When knee problems occur, many people don’t know what to do. Some people think exercise is good, others think rest and recuperation is necessary. There are many different opinions and opinions. In fact, there are many misconceptions about how to exercise for osteoarthritis of the knee.
Myth 1: Exercise accelerates the aging of the knee joint
The knee joint exists to help people walk and move. Reasonable exercise can increase the strength of the leg muscles and the elasticity of the ligaments, effectively reducing the incidence of knee arthritis in the elderly and reducing pain.
Older adults with knee problems should avoid strenuous exercise and weight-bearing activities and instead choose exercises that are less damaging to the knee joint. Such as swimming, cycling and jogging. Jogging can enhance the elasticity of joint ligaments and the coordination of joint movements. But the elderly can not run too fast, not too strong. It is best to let the front part of the foot hit the ground first when running, so as to cushion the vibration of the leg and prevent knee injury. In addition, the elderly should try to avoid squatting, especially weighted squats. If you must squat, do it slowly and try to use your hands for support.
Myth 2: A lot of exercise can “wear out” bone spurs
In order to maintain the flexibility of the spine, knee and ankle joints, and to reduce the interference of bone spurs with the surrounding soft tissues, it is necessary to engage in appropriate physical activity. In addition, exercise allows the soft tissues around the bone spur to adapt to the local stimulation of the spur as soon as possible, thus reducing discomfort and pain in the body. However, it is not possible to “wear out” the spur; on the contrary, excessive exercise can aggravate the damage to the knee joint.
Myth #3: Climbing mountains to exercise the knee joint
Many older people have the habit of climbing. Although climbing is a good exercise to refine cardiorespiratory function and reduce fat, but it is not conducive to protecting the knee joint. When climbing, the knee joint bears its own weight, and when going downhill, in addition to its own weight, the knee joint has to bear the force of the downward stroke, increasing the wear and tear on the knee joint. It is recommended that older people walk up the mountain, wear knee pads and use hiking poles, and take the cable car on the way down.
Myth #4: Tai Chi is good for your body and joints
Taijiquan does play a big role in national health care, giving some older people something to do every day and exercising their bodies. However, it is not suitable for people with osteoarthrosis of the knee joint, because the knee joint has degenerated, and if you squat too low when playing Taijiquan, it will increase the weight and wear of the knee joint, and in serious cases, there will be damage during the squatting process. Therefore, people with osteoarthritis of the knee playing taijiquan, do not squat too low, there are difficult movements do not pursue must do.
Patients with osteoarthritis of the knee should choose the right type of exercise and avoid excessive exercise intensity. If there is difficulty in conversing with bystanders during exercise, it suggests that the amount of exercise is too much. Each exercise can be done in about 30 minutes, with breaks in between, no less than 3 to 4 times a week, and you must do warm-up before exercise and relaxation after exercise.
Knee osteoarthritis exercise must be less weight-bearing
Early knee pain is usually painful when going up and down stairs, or when standing up after sitting for a long time, are obvious pain when bearing weight on the knee joint, because weight bearing will increase the friction of the knee joint. Therefore, patients with osteoarthritis of the knee should perform functional exercises without or with less weight bearing.
Straight leg raise
Patients with osteoarthritis of the knee can straighten their legs while sitting with their heels on the ground, so that the legs are not bearing weight, and then hook their feet upward, to feel the quadriceps above the thighs tighten. This type of exercise is mainly to strengthen the quadriceps and reduce the pressure and wear on the knee joint during exercise. Most patients in the early stages have a more severe lateral patellar lesion because the lateral patellar ligaments are generally tighter than the medial ones, which yanks the patella outward during activity and wears the lateral side more severely. The strength of the quadriceps muscles can resist the strength of the lateral patellar ligament through straight leg lifts, keeping the patella in a normal position and reducing joint pain when going up and down stairs.
Squatting exercises
Squatting exercises are mainly for patients with early patellar cartilage injury, which allows the patella to adapt to the pressure of bending, and also increases the strength of the quadriceps muscle to maintain the patella in a normal trajectory. The specific practice is to squat with your back against the wall, so that the center of gravity backward to reduce the weight of the knee joint; do not squat too deep, bending the knee about 30 degrees is the best, the maximum do not exceed 45 degrees, squatting angle will increase the weight of the knee joint; two feet together or apart is okay. Do not squat for too long, a squat 15 minutes ~ 20 minutes, a day on the practice of each morning and afternoon. The elderly should pay attention to the gradual process when performing static squatting exercises, slowly adapt to the wall.
