These may be the 3 most effective non-drug ways to treat knee arthritis
A knee brace appears to be one of the more effective ways to treat the pain - as well as improve function and stiffness - from osteoarthritis, the common degenerative process where the cartilage cushioning the joint deteriorates over time.
Researchers in China ranked the relative effectiveness of a dozen treatments, ranging from laser and ultrasound therapy to wedged insoles and kinesiology tape, studied in 139 randomized controlled trials.
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Based on the results from 9,644 participants, the simple knee brace ranked highest in effectiveness to alleviate symptoms of arthritis, the researchers concluded.
However, 'the challenge,' said Prakash Jayabalan, the director of musculoskeletal research at the Shirley Ryan AbilityLab in Chicago, 'is getting patients to actually wear knee braces.'
Jayabalan and other clinicians who weren't involved in the study said knee braces can provide certain people immediate relief by supporting the load on the joint. But, some patients find braces uncomfortable to wear.
Hydrotherapy and exercises such as weightlifting and yoga placed second and third in the meta-analysis ranking. Hydrotherapy, also known as water exercises or aquatherapy, is a treatment approach designed to improve symptoms.
And experts said staying active and maintaining a healthy weight are the most effective ways to relieve symptoms of knee osteoarthritis.
'Both of those can improve symptoms and slow the progression of arthritis,' said Morgan Jones, a sports medicine orthopedic surgeon at Mass General Brigham.
The peer-reviewed study published in PLOS One on Wednesday. It was led by Yuan Luo, a researcher in the department of rehabilitation at the First People's Hospital of Neijiang, China, who did not respond to questions by the time of publication.
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What causes knee osteoarthritis?
When cartilage in the knee breaks down, the joint is left with 'bone on bone motion,' Jayabalan said. Cartilage can't repair itself like other tissues in the body and, oftentimes, people don't know they've lost the cartilage in their knee until it's gone, he said.
There are two common risk factors for knee arthritis - a previous knee injury such as an ACL tear and unhealthy weight gain, said Steve Messier, the director of the J.B. Snow Biomechanics Laboratory at Wake Forest University.
Every pound of additional body weight amounts to four pounds of stress on the knees when a person is walking, Messier said. Once someone has arthritis in their knee, they need to make broad lifestyle changes with regular exercise to manage the pain, he said.
'It really doesn't matter what type of exercise you do, just so you're being active,' Messier said. 'They all will reduce pain.'
Other clinicians agree staying active is one of the best ways to relieve knee arthritis pain. It's the first recommendation in guidelines published in 2019 from the Osteoarthritis Research Society International.
Around 33 million U.S. adults have osteoarthritis, according to the Centers for Disease Control and Prevention. People commonly take NSAIDs such as ibuprofen to relieve the symptoms. But, these pain-relievers can damage the lining of your gut. Jayabalan said he recommends people use NSAIDs for no more than 10 days when they're experiencing 'debilitating pain' that is impacting their function.
'You should not be taking these every day,' he said.
Knee replacements have long been the gold standard for damaged joints, but it can take up to a year for some people to fully recover from surgery. Emerging alternatives target the nerves to stop the knee pain and block blood flow to reduce inflammation.
'Two people can have the same amount of structural damage in their knee and have totally different pain profiles,' said Jones, also an assistant professor of orthopedic surgery at Harvard Medical School. 'The decision for knee replacement ends up being really individualized, and the focus is on the person's symptoms.'
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What did the study find?
The knee brace ranked best on various scores of pain, stiffness and function, and had the 'highest probability of being the best technique,' the researchers wrote.
Jones said a knee brace can be 'very effective' in people who have arthritis in certain compartments of the knee because the brace can shift the load to another part of the joint.
'But, if somebody has arthritis throughout their knee, an unloader brace is not as likely to be helpful,' he said. 'They don't have a more-normal area to off-load the force to.'
The researchers compared a dozen interventions: low-level laser therapy, high-intensity laser therapy, transcutaneous electrical nerve stimulation, interferential current, short wave diathermy, ultrasound, lateral wedged insole, knee brace, exercise, hydrotherapy, kinesio taping and extracorporeal shock wave therapy.
Hydrotherapy ranked second in some scores. Water buoyancy takes pressure off the knee joints and helps improve range of motion for some people, Jayabalan said.
Ultrasound pulse therapy to treat knee arthritis 'remains contentious' and performed the worst across multiple scores, the researchers wrote. And, they concluded that wedged insoles, which attempt to shift the load on the knee by lifting one side of the foot, did not 'outperform neutral devices in pain reduction.'
Insoles used to be a popular therapy for knee osteoarthritis but 'multiple studies' have shown they don't help, Jones said.
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The study's limitations
Many of the studies in the meta-analysis are short, six to 12 weeks, Messier said. Therefore, the results support only short-term pain relief from these treatments.
'It may relieve pain for a little while, but it's not going to change pain in the long run,' Messier said. 'The most effective thing they have here is exercise.'
Jayabalan said none of the studies are looking at whether the treatments led to mechanistic improvements in the knee - 'they were not regrowing cartilage, or something like that.' Instead, the studies recorded clinical observations that these treatments may provide a potential benefit.
And, many of the randomized controlled trials were conducted on small groups of participants, Jones said. 'There's a lot of variability in the studies and how long they follow their patients,' he said.
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