This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2019. For the original video go to https://www.youtube.com/watch?v=aWrLX4otJAU&t=308s
Bob: Today Brad, we’re going to talk about seven big lies about treating knee arthritis you should know.
Brad: There’s a little controversy, we’ll talk about it as we go through it.
Bob: So, this is a study that was first done in 2009. I shouldn’t say study, they looked at hundreds of studies, Brad. This is the Royal Australian College of General Practitioners. So, they look at hundreds, maybe thousands of studies regarding knee arthritis and hip arthritis too. They first did it in 2009, they redid it in 2018. It’s guidelines for non-surgical management of hip and knee arthritis. Today, I’m just going to talk about knee arthritis since that what the title is. What they do is they do various degrees of recommendations. They’ll say strongly against or conditionally against, which is not as severe. They also go strongly for or conditionally for.
Brad: So, there’s a gray zone?
Bob: Yeah, right. So, let’s start off with the first one, Brad because I get a lot of people who ask me this. Should I use Glucosamine and Chondroitin?
Brad: And what did the study say?
Bob: They said they were against the use of it. They didn't see any benefit to it and concerning the cost.
Brad: And so, it’s strongly against?
Bob: I'm sorry I don't remember I just put recommended against, I didn't do the conditional ones on those.
Brad: I don't think what those there's any bad side effects.
Bob: No, but again they're like, you know why do things that aren't going to help basically.
Brad: Right all right they're scientists.
Bob: The second one is going to be may surprise you a little bit. They recommended against use of an ice pack. To me, it makes sense because a lot of times arthritis is inflammation. So, you think you want to put ice on it, but the thing is generally they found out a lot of people like with arthritis they like the heat a lot better. They recommended against use of an ice pack.
Brad: I must admit I had a patient that had severe knee arthritis. She couldn't even walk and she did not like heat. She was very alert. She said she kept ice packs in a room, and we put ice on it.
Bob: There may be exceptions to the rule. This is the biggest one I think of the seven, Brad. They recommended against arthroscopic meniscectomy cartilage repair. All these surgeries unless the knee was locking.
Brad: So, a mechanical clarity.
Bob: And you say well how could they recommend, I'm having a lot of pain. They found out that if you had the surgery, five-six months later, you're back to right where you were before.
Brad: Okay, we're not talking about knee replacements though.
Bob: Not knee replacements, we're talking about arthroscopic surgeries. Where they go in and replace or trim off the meniscus. This is a big one. You'll find doctors that do recommend this.
Brad: Right, go in there clean it up a little bit and see how things hold off.
Bob: I must be honest, a lot of the people that I know that did have it done, they were back to square one right quickly. It's a little discouraging.
Brad: They wouldn't go to the therapist if it worked.
Bob: No and that's the thing. You always want to recommend conservative things to try first before you try things like that. They recommended, I kind of through three of them together here on number four. They recommended against acupuncture, kinesio tape and topical capsaicin. So, I just heard of it. I never used it, topical capsaicin. It’s just a rub you put on.
Brad: I've got some kinesio tape on here.
Bob: You see it, very popular. You see the Olympic athletes wearing it. Everybody thinks, oh boy, that’s cool. But the studies have just not held up on these, sorry.
Brad: And we have people comment that they love their kinesio tape, that it helps. I personally think, if it works and you really think it helps, I don't think there's any negative side of it.
Bob: No, it's a placebo effect sometimes. And if it's a placebo, it works.
Brad: It's better than taking pain pills if it does that.
Bob: Alright. They had a whole bunch of things they recommend against, but those are the ones I singled out. Now, I'm going to give you some things they recommended. Unfortunately, with the knee, you are limited. There's not a great amount things. They strongly recommended land-based exercises. What is that? That means versus water-based exercises. So, they thought it was better that you exercised out of the water than in the water.
Brad: So, walking.
Bob: Walking, muscle strengthening, and Tai Chi was highly recommended.
Brad: Okay. That’s such a slow form of exercise.
Bob: Do you know how to do it at all?
Brad: No, it's a martial arts. I've trained in a different style, drastically different but from what I understand, you go through moves very slowly.
Bob: Very slow and controlled.
Brad: It makes sense you. It’s going to help with your balance, range of motion, strength.
Bob: Give that a shot, but the walking. Also, number six, they recommended, shock absorbing footwear. Put something in your shoe and no high heels. Because that’s going to put stress on there. So, you’re going to stop wearing high heels, Brad?
Brad: No, not me. I'm sticking with them.
Bob: You’re going to stick with your fashion. Number seven, no surprise here either. Recommended weight loss. While you’re trying to lose weight, sometimes this is a motivator, you could use a cane or a crutch or a walker. My wife was having some knee pain, and it was to the point where, at first, she said, “There’s no way I’m going to use a cane or crutch.” But she ended up using a crutch because it was so bad that she was limping, she couldn’t walk.
Brad: So, with the crutch, it was much better.
Bob: Yup, I even got some padding for her. It helps to use some padding because you’re using it all the time and your arms and hands are going to get sore. After a while it calmed down and now, she’s back to walking. It’s not an issue anymore. I did some manual things on it too.
Brad: Well, we don’t have to get into that.
Bob: That was it Brad. That’s number seven, you must try to take some of the weight off it, so you can use the cane or crutch, or a walker.
Brad: Well, I did want to say one thing. I wanted to back up a few steps. I’m surprised that the water exercise wouldn’t be good for it. I think most people would question it.
Bob: Yeah, I’m surprised they talked about it. I don’t remember if they recommended against it or if it was a recommendation, but it was a lesser recommendation. I think there’s something about taking the full weight through the leg, and the effect that it has on the knee, and creating some of the oil there.
Brad: You lost everybody.
Bob: Yeah, I lost my thought.
Brad: That’s okay. I’m saying if you have a swimming pool, and it feels good to get in there and exercise. I recommend that to my patient, but the problem is, very few people have that option.
Bob: Right. They take everything into account. The convenience of it, the cost of it. They’ll recommend things that are a lot easier to do.
Brad: Sure, that makes sense. Then I concur.
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