To the knee joint “injection” are to pay attention to what
When it comes to injections, no one is a stranger to them. Many patients often do not take injections seriously, thinking that it is just an injection into the knee joint, which does not sound complicated and can be done at any clinic, but is this really right? What exactly is the importance of “injecting” the knee joint, and what should I pay attention to after the injection?
Professor Cao Yongping of the Department of Orthopaedics at Peking University First Hospital says that a course of sodium vitaminate injections requires 3-5 injections, usually once a week. After two or three injections can work, the effect can be maintained for two or three months, but some patients are not obvious after the injection because of the heavy condition or the condition is too mild.
Since the injection of sodium vitreous acid has to be given continuously for 3~5 injections, coupled with the large number of patients in large hospitals, many patients are reluctant to always go to the hospital for injection and return to the small clinics near their homes for injection after one injection in the hospital, which is not recommended. Prof. Cao Yongping explained that although the knee joint cavity is large and it may seem easy to inject drugs into it, it is not. The knee joint is made up of many structures and it is important to not only accurately inject the medication into the joint cavity, but also to avoid other tissues. A common injection site is from the lateral aspect of the suprapatellar capsule (pictured). General clinics and even community hospitals cannot guarantee that the drug will be injected into the joint cavity, which often results in the following consequences: first, the drug is wasted and suffers for nothing; second, it is easy to hit the soft tissues, and the molecular weight of sodium vitrate is very large, which will cause swelling and pain in the soft tissues and is difficult to absorb; third, if the sterilization is not qualified, it is easy to cause infection. So try to inject in a large hospital and have a start and finish.
For patients with effective sodium vitreous acid injection, one course of injection in a year is enough, if the number of injections is too many it is easy to increase the risk of joint infection. For patients who are not effective after the injection, there is no need to inject again. Be careful to avoid bathing on the same day after each injection, because after all, there are needle holes that may be infected.
Prof. Yongping Cao reminds patients that if slight redness or swelling occurs after the injection of sodium vitrate, it may be caused by the drug stimulating the synovial membrane to secrete joint fluid. If the pain is not serious, you can apply cold compresses appropriately and avoid joint activities; if there is severe swelling and pain, you should seek medical attention as soon as possible to avoid drug injection to other parts of the body.
Knee replacement is the best choice for “last resort”
The most typical manifestation of osteoarthritis of the knee is swelling and pain in the knee joint, especially when waking up in the morning, going up and down stairs, and when bearing weight. If the pain is still unbearable after trying medications, arthroscopy, etc., or if there is a severe O-leg, which makes walking difficult and seriously affects daily life, patients may choose to have knee replacement surgery as a “last resort. However, these older people often have many concerns about this surgery and are unable to make the “hard decision” to have the surgery.
Concern 1: There is no need to spend money when you are old and have bad legs
Many seniors think that people will have knee pain when they get old, so it is not a disease and there is no need to spend money on surgery. In the days when technology was not developed and medicine was not developed, there was some truth to this statement, or so it seemed. But today, with the advent of medicine, the elderly are not only seeking to live longer, but also to live a quality life. When we get old and lose our teeth, we get dentures in order to eat better; similarly, when our joints are bad, we can get a “prosthetic” joint.
In addition to pain, osteoarthritis of the knee in the elderly often brings other problems. For example, some patients have trouble getting up from squatting in the toilet. This inconvenience in life often leads to falls and even head trauma, bleeding, fractures, etc. In addition, the severe pain and deformation of the knee joints lead to mobility problems, which may lead to uncontrolled or further aggravation of medical diseases that previously required exercise regulation, such as diabetes and coronary heart disease.
Therefore, although all knee joints will hurt as we age, we should go to a regular medical institution and let the doctor determine how bad the joint has become, and if joint replacement surgery is really necessary to improve the disease and quality of life. Then, we can choose to replace the artificial joint just like we choose to replace our dentures.
Concern #2: An artificial joint is a prosthetic leg after all, not as good as your own leg
Nowadays, knee replacement technology is very mature and patients are able to resume normal activities after surgery, such as daily walking and cycling, common household chores, sexual needs, and many are even able to resume some low-intensity physical exercise.
The reason for this concern is that many patients think that knee replacement surgery means replacing the entire joint with a prosthetic one. In fact, the full name of a knee replacement is called a total knee surface replacement. Like a nail palm, the surgeon simply removes the worn cartilage and some of the subchondral bone from the surface of the joint, puts a metal “face” on it, and then puts a polyethylene plastic spacer in the middle. The joint is still your joint, not damaging your own nerves or affecting your sensation, but the friction surface is replaced with metal and plastic.
