The knee is a complex joint that consists of bone, cartilage, ligaments, and tendons that make joint movements easy and at the same time it is more susceptible to various kinds of injuries. Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Injuries to the knee can be caused by degenerative diseases such as arthritis, traumatic injuries, and sports injuries. These conditions may affect the bones & joints and impair the mobility as well as the quality of life of the patients. All these conditions require appropriate treatment, may be surgical or non-surgical to restore to normal activities. The non-operative orthopedic treatment options include non-pharmacological and pharmacological interventions. They are aimed at providing symptomatic relief and improving the quality of life of the patients. They can be used as a treatment option to treat certain conditions or to decrease pain as well as promoting functioning and quality of life after the surgical treatment.
Non-pharmacological interventions
Non-pharmacological interventions may range from simple lifestyle modification or physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:
Physical Therapy
Physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities, such as walking, getting in and out of bed and climbing stairs, easier.
Weight reduction and physical exercise
The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in the prevention and management of knee conditions. The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered overweight and BMI over 30 is considered as obese. Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore, rigorous exercises are not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.
Cryotherapy
Cryotherapy refers to a treatment in which tissues are superfreezed to destroy them. It is used to remove precancerous skin lesions, warts, etc. Cryotherapy is also used to treat skin cancer that does not affect deep tissue.
Thermotherapy
Thermotherapy involves the application of hot or cold packs to the affected area on the knee. Although there is some evidence to support the use of cold therapy in providing symptomatic relief, it is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease, and hypertension, or who are pregnant should use it with caution.
Acupuncture
This method involves the insertion of sterile needles into specific acupuncture points or pressure points on the knee. It is believed that insertion of needles at specific points restores the flow of “qi”, a form of energy and thereby relieves the pain. A modification in acupuncture is electro-acupuncture where the needles are stimulated by an electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and offers pain relief. However, it may have certain risks if treated by untrained professionals.
Massage therapy
Massage is one of the oldest methods of treatment and can help to reduce pain through increased circulation of blood and lymph, decreased muscle tension, and therapeutic effects of the touch.
Pharmacological interventions
Pharmacological interventions include management of pain using medicinal preparations such as pain-relieving medications or injections.
Non-steroidal anti-inflammatory drugs
These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the knee. Caution must be taken while using NSAIDs for overdosing as they are known to cause liver toxicity. Patients with liver diseases must take extreme care while using them. They can cause a range of side effects that increase with the concomitant use of diuretics, angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants, or oral corticosteroids.
Steroid injections
These injections of steroids are given directly into the affected knee joint for severe pain when the use of NSAIDs does not bring appropriate relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.
Opioids
Opioids are prescribed when the use of analgesic medications or NSAIDs do not offer symptomatic pain relief, if other treatments have intolerable side effects or when surgery is delayed or contraindicated. Though they offer better pain relief than NSAID’s they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness, and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise it can cause withdrawal effects. Opioids are also known for addiction and should be used short-term as directed.
Disease-modifying anti-rheumatic drugs and biological agents
Disease-modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of the disease and offer symptomatic relief. Biological agents are antibodies against the disease-causing agents that are manufactured using genetic engineering technology. These agents are recommended in individuals with severe disease conditions.
