Chronic knee, hip and low back pain are the most common types of pain limiting comfortable walking, therefore limiting quality of life and independence. Together with our modern sedentary lifestyle, the pain in these joints prevents people from pursuing an active, healthier way of life. Why do we get this type of pain, and what can be done about it if we don't want surgery?
Osteoarthritis, when the connecting soft tissue between two bones wears away, is the most common underlying culprit for these pains, followed by muscle, tendon, ligament (sprains) and nerve disorders (such as a "pinched nerve"). There are several non-surgical ways to reduce the pain and improve function from these debilitating musculoskeletal disorders. These include:
-- Lifestyle changes: Weight loss, education to modify risky sports/leisure activities and balanced diet/nutritional support
-- Muscular stimulation: Physical therapy for therapeutic exercise and modalities (such as electrical stimulation on skin and ultrasound)
-- Assistive devices: Shoe inserts, such as orthotics to shift how weight is distributed on the foot, knee braces for support while building back muscle, a cane to help with balance and a lumbar corset/brace to provide additional core support
-- Pain medications: Oral medications (acetaminophen, naproxen and ibuprofen) and topical medications for pain control, steroid injections to reduce inflammation or gel solutions called visco-supplementation (an injection into the knee of a substance similar to the fluid naturally occurring in the knee to help lubricate the joint)
-- Regenerative medicine: Injection with platelet rich plasma (a concentrated component of one's own blood), which can help your body heal
-- Biomechanical manipulation: Emerging new treatments like biomechanical manipulation using therapeutic shoes
[See: 11 Ways to Cope With Back Pain.]
Exercise Is Key
Exercise is the most integral part of any treatment to improve chronic knee, hip and back pain, whether you pursue surgical or non-surgical methods. There is no more effective way to improve muscle function (the engines needed to move the joints) than exercise, especially strengthening exercise. Improving neuromuscular function (fine-tuning and optimizing joint movement) has been increasingly recognized as an important factor to improve function in people with painful arthritis. Our role as physicians is to help you engage safely and comfortably in appropriate exercise, making it a part of a daily routine.
Emerging New Treatments
As rehabilitation and sports medicine specialists at Montefiore Health System in the Bronx, New York, we provide several emerging non-surgical options for the painful conditions described above. Recently, we have started an innovative physical therapy program using therapeutic shoes, called AposTherapy. This personalized home-based exercise program aims to optimize abnormal biomechanics (joint alignment and joint-loading patterns) of walking and neuromuscular function in order to improve pain and function. A home-based exercise program, rather than going to a series of physical therapy sessions for limited amounts of time, has the advantage of maximizing the benefit of exercise, since the benefits of exercise decrease once we stop doing it.
One Patient's Story
Jane, 50, suffers from low back and knee pain resulting from osteoarthritis. She used to be athletic and enjoyed being able to stay on her feet all day as a nurse. Since her pain has worsened, especially when walking, she has had to stop jogging. Her responsibility as a nurse became increasingly stressful. After she discussed her conditions with her orthopedic surgeon and us, she decided on non-surgical treatment.
During the initial evaluation, she was noted to have pain in the inner side of the knee with mild bow legging, a condition in which the legs curve out, leaving a gap between the knees. She also had dysfunctional -- in her case, too little -- movement of the sacroiliac joint in the lower back and buttock. Although traditional physical therapy is the mainstay of non-surgical treatment, her busy work and home life didn't easily lend itself to physical therapy sessions, which are typically two to three times a week. Her goal was to get back to jogging and her active lifestyle.
A computerized analysis showing how Jane walked provided the information we needed to appropriately calibrate therapeutic pods on the bottom of a special shoe to improve Jane's joint loading pattern on the knee -- redistributing pressure the knee takes from walking and retraining her neuromuscular function. After a few weeks on the therapy regimen, Jane's pain improved, her body is appropriately compensating for the orthopedic issues associated with her osteoarthritis and she is able to jog again, as well as enjoy her service to her patients.
There are a wide variety of non-surgical ways to improve painful conditions in the knee, hip and low back. The choice of treatment is based on the underlying cause of the pain, along with a person's lifestyle and preferences, to optimize the outcome. It's important to discuss these with your doctor to find out the best option for you. Regardless, exercise should be an integral part of the management.
Karen Morice, MD, specializes in physical rehabilitation and medicine and is an Assistant Professor of Physical Medicine and Rehabilitation at Montefiore Health System/ Albert Einstein College of Medicine . She is the Associate Program Director of the Sports Medicine Fellowship in the Department of Physical Medicine and Rehabilitation. She is a graduate of New York Medical College and received residency training at St. Vincent's Catholic Medical Center. She is board certified in physical medicine and rehabilitation and in sports medicine.