Low-impact exercise can ease chronic joint pain

Published: Saturday, Aug. 12, 2006 10:00 p.m. MDT
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Knee pain dominated the calls on Saturday's Deseret Morning News/Intermountain Healthcare Hotline on sports medicine and orthopedic injuries.

Dr. Eric Heiden, orthopedic surgeon and five-time Olympic Gold medal speedskater, and Dr. Max Testa, internationally known sports medicine researcher, both of The Orthopedic Specialty Hospital, took several dozen calls from as far away as California and Florida. Most of the calls concerned chronic pain of the knees, shoulders, elbows and hips.

Heiden said most of his callers complained of difficulty doing things that used to be easy because they now have one or more painful joints. Several asked about total knee replacement options.

Heiden said the ideal patient for a total knee replacement is an individual who is 60 or older, because even the best replacement doesn't last forever. And replacing a replacement knee is more unpredictable than the first time around.

An ideal patient would also be someone who doesn't place unusually high demand on the knee. Afterwards, he warned, "They may be able to play doubles tennis, although that's unusual." The results usually don't prepare someone to play professional sports.

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"We encourage people to wait as long as possible" for such a procedure, trying non-surgical options first. "It's important to pursue conservative, non-surgical management first," Heiden said. But when you have to sit down every 15 minutes when you're just out shopping, it's time to do something to ease the pain, he said.

The result can be dramatic. Testa said total knee replacement can change quality of life for someone who has been suffering, bringing great relief.

Exercise is important, even for those in pain. Even mild weight loss brings tremendous relief to a sore knee because the stress reduction can be "pretty profound," Heiden said. Three times a person's body weight is transmitted through the knee joint, so someone who weights 150 pounds puts the knee under 450 pounds of pressure. And losing 20 pounds reduces that by 60 pounds. When you're climbing stairs, the pressure can be nine to 11 times the weight.

Testa joked about a medical regime that involved ibuprofen at breakfast, lunch and dinner. "Before or after?" the imaginary patient asks. "Instead of," the doctor replies. "You need to lose weight."

Figuring out how pain started and when it happened is a first step. If someone remembers that they were squatting in the garden and felt a crunch in the knee, that goes a long way to help the physician identify the pathology of the injury.

As a first step for many orthopedic injuries, they recommend rest, ice, compression and elevation. They also tell patients to stay away from what made them sore for a while. Soft tissue usually heals in about six weeks. After that, it's typically safe to try the favored activity and see what happens.

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