There is no denying it—Singaporeans, young and old, are susceptible to knee pain. Whether competing in sports, working on the job, or simply getting up from a low chair, anyone can suffer from the sudden onset of severe knee pain. Even for those who suffer from mild knee pain, most would still wonder if there is a point in seeking treatment. This book was written to tell its readers that it is never too early to treat knee pain, and also to shed some light about the effectiveness of treatments in knee pain Singapore today. The book is presented in 3 sections. The first section helps the reader to understand and identify the nature of their knee pain. The second section delves into different experiences of patients who sought treatment for their knee pain from a knee specialist in Singapore. The third section seeks to explain various types of knee treatments available in Singapore, and also to provide an objective view about the effectiveness of these treatments. This book should be able to provide ample information for the layman to make an informed decision about the numerous options of knee treatment available today.
Understanding Knee Pain
Pain can’t exist without a brain. In other words, pain must be perceived to be felt. Our senses are responsible for perceiving stimuli such as light, sound, temperature, and pressure. This information is relayed to the brain where it is processed and ultimately experienced as a particular sensation, such as pain. A very complex and wide-ranging group of conditions can cause pain in Singapore, but for the purposes of this demonstration, we will focus on knee pain. The knee is a hinge joint that provides motion at the point where the thigh meets the lower leg. The thigh bone (femur) is connected to the shin bone (tibia) by the patella (kneecap), a small bone that glides in a groove on the end of the femur. Pain can occur when this system of bones, ligaments, and cartilage is compromised. There are many causes of knee pain. Some less severe, self-limiting, and others that are chronic and debilitating. Some common causes of knee pain are: – Fractures: In the event of a broken bone, pain, swelling, and bruising can be immediate. – ACL injury: This is the over-stretching or tearing of the anterior cruciate ligament. This is one of the major ligaments in your knee and is often injured during sports activities. – Dislocation: A dislocation is when the bones of the leg are moved from their normal position. – Meniscus Tear: The meniscus is a rubbery, C-shaped disc that cushions your knee. It can tear with a forceful twist or rotation of the knee. Older people can still tear a meniscus with milder injuries because the meniscus weakens and wears thin over time. – Knee Bursitis: Some people have an overlying band of connective tissue in their knee that can impinge on the bursa and cause irritation. This is often the result of an injury and an associated over-production of fluid in the bursa. An inflamed bursa with an excess fluid build-up is known as knee bursitis. This can result in significant pain and swelling in the knee.
Importance of Seeking a Knee Pain Specialist
Following an accurate diagnosis, the knee pain specialist will then be able to recommend the most appropriate treatment for the knee pain. This could involve referral to another specialist for conditions not directly related to the knee joint or provision of a range of non-invasive treatments such as medications, physiotherapy, injection therapy, or use of an unloader knee brace. For patients with severe knee joint damage, the most appropriate treatment may be a total knee replacement, and an experienced knee pain specialist will be able to refer the patient to a knee surgeon at the right time. With such a wide range of treatment options available, it is essential that the patient understands the cause of their knee pain and is aware of their treatment options.
The first step to seeking treatment for knee pain is to understand the cause of the pain and the available treatment options. In some cases, the cause of knee pain may be unknown or the pain may be referred from other areas such as the lower back. A knee pain specialist with a good understanding of knee joint conditions will be able to conduct a thorough assessment of the knee to diagnose the problem. This may involve the use of special tests such as knee joint X-rays, MRI, or in more complex cases, an arthroscopy may be required to confirm the diagnosis.
When suffering from prolonged knee pain, you may have consulted many different types of healthcare professionals, such as a general practitioner, physiotherapist, or even a traditional Chinese medicine practitioner. While some cases of knee pain may be resolved through non-invasive treatments, sometimes the relief is not long-term and the pain recurs. Some patients may be recommended to undergo knee surgery, but surgery should always be considered the last resort and should only be performed by an experienced knee surgeon. With so many different options for healthcare available today, this essay explores the importance of seeking a knee pain specialist.
Success Stories from Patients in Singapore
Mr. Tan attempted physical therapy as a final resort to avoid an early onset of knee replacement for his left knee. He was not too optimistic but felt that he needed to give it a final try. The decision in doing so has changed his views on his knee massively. Through a period of 3 years, we were able to successfully help him strengthen his knees and address his muscle imbalances. This was the turning point for him as his legs felt stronger and the muscle balance work had helped unload the excessive forces acting on his knees. With stronger legs and an improved ability to control his knee joints, his pain and function gradually improved to the point where he is now able to lead a much more active lifestyle without those discomforting setbacks. His knees have shown vast improvements coupled with our maintenance programs, and he is happy in a sense where he is able to do a lot of regular exercises and even play badminton twice a week without any pains. According to Mr. Tan, “It was really an enjoyable and satisfying process. A substantial improvement compared to over 10 years ago and a tremendous relief from an impending sentence for knee replacement.”
Years later, Mr. Tan injured his right knee, which eventually led to an Anterior Cruciate Ligament (ACL) injury. The left knee at this point in time was already showing signs of degeneration. His abilities to function optimally were impeded, and he was not able to engage in sports or physical activities without pain and discomfort. The struggle was not only due to pain and loss of function but also the emotional impact as he was not able to do the activities he enjoys. He has had to give up soccer, a sport he loved. The last straw for him was when he was not able to serve during a game of badminton with his friends. Imagine the dismay! He has had 2 keyhole surgeries for his right knee and 2 for his left knee before he came in to seek physiotherapy at Core Concepts.
