Knee Osteoarthritis Care Issues and Measures

The core issues in knee osteoarthritis (hereinafter referred to as KOA) care can be summarized into four categories: improper pain management, accelerated functional deterioration, impairment of daily behaviors, and cognitive biases. The corresponding core intervention is "stratified symptomatic treatment, combination of movement and static, and long-term maintenance." There is no unified plan suitable for all patients, and individualized adjustments are required based on the course of the disease, wear location, and personal living habits.

Last month, I met 62-year-old Aunt Zhang at the orthopedic clinic. She danced squarely every day after her retirement. When she squatted down to pick up vegetables, her knees suddenly hurt so much that she couldn't stand up. She applied blood-activating plaster at home for half a month and used a baking lamp to grill her for 40 minutes every day. As a result, her knees were swollen like steamed buns, and she started sweating in pain even after taking two steps. This is the most common pitfall in pain management: many people default to "old cold legs, just activate blood circulation" when they feel pain, without distinguishing between the acute phase and the remission phase. In fact, there has always been academic controversy here. In the early years, traditional orthopedics generally recommended complete immobilization, bed rest, and even plaster immobilization during the acute pain period of KOA. However, more and more sports medicine and rehabilitation scientists now propose that as long as it is within the pain-free range, there is no need to remain motionless. Doing a little isometric contraction of the quadriceps can promote the absorption of fluid accumulation and shorten the pain cycle. In situations like Aunt Zhang's, there is already exudation in the joint cavity in the acute stage. Blind blood circulation and hot compresses will only aggravate the swelling. Instead, apply cold compresses first, and wait 72 hours after the exudation stops before considering hot compresses and physical therapy. If the pain is severe, follow the doctor's advice and take some non-steroidal anti-inflammatory drugs. Don't force it or use drugs indiscriminately.

Many people get scared after experiencing pain once. They dare not walk much for the next few months and have to be carried by family members when going up and down stairs. This leads to the second pitfall: long-term disuse of joints to avoid pain will accelerate functional degradation. Aunt Zhang stayed at home for three weeks. The swelling subsided, but her legs felt weak when she walked. During a muscle strength test, it was found that her quadriceps muscles had shrunk by almost 1cm. The muscles are the "natural shock-absorbing belts" of the knees. The muscles have no strength. When walking, all the weight is pressed on the cartilage, and the wear rate will naturally accelerate. It doesn’t mean that you have to carry the pain to exercise. To put it bluntly, it means “it doesn’t hurt, and it doesn’t hurt to move.” When you usually sit on the sofa and watch TV, straighten your legs and tighten your knees for 10 seconds and then relax. Do one set of 20, and do three or five sets a day. You won’t feel any pain and can still build muscles. It is much more useful than knee pads that cost thousands to buy. By the way, there has been controversy about whether to walk more. Some people say that KOA should walk less to save energy, while others say to walk more and exercise. In fact, it all depends on the degree of the disease. In the early stage, patients who only have a little pain going up and down stairs will have no problem walking five to six thousand steps a day.

Hidden injuries in daily behaviors are the most easily overlooked. I have seen many patients clearly remember the doctor's instructions when they were discharged from the hospital. They squatted on the floor and wiped the floor once, or climbed the stairs for three days, and then relapsed immediately. There are still many people who are superstitious about "quieting quietly to strengthen the knees". Here we must make it clear: some schools of traditional Chinese orthopedic medicine do advocate squatting quietly to exercise peripheral muscles, but this method is only suitable for patients with early stage and no obvious wear and tear on the patellofemoral joint. If you already have patellar chondromalacia and your knees hurt when you squat, and you insist on squatting for 15 minutes, it will completely increase the burden on the knees, and it is better not to practice at all. Small details in daily life are more important. For example, don't use a toilet that is too short. When you sit down, your knees bend too much, and the pressure is three times that of standing. If there are elderly people at home, install a toilet booster pad that costs more than ten yuan, which can save you a lot of troubles. Also, don’t expose your knees in winter. This is not an old feudal rule. Low temperature will constrict the blood vessels around the joints, reduce synovial fluid secretion, increase friction, and naturally increase the probability of pain.

Finally, let’s talk about the problem of cognitive bias. Many people feel that the sky is falling as soon as they find out about KOA, saying that it is an “immortal cancer” that cannot be cured. They either buy the folk prescriptions of “cartilage regeneration magic medicine” or “acupuncture to cure arthritis” everywhere, or they just smash the jar and throw it away. Anyway, if it can’t be cured, they will make whatever they want. I met a 58-year-old uncle who had just retired and was about to drive to Tibet with his wife. He was diagnosed with mid-term KOA and lay down at home for three months. He said he would be paralyzed for the rest of his life. As a result, his muscles atrophied even more. Later, he came to the rehabilitation department for two months and now he can walk seven to eight thousand steps a day. He also went to play around last week. In fact, KOA is a degenerative disease, just like gray hair when people grow old. It cannot be completely cured, but if it is well controlled, it will not affect normal life at all. Don’t be too anxious, and don’t pay the IQ tax randomly. Currently, only glucosamine is clinically recognized as having a certain protective effect on cartilage, and it is only useful for early-stage patients. It is useless if taken in the late stage. Don’t believe those exaggerated propaganda.

I have been in the clinic for almost eight years, and I have seen too many KOA patients take detours. In fact, nursing is really not that complicated. To put it bluntly, it is to pay more attention to the feeling of your knees, rest if it hurts, and exercise some muscles if it does not hurt. Don't blindly follow other people's exercise methods. Regular check-ups with a doctor are better than anything else. Oh, by the way, patients who are overweight should first lose weight. By losing 10 kilograms, the pressure on the knees can be reduced by 50 kilograms. This is real and more effective than any maintenance method.