We have been here before but we revisit the value of exercises and weight loss for the treatment of knee pain. All too often it is easier to prescribe the NSAIDs than spend time with the patient addressing lifestyle issues.
Knee pain is one of the commonest musculoskeletal symptoms presenting in primary care. Osteoarthritis of the knee joint os often (but not always) associated with knee pain. Obesity is a major risk factor for both knee pain and osteoarthritis of the knee. A recent study conducted in 5 general practices in Nottingham and published in
BMJ adds further evidence to support the use of simple home-based exercises to strengthen the knee musculature as he first-line treatment of knee pain in the overweight and obese. Exercises significantly reduced the experience of knee pain and improved mobility, and the improvement was maintained over 24 months. Dietary interventions and weight loss, in contrast, did not improve knee pain or mobility but did reduce levels of depression. 1
Another study from the USA,
looked at the value of quadriceps strength in preventing knee pain. The study followed over 3000 subjects aged 50–79 for 30 months looking to see whether quadriceps strength (or lack of) could predct the development of osteoarthritis symptoms and changes on x-ray. Knee strength was found not to predict radiographic changes of osteoarthritis; however the strongest knees were associated with the lowest incidence of symptomatic osteoarthritis, suggesting that the value of strong knees is in preventing symptoms – knee pain rather than pathology. Interestingly this benefit was much stronger in women, men having only slightly reduced incidence of knee pain with increasing strength. This is perhaps not surprising as we know from the Allied Dunbar National Fitness Survey 2 that 30% of men and 50% of women aged 65–74 had very weak quadriceps musculature – 'lacking the strength to allow the subject to rise from a chair without using their hands'. Our patients' sedentary lifestyles cause many problems. 3