Three Ways to Protect Your Knees

The knee is known as the largest and one of the most complex joints in the human body, and also one of the most vulnerable, as it supports the weight of the entire body. The knee joint is made up of several elements including the knee cap, meniscus, connective tissue, tendons, ligaments, cartilage, and muscles. Damage to any part of the knee can cause chronic pain. So how can you protect your knee from damage and injury? Take a look at these three points!

Dealing with Load: Weight is a big one. Carrying around extra pounds and kilograms can be detrimental for your knees in the long run. Your knee is not equipped to handle the excessive weight. It already supports three to five times your weight when you get up and walk around or indulge in some mild jogging. One must be careful of those extra pounds to take the load off the knee and keep it from falling prey to damage.

Exercise: Moderate to intense exercise is prescribed for one and all. This, of course, depends on one's overall health and age. If you are already suffering from joint pain, then you may want to go easy on the exercise with a focus on building muscle strength and foundation. If you are healthy, then some amount of daily exercise as a routine will keep those knees in prime working condition and well lubricated as well. Inactivity and a sedentary lifestyle can affect the knees very badly.

Do not Ignore: Warning signals such as chronic or acute knee pain should not be ignored. Remember to see a doctor or an orthopaedic specialist to find out if you have contracted an infection or if you may have suffered a fracture due to an injury. Also, it is important to take a bone density test regularly, especially after the age of 40 or for women going through menopause, as this will point to any deficiencies and even warn you in case there is any trace of osteoporosis.

Rest, exercise, and food should be kept in fine balance for a healthy body. These are a few measures that one can take to keep knee pain at bay. Yet, it is also advisable to speak with a doctor at length regarding measures to protect your knees.

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Three Ways to Protect Your Knees

Calcium is known for its role in maintaining the bone health, from keeping your teeth stronger to normal functioning of the cells.  But there are various factors, which lead to a deficiency of calcium in the human body and paves the way for several complications.

Here are the top three signs that indicate you are suffering from calcium deficiency.

Difficulty in sleeping: Sleep is essential for your bone health and calcium is directly associated with your sleep cycle. The level of calcium in your bones rises and falls when you are asleep and it reaches its peak when you are in deep slumber. This indicates that when you are unable to sleep properly, it is a warning sign of calcium deficiency. There are various researches that have confirmed, that by increasing the level of calcium, it is possible to restore the normal sleep cycle of an individual. This is also related to the role that calcium plays in the production of a sleep hormone called melatonin. When the calcium content in the body is really low, this hormone is not produced, thus, making it difficult for a person to sleep.
Difficulty in losing extra pounds: Yet another frustrating aspect of any individual s life is the inability to shed off excess pounds. This issue is also linked with the lack of calcium supply in the body. The calcium that s stored in the cells assists in the processing and storage of fat. So the fat cells with high calcium content burn faster, making you lose weight. Thus, if you have trouble losing weight in spite of having a well-regulated diet and regular workout, it s a sign that you are suffering from low calcium.
Paresthesia: Though this ailment is not much heard of, it could be a sign of calcium deficiency. Paresthesia is a nervous disorder, which causes tingling sensation, tremors, numbness and loss of sensitivity. It could also lead to poor concentration, amnesia, confusion, hearing impairment, twitches and other physical as well as neurological impairment. This is because low calcium in the blood is connected with the health of your nerves.
The deficiency of calcium can manifest itself in different intensity, ranging from the non-existent to minimal to severe levels. Chronic calcium deficiency can lead to life-threatening diseases like rickets, osteopenia, and even osteoporosis. Therefore, you shouldn t ignore these signs and consult an expert without delay.

Calcium Deficiency - 3 Signs You are Suffering from it

Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

Myths about Total Knee Replacement

Myth#1 - Knee replacement is a surgery for old people. “I’m too young for a knee replacement.”
Fact - Candidacy for a knee replacement is not based on age, but on the person’s level of pain and immobility. Living with a painful joint that prohibits you from working or participating in normal life activities is an outdated way of thinking. Age is not necessarily a limiting factor. Often times, a patient is actually fearful about the uncertainty of surgery. Once they are able to resume many of the activities they enjoyed before the surgery, with increased mobility and with less pain, they are very happy they had the surgery. The quality of life one achieves by living without knee pain is priceless.

Myth#2 - “I should wait as long as possible to undergo knee replacement surgery” 
Fact - You don't need to suffer by waiting until the pain is intolerable. The longer life of joint replacements enables people to consider surgery earlier and at a younger age. Osteoarthritis is a degenerative disease that continues to damage the joint and delaying surgery makes both surgery and return to activity more difficult. Delaying surgery lowers a patients’ quality of life not only before the operation, but even for up to two years following surgery.

Myth#3 - “I should continue with medications as long as possible”
Fact - Medicines including painkillers just give symptomatic relief for a temporary duration and prolonged usage is riddled with serious side effects such as renal failure, peptic ulceration  etc. All these medicines are NOT curable.

Myth#4 - Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy; braces will cure my advanced arthritis and knee pain.
Fact - Till date there is NO cure for advanced knee arthritis and these alternate therapies are not backed by established scientific data. All these modalities give temporary pain relief in early to moderate arthritis for some duration only and are NOT curative. Often times, a patient who is actually fearful about the uncertainty of surgery lands up trying these in order to avoid surgery. 

