Arthritis of the knee is a very common condition and on of the most common causes of pain and disability around the world. Arthritis of the knee when not further specified, usually implies osteoarthritis rather than rheumatoid arthritis or other inflammatory joint conditions. Over the years many ideas with respect to arthritis of the knee have become accepted among the general public and even doctors. The general thinking is that arthritis of the knee is a normal process of aging and also due to excessive body weight. More importantly many people think that there is not much that can be done with respect to arthritis of the knee until the knee become so dysfunctional or painful that a total knee replacement is necessary.
This line of thinking cannot be further from the truth. There are two main problems with this very common approach. The first problem is that people are unnecessarily dealing with pain and disability. The second problem is that people tend to become less active because of their pain leading to a worsening of their arthritic condition and a general decline in fitness and health.
There are many non surgical and non drug treatments available for arthritis of the knee which can eliminate pain and increase function as well as prolong the life of the arthritic knee. The effective treatments for arthritis of the knee include comprehensive physiotherapy, custom made orthotics and insoles, glucosamine/chondroitin supplements, hyaluronic acid injections and osteoarthritis unloading knee braces.
Not all knees are the same and not all treatments will work for each knee. A detailed assessment of each patient is required to put together a plan of approach that will be successful. At the Toronto Centre for Sports Medicine, Dr. Jack Hakoun has been treating arthritis of the knee for 32 years and has incorporated all of the latest effective approaches to osteoarthritis of the knee. It is not uncommon for people to come into the Toronto Centre for Sports Medicine believing that they need a knee replacement and leave on the same day with an improved ability to walk and with much less pain. These people can often delay knee surgery for years or never have the need for surgery. Their pain is significantly reduced or eliminated and their functional activity and strength are improved. Less pain, improved function and improved health without surgery.
While everyone seems to be watching the Olympic athletes compete, some of us may think just how far from being an athlete we are. This could not be further from the truth. Although the Olympics and professional sports competitions get a lot of publicity the underlying notion in sports medicine is that an athlete is someone to tries their best. If you take money out of the picture, that is what is left and what constitutes the root of the athlete. Winning is only part of it. To many athletes, winning is performing at their personal best. We are not all created equal from the physical standpoint and therefore competition is already skewed. Competing against yourself to push your personal best to the next level is the ultimate competition and the source of the ultimate reward.
At the Toronto Centre for Sports Medicine we applaud all of our past current and future patients for their efforts in maintaining a healthy lifestyle by including physical activity in their lives.
At the Toronto Centre for Sports Medicine, all of our patients are athletes.
Discovering the connection between a computer monitor and painful running occurred recently when a 33 year old accountant came in with a few month history of pain in the chest within running a few minutes. Despite taking a few weeks off to rest, the symptoms did not improve. Investigations carried out before being assessed at our centre included chest x-ray spinal x-ray and a cardiac stress test. All of the investigations were negative. With a proper sports medicine assessment it was evident that this accountant, like many others, uses two monitors and is constantly rotated to one side through the thoracic spine when working. After a few years of this type of positioning, the spine fixes itself in the same rotated pattern. With running there is a symmetrical rotation required through the spine. With the spine pre-rotated in one direction, the normal rotation during running is inhibited. This in turn causes a strain in the spine and its connection to the corresponding rib. This strain produces pain along the course of the affected rib causing chest pain with running. The treatment: appropriate physiotherapy including a review of office ergonomics, suggestions for improvement and reduction of the spinal rotation with exercises to maintain proper posture and spinal alignment.
We see patients who have been referred to us for lack of progression with their physiotherapy program performed elsewhere. Generally you should notice an improvement in your condition over any two-week period. No improvement over two weeks indicates that there may be something wrong with your program. Here is a checklist we use to determine why you may not have seen improvement in your condition with your current physical rehabilitation program.
Did the you have a specific diagnosis? Who made the diagnosis, a sports medicine doctor or physical therapist? Was your diagnosis based on any special tests such as x-rays ultrasound or MRI?
How often did you attend therapy and for how long? Did you perform the required exercises appropriately and with the prescribed frequency?
Does your program include hands on treatment and exercises or only passive modalities such as ultrasound, interferential current, laser and some exercises? Were you treated by a registered therapist or a physiotherapy assistant?
Did you refrain from activities that aggravate your condition?
Without a diagnosis only symptoms are being treated. By not performing the prescribed exercises you most likely will not progress. If you do not have a comprehensive physiotherapy program including hands on treatment your treatment may be lacking essential components. By participating in aggravating activities you are setting back your recovery.
If your physiotherapy program has not resulted in an improvement of your condition a review of these factors and your condition is recommended.