left intact in healthy areas of the knee.

In total knee replacement, the surgeon cuts away the damaged cartilage. Then also a small amount of underlying bone on the lower end of the femur (thighbone) and the top of the tibia (shin bone). Metal replacement parts are then attached, separated by a plastic spacer so that the new joint can glide freely.

Even if you eventually opt for knee replacement, the effort you've spent on exercise and losing weight will not be wasted. Preoperative exercise can shorten your hospital stay, and postoperative rehabilitation and weight loss can help reduce the burden on your new or repaired knee joint.

Regular contact with a health professional will help you make the most of self-management strategies, medications, and other means of slowing the course of knee osteoarthritis and maintaining the best possible quality of life. That professional is usually your primary care provider, but it can also be a rheumatologist, a specialist in physical medicine and rehabilitation, or an orthopedic surgeon.

But no one at the Harvard School of Medicine or the Academy of Orthopedic Surgeons suggested that knee pain can be treated psychologically. Something in our past may be causing the pain. An experience as far back as our childhood may be the culprit, deeply hidden in our unconscious mind. A more recent event of a similar nature may have triggered the past memory, bringing it to the surface, and that is what is causing the knee pain.

Giving TMS a chance to heal knee pain ought to be a top consideration before taking any medication or considering surgery. It’s not hard to do, and it’s free. You don’t even have to drive to a doctor’s office to try it. You can do it at home, in just half an hour a day or less.

Dr. Sarno’s 12 Daily Reminders, in his book Healing Back Pain, tell how to heal your knee, back, or other pain through believing in and practicing TMS. They are:

1.The pain is due to TMS,not to a structural abnormality

2.The direct reason for the pain is mild oxygen deprivation

3. TMS is a harmless condition caused by my repressed emotions

4.The principal emotion is my repressed ANGER

5. TMS exists only to distract my attentions from the emotions

6. Since my back is basically normal there is nothing to fear

7.Therefore,physical activity is not dangerous

8. And I MUST resume all normal physical activity

9. I will not be concerned or intimidated by the pain

10. I will shift my attention from pain to the emotional issues

11. I intend to be in control-NOT my subconscious mind

12. I must think Psychological at all times, NOT physical.

 

My mom (75) is having some knee issues and considering knee replacement surgery. She isn't willing to consider TMS or even do anything alternative like Feldenkrais. I was just trying to learn: how can knee pain be TMS if someone really lost all the cartilage in their knee? Wouldn't that be pain from an organic cause? Or does this not necessarily cause pain (like spinal abnormalities)? But you mentioned bone-on-bone rubbing being painful, so I'm just wondering how a person in this situation shouldn't be considering surgery? Thanks so much for any insight.

 

I suggest you consult a free TMS therapist for advice on whether your mother should get knee surgery.

http://www.tmswiki.org/forum/forms/ask-a-tms-therapist.1/respond

 

Thanks Walt. Will do.