Myth#5 - After a knee replacement, it takes months to recover.
Fact - Depending on the activity, most patients who undergo knee replacement are able to perform routine tasks within a few weeks. A return to rigorous activity takes only a few months. One becomes independent for himself before discharge from hospital. There’s no prolonged best rest required after the surgery.


Myth#6 - After knee replacement, I’ll have to give up some activities and sports.
Fact - You have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks. It will take a bit longer to return to more rigorous activities and contact sports. Squatting and sitting cross legged though possible but at best should be kept to minimal.

Myth#7 - Knee replacement surgery leaves a large scar that is noticeable.
Fact - Scarring is minimal compared to traditional surgery. In fact, the scar is typically only 3 to 5 inches long. As time passes, the scar will fade and become less noticeable.

Myth#8 - Knee replacement is a very painful surgery. There is lots of pain in post operative period.
Fact - With modern day pain management such as in a multimodal approach, ensures that the patient does not feel any pain in post op period and has a smooth recovery.

Myth#9 - Knee replacement is done one at a time.
Fact - Both the knees can be operated at the same time if the patient does not have significant co morbidities and is deemed fit to undergo the procedure by the doctor.

Myth#10 - The new knee lasts for 5-6 yrs. only.
Fact - With modern day precision including computer assisted knee replacement and advancement in biomaterials, the survivorship has increased considerably. Today's joint replacements last 25 years or longer and, for most people, will last a lifetime.

Myth#11 - Knee replacement cannot be done a second time.
Fact - Knee replacement can be done multiple times what is called as a revision joint replacement surgery with good survivorship.

Myth#12 - “I am obese, I cannot undergo Knee replacement surgery.”
Fact - Knee replacement can be successfully done in an obese patient though the recovery is somewhat prolonged and might require additional implants. However, patients who are morbidly obese and have restricted mobility primarily due to obesity are better off after a bariatric procedure.

Myth#13 “I have diabetes or hypertension or heart ailment, so  I cannot undergo Knee replacement surgery.”
Fact  - diabetes hypertension or heart.



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 13 Myths About Total Knee Replacement (TKR), Busted!

It is normal and alright to feel pain in the knees occasionally after a physical activity or prolonged walking. However, it is a serious cause of concern if the pain is experienced every now and then. Not responding to your knee pain for long can lead to the extreme disability. Knee pain does not crop up in a day and it may surprise you when it first appears. 

Initially, you may notice slight pain and discomfort. If you have identified knee pain at this level, managing it is easy. You can perform different exercises to prevent pain from occurring. If the pain severe, you need to go consult a doctor, who will then help identify the real cause of pain. The following exercises, along with medications, can help you overcome knee pain and restore the mobility of the joint.

Stair Step ups: Choose a comfortable stairway. Place your hand on the wall or banister. This is to ensure that you are balanced. Your left foot should be on the taller step. Your right foot should be on the ground. Stay in this posture for a second. Now, step back, and bring left foot to the right foot. Repeat this 6 times. Reverse the legs and continue doing for 6 times. If you want to take rest between the steps, feel free to do so.
Ups and Downs: You need an armless chair that is strong. Sit on the edge but comfortably. Your arms should be at your side, relaxed and loose. Sit erect and your feet should be flat. If you feel you need balance, and then cross your arms. Start standing up. This should not be instant but deliberate, controlled, and gradual movement. Stand slowly up to the full height, and hold on for 2 seconds. Again sit down. Repeat this 5 times.
Straight Leg Raise: This can be a part of your everyday exercise regime. This is a strengthening workout that does not put too much effort on the knees. Lie down on your back. One leg should be straight on the ground and the other one should be bent. Now, slowly lift the leg that is straight, and the toes should point upward. Raise your leg up to 30 degrees, but you can start with 15 to 20 degrees in the initial stage. Repeat 15 times and perform at least 3 sets of this exercise. Keep alternating legs. This workout strengthens the knees, thigh muscles, and the ankle joints, thus offering multifold benefits.
Wall Hamstring Stretch: Hamstring muscles too can be the cause of knee pain and discomfort. To strengthen the hamstring muscles and alleviate knee pain, this exercise helps a lot. Lie down on the floor flat. Your feet should be flexed. Choose a space that is close to a wall, or a sturdy table. Your right leg should be propped on the wall or table. If you don t prefer any, a resistance band is a good alternative. When stretching, you can find your flexibility level and when you feel that you have reached the deepest point, start relaxing. Keep alternating contracting and relaxing every 5 seconds. After 10 to 15 sets, you can try the same with the left leg.
Knee Rolls: Use an exercise mat or a carpet that is cozy. Lie on your back. Bend the knees, and ensure your feet are flat. Your arms should be stretched on the sides. Look at the ceiling, and hold the knees together. In the same posture, slowly roll the knees towards the right. When you feel a gentle twitch or after 5 seconds, move to original position. Then lower the knees to the left. Hold and release. For each side, repeat 10 times.
These exercises strengthen the knees and improve the quality of life by bidding bye to the pain. Understanding that these are magic remedies that work overnight is the key to stay focused and keep going without quitting.

Exercises That Can Help Relieve Knee Pain!

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

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