Our Top 5 Treatments for Knee OA

Whether it be mild, moderate or severe knee osteoarthritis, here are our top 5 treatments. If you can incorporate these into your regimen, then you undoubtedly will see the benefits of less pain, better function and greater longevity for your knees.

1) Weight Loss: for every 1 pound a person is overweight, an extra 4 pounds of force are going through the knees. So, lose 10 pounds, and you have 40 pounds of less force on those knees. Lose 25 lbs, and 100 fewer lbs. of force! A recent study indicated that when those with knee OA lost 10% of their weight, their pain decreased by 50%

2) Healthy Eating with an Anti-Inflammatory Diet: healthy eating doesn’t always result in weight loss, but choosing the right foods often results in less inflammation in our body. This means less pain and a better environment for the joints. Choose fresh foods over processed ones. Reach for the fresh foods in the refrigerator more than packaged food in the pantry. Eat at home more and go out to restaurants infrequently. Fruits, vegetables, whole grains and lean meats should be the staples of your diet. Alcohol in moderation. Red meat, fried foods and processed food only on occasion and when necessary. Sodas rarely and watch out for artificial sweeteners.

3) Injections: these are often a faster path to relief for most patients. Platelet-rich plasma (PRP) injections utilizing your own blood and concentrated growth factors are the star of this category. Long-term benefits are most common with PRP. Hyaluronic acid injections (brand names: Orthovisc, Trivisc, Gelsyn, Euflexxa, etc.) are good options for many. At times, we combine the PRP and hyaluronic acid injections to boost the benefits. Steroid injections are the final option and can have great utility when a patient needs to feel better quickly such as during a flare or before a big trip.

4) Exercise/Physical Therapy: choose exercise you like, you will stick to, a variety and types that do not cause pain in your knee, both during and afterwards. Sometimes, it’s not just the type of exercise, but the intensity and duration. Find your “sweet spot,” meaning your knee might feel great if you walk a one mile but hurts if you go further. You can bike for 30 minutes, but beyond that causes swelling. So, stay below your pain threshold. Lower-impact options like biking, elliptical, rowing and swimming/aquatic exercises are often the best choices for most with knee OA. Physical therapy is often a good starting point to strengthen the muscles around the joints and to improve biomechanics, functional movement patterns and flexibility.

5) Supplements: our favorites are collagen, curcumin (the active ingredient of turmeric) and for more advanced knee OA, glucosamine and chondroitin. Others like fish oil may have benefits for the joints as well. The key here is choosing a high-quality brand and taking these on daily basis. Admittedly, they don’t help everyone, and you need to make sure that your physician knows you are taking these, especially if you are taking other medications and/or will soon have a medical procedure.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

What Does "Being Proactive Over Reactive" Mean?

Proactive Interventional Orthopedics (PIO)…a concept we will continue to promote. What does it mean in orthopedics to be proactive over reactive? Here are some examples and brief explanations:

Choose maintenance and more long-term injections over short-term steroid/cortisone injections: platelet-rich plasma (PRP) and hyaluronic acid injections often produce a more clinically significant and longer duration of benefit than steroid injections. For your knee and hip arthritis, tennis and golfer’s elbow and plantar fasciitis, just to name a few, choose these injections.

A course of physical therapy over exercises you simply found online: patient outcomes are generally better when you work with a physical therapist over Dr. Google or YouTube. We have fantastic relationships with physical therapists across Middle Tennessee and can work with you to find the best fit.

Regular use of supplements over prescription or over-the-counter medications: there’s a time and place for prescription meds when managing orthopedic conditions. However, for long-term management, we prefer options like curcumin/turmeric, collagen, and glucosamine/chondroitin. That being said, it’s always wise to consult with a physician before starting new supplements.

Don’t wait for your pain or disability to reach high levels before you seek treatment: orthopedic conditions treated early after the onset of symptoms and when pain and dysfunction are at a low level typically respond better to less-invasive treatments, and this early treatment can lower the risk of further damage to the joint or tissue.

Choose a specialist over a primary care physician for your orthopedics needs: PCPs work really hard and a do a great job to care for your overall health, but they do not necessarily have the expertise, the tools such as on-site imaging and advanced equipment or the time to dedicate to your orthopedic conditions.

Healthy eating patterns over a fad diet: weight loss is a vital part of the treatment plan when it comes to weight-bearing joint problems like hip and knee osteoarthritis. Through a variety of options, we can help you a structure a plan to gradually lose weight in a manner that the weight will stay off and through means that can be maintained for the long-term.

As always, let us know if we can help you overcome an injury, treat an orthopedic condition or find the pathway to greater wellness with an improved quality of life!

F. Clarke Holmes, M.D.

What Supplements Might Be Useful In Orthopedics?

Many people prefer to try a natural approach when it comes to preventing conditions or treating symptoms by taking various vitamins and supplements. There are many options for supplements and vitamins out there, but are they really effective? Unfortunately, there is little education or research on these products.