With today’s medical care, patients are generally able to get off the floor and live basically on their own 2-3 days after knee replacement. within 4-6 weeks they are walking with a walker. Often, when walking to the outpatient clinic for a review at 2-3 months, it is not obvious that the person has had surgery. So after the artificial knee replacement, your leg will still be your leg, but it will be a “painless, freely moving” leg.
Concern 3: People who have had the surgery say that it is particularly painful because they have to saw the bones.
There is a concept of “pain-free wards” in knee replacement surgery, just like “pain-free childbirth”, to avoid excessive pain and unpleasant experiences before, during and after the surgery. Thanks to improvements in pain medication and anesthesia, current artificial knee replacements are completely painless to the patient during surgery. The knee gradually regains local sensation after surgery, but the patient does not feel excessive pain due to the use of PCA analgesia (a pain pump controlled by the patient), nerve block anesthesia (which simply makes the leg undergoing surgery painless without affecting its movement), and various pain medications.
It is true that there is a certain amount of pain after joint replacement surgery, and this pain occurs mainly during the functional rehabilitation after surgery. This pain is acceptable to the patient and is necessary for recovery. However, the joint surgery ward nowadays is far from the imaginary scene that patients have to endure like Guan Gong scraping the bones. Under the guidance of the “pain-free ward”, “multimodal analgesia” and more advanced rehabilitation concepts, patients can easily go through the surgery and complete post-operative training. As the rehabilitation process progresses, patients will eventually achieve a completely pain-free, freely moving knee.
Concern 4: I’m too old and have too many medical problems, so the risk of surgery is too high
Doctors who perform joint replacements often joke that they are half geriatricians, because most joint replacements are performed on older people, and most have a variety of medical conditions combined. Joint replacement is generally not a high-risk procedure, and experienced surgeons often end the battle within an hour, so it is not too disruptive to the patient. Older adults with medical conditions can bring their various test results and labs to the clinic and consult with the surgeon if the risk of surgery is assessed to be acceptable. If the risk of surgery is assessed to be too high, then other treatment options with lower risk can be chosen, or they can wait for further control of the medical disease before undergoing surgery under the treatment of an internal medicine doctor.
Concern 5: You can’t do MRI after replacing the artificial joint, you can’t fly; the artificial joint will wear out in a few years
The mainstream artificial knee joint is mainly made of cobalt-chromium-molybdenum alloy with a metal surface and a spacer made of polymer polyethylene. Although it is also metal, it is a non-magnetic metal. In other words, if you have an artificial joint, you can go to the MRI and fly on a plane without worrying, and it will not alarm you when you go through security.
Regarding the life of the artificial joint, most scholars believe that if the surgical technique is appropriate and the patient uses it normally, it can last at least 20 years. However, no one can tell you exactly how many years it will last because it depends on many factors. However, there is absolutely no evidence to support the idea that “sparing” the use of an artificial joint after it has been done will extend the life of the joint.
Concern #6: Artificial joints have a life span and the later you have them, the better
It is important to understand that due to advances in prosthetic design and material science, most modern artificial knee joints have a life expectancy that can meet the needs of older adults (>60 years of age). So while the artificial joint has a certain lifespan, the later the procedure is done, the better.
First of all, osteoarthritis of the knee is a continuous progression, and the pursuit of “late” surgery may lead to further aggravation of the osteoarthritis of the knee, more bone fragments, more severe deformities, and more severe soft tissue contractures. This makes surgery more difficult, and post-operative rehabilitation takes longer and is more difficult. There are even times when osteoarthritis is so severe that there is loss of ligament function or large bone defects, and the surgeon must use very expensive artificial joints to perform the surgery, and at this time both the surgical results and the patient’s self-satisfaction are not as good as when the disease is not so severe, and the surgery time, risk, and cost are also much higher than conventional surgery.
Secondly, as the elderly age, their body functions and tolerance to surgery are getting worse. Therefore, if you pursue surgery “late”, you may miss the best time for surgery. Therefore, it is possible to miss the best time for surgery, or to let a surgery that is not very risky become more risky due to some geriatric comorbidities that may occur if the surgery is delayed too long. Therefore, the timing of surgery should be determined by the extent of the patient’s disease and physical condition, not just the later the better.
The price of knee replacement depends mainly on the number of replacement sites and the material of the replacement prosthesis. Total knee replacement is relatively expensive; if you choose a domestic prosthesis, the cost is about $10,000 and the full cost of the surgery is about $13,000 to $14,000; an imported prosthesis is $30,000. The main difference between the two is the degree of wear resistance of the plastic pad in the middle of the prosthesis, the imported prosthesis uses polymer materials, good wear resistance, the current domestic prosthesis is also improving, in general, the domestic prosthesis can also be used for more than 20 years.