Remember, the FDA does not regulate supplements and vitamins. Talk to your healthcare provider before beginning any supplements or vitamins. If you are pregnant or breastfeeding, discuss supplements and vitamins with your provider.

Here are a few common vitamins and supplements we discuss with our patients in orthopedics.

Turmeric

Known for its anti-inflammatory properties, turmeric is a great tool to help combat full body inflammation. We recommend a turmeric supplement that contains extract instead of ground root powder, 95% curcuminoids, curcumin, and bioperine (black pepper) to help with absorption. Daily dose recommendation is 500mg-2,000mg. Turmeric can slow blood clotting and should be avoided in those who take blood thinners, have bleeding disorders, anemia, gallbladder conditions, or pregnant. Caution should be used in those who take diabetes medication, as turmeric may make the effects of these medications stronger and therefore may result in hypoglycemia. Note: cooking occasionally with turmeric does not provide the amount needed to reach anti-inflammatory effects.

Glucosamine

Glucosamine is thought to increase cartilage and fluid around joints and/or help prevent cartilage breakdown, therefore, decreasing pain and improving function. Research studies’ results have shown conflicting information. Taking this does not reduce your risk of getting osteoarthritis. The recommended dose is 1,500mg daily. Do not take this supplement if you take warfarin (coumadin) as it increases the effects of warfarin, elevating your risk of serious bruising or bleeding. Do not take this supplement if you have personal or family history of glaucoma, are on cancer treatments, or have allergies to shellfish. Take caution if you have diabetes, as glucosamine has been shown to increase blood sugar levels and decrease the effectiveness of diabetic medications. Also, take caution if you are pregnant and/or breastfeeding, have asthma, glaucoma, hyperlipidemia (high cholesterol/triglycerides), and hypertension.

Chondroitin

Usually taken in combination with glucosamine, chondroitin sulfate is one of the building blocks of cartilage. Used to help decrease osteoarthritis pain and improve function. Recommended daily dose is 800-1,200mg. Do not take if you have prostate cancer or are pregnant/breastfeeding. Take caution in those with asthma. There is an increased risk of bleeding if taken with warfarin.

Hyaluronic Acid (HA)

HA’s action in orthopedics is to lubricate the joints and maintain normal joint cushioning to provide more support, resulting in decreased pain and increased functioning. In osteoarthritis and as we age, this substance becomes naturally depleted due to wear and tear. It comes in many different forms, but injections are the most widely used and most effective in sports medicine and orthopedics. We like to tell our patients to think of HA injections like an oil change for your knee; the oil is the HA substance and, your joints are the car. HA oral supplements have not shown to be effective for musculoskeletal use.

Vitamin D

Most people do not receive enough daily vitamin D from food and sun alone. Vitamin D has many benefits. From an orthopedic standpoint, vitamin D modulates inflammation, prevents involuntary muscle spasms, and cramps, and enhances calcium absorption into the bone which helps with bone growth and bone remodeling. Vitamin D plays a key role in helping prevent osteopenia and osteoporosis (thin and brittle bones). The recommended dose is 600-800 international units (IUs) daily, yet supplementing with 1000-2000 IUs of D3 is safe for most patients. Some patients are found to have vitamin D deficiencies with a blood test and will require higher dosing often for at least a month. Foods high in vitamin D include salmon, sardines, tuna, egg yolks, mushrooms, cow’s milk, soy milk, yogurt, orange juice, cheese, fortified cereal, and oatmeal.

Calcium

Calcium helps build and protect bones. A low calcium intake can result in fractures, osteopenia, and osteoporosis. Most people get enough calcium in their normal diet. The daily recommended amount of calcium needed is dependent on age.

1-3 years old: 700mg

4-8 years old: 1,000mg

9-18 years old: 1,300mg

19-50 years: 1,000mg,

51 years to 70 years: males 1,000mg and females 1,200mg

71 years and older: 1,200mg.

Who needs a calcium supplement? Those who are vegans, lactose intolerance, consume large amounts of protein or sodium, on long term steroid treatment, those who have inflammatory bowel disease and celiac disease, and those who do get enough calcium in the foods they eat. Overall, it is better to get the calcium your body needs through food instead of a supplement. There are some studies that have linked calcium supplements to heart disease, colon polyps, kidney stones, and heart attacks. Foods high in calcium: almonds, oranges, dried figs, soybeans, garbanzo beans, white beans, pinto beans, milk, yogurt, dark leafy green vegetables.

Ashwagandha

Ashwagandha helps in reducing anxiety and stress. On the label you want to look for root extract, as this is more potent that ground root powder. KSM-66 ashwagandha root extract has been studied in many clinical trials with positive outcomes. Daily dose recommended is between 500-1,500mg.

Potential side effects include gastrointestinal upset or headache. It can potentially lower blood pressure, lower blood sugar, and affect thyroid hormones, and in rare cases, have a negative effect on the liver. Women who are pregnant or breastfeeding should not take this.

Taylor Moore, FNP-C

Impact Sports Medicine and Orthopedics