When speaking of knee pain sufferers and chronic knee pain patients, Mr. Tan is one prime example. Knee pain has been a struggle for him for close to 10 years. It all started when he injured his left knee while playing soccer. The initial injury resulted in a torn meniscus, and the road to recovery was tough. He has had 2 operations on the same knee, and full recovery remained a mere goal.
Case 1: Overcoming Knee Pain through Physical Therapy
Mrs. Ow started physiotherapy treatment for her knee. She had tried a variety of anti-inflammatory medication with not much effect on the pain and was keen to try something else. She attended physiotherapy sessions twice a week and was given a home exercise program. The therapist stated that there was involvement of the muscles of her hip and thigh causing abnormal forces on the knee joint. This was the area that they needed to target. Initially, the pain had to be settled with advice and use of electrotherapy modalities. Due to the severity of the pain, this took a number of sessions and Mrs. Ow was feeling despondent as to whether this was the right thing to do. However, with continued sessions, the pain started to ease and she was able to start on her exercise program. The program initially focused on increasing muscle strength of the hip and thigh as it was noted that the muscle bulk was very poor. This, in turn, was progressed to muscle endurance and more functional activities. At this point, Mrs. Ow was noticing a significant improvement. She was feeling more steady on her legs and was not relying as much on her stick. The exercises were progressed to more dynamic activities and lower limb coordination. A specific exercise was practicing going from sit to stand as it was noted that Mrs. Ow had lost confidence with this and was using a high dependency on the chair or her arms. This was ultimately what she wanted to achieve, to be able to move around better and to avoid a wheelchair. She had succeeded in this and was able to continue with normal daily functional activities. The last phase of the rehabilitation program was looking at prevention. There was a fear the pain would recur, and Mrs. Ow had already learned that there was an association with her poor muscle strength and the pain. She was taught a maintenance program of exercises which she could continue with on her own. Mrs. Ow has essentially “cured” her knee pain and is well and pain-free now. She is very happy with the treatment and the physiotherapist.
Mrs. Ow, a 68-year-old woman, has been suffering from knee pain for the past six months. The knee pain worsened while walking or going up stairs. There was no injury to her knee, but the pain was getting so severe that it was affecting her life. She had to rely on a walking stick to get around and was considering a wheelchair if there was no improvement. She was hoping to avoid surgery and was looking for alternative methods of treatment.
Case 2: Surgical Intervention for Knee Pain Relief
A 68-year-old lady presented with a 2-year history of left knee pain, with no significant injury. This resulted in a significant impact on her quality of life, rendering her unable to walk for more than 10 minutes. Her pain was localized to the medial aspect of her knee and was associated with mechanical symptoms of clicking and giving way. She had failed anti-inflammatory medication and physiotherapy. Examination revealed a mild fixed varus deformity with medial joint line tenderness. Her 6-minute walk test was only 150 meters. Standing XR confirmed tricompartmental osteoarthritis with medial joint space narrowing and varus alignment. She underwent an uneventful bilateral Oxford medial unicompartmental knee replacement, with an excellent postoperative result. At 3 months post-op, she has no further medial-sided pain, with resolution of her mechanical symptoms. Her walking capacity has improved to greater than 30 minutes, with a 6-minute walk test of 400 meters. Standing XR confirmed correction of her varus alignment and good position of her unicompartmental replacements. She is extremely happy with the outcome, with significant improvement in her quality of life. Despite the fact that her surgery was done on a bilateral sequential basis, it is still considered an excellent example of high demand unilateral UKR. It is impossible to predict the functional outcome of the second knee, and it should be noted that she had an excellent improvement in the quality of life from an isolated procedure on her left knee.
Case 3: Alternative Treatments for Knee Pain Management
…Ms. A, a 56-year-old teacher, complained of bilateral knee pain which was worse on the left and had troubled her for over three years. She had been diagnosed with chondromalacia patellae and had multiple arthroscopies on both knees, largely with minimal change in her symptoms. She had read about the benefits of prolotherapy for chondromalacia patellae on the internet and wanted to find out whether it might be an option to help her knee pain. After extensive discussion of the risks and benefits of the procedure, it was agreed that she would try prolotherapy on her left knee first to see if it would help. This involves a series of injections, which can include a variety of solutions. Ms. A had six sessions of dextrose prolotherapy over a six-month period. At the end of the treatment, she reported that her knee pain was around 30% better. This continued to improve and she estimated that her left knee was 70% better after the prolotherapy, with increased strength and stability. She has since had a similar result with platelet-rich plasma prolotherapy on her right knee. She reported that this was the most effective treatment she had had and was very pleased with the outcome. Based on these two experiences, she has recommended prolotherapy to a number of friends with a variety of musculoskeletal problems, and she herself is considering further treatment on her knees if the pain returns. It is especially important to note that there is currently no strong evidence to support prolotherapy for chondromalacia patellae, however, these positive experiences highlight the fact that certain treatments may still be worth trying on an individual basis.
After discussion with the patient, it was decided that he would try a treatment program using acupuncture. It was explained to Mr. X that while there was no strong scientific evidence to show that acupuncture would help his knee pain, it was a low-risk option which may help improve his symptoms. A physiotherapist who is trained in acupuncture was arranged to perform the procedure. After the third session, Mr. X reported that his knee pain was 50% better. This continued to improve and after ten sessions, he reported that his knee pain had improved to a level where he was only aware of it occasionally. He has continued with regular maintenance acupuncture every four to six weeks and has been able to greatly increase his mobility and engagement in social activities. He has expressed great satisfaction with this treatment and is happy to avoid knee surgery if possible.
…When Mr. X, a 77-year-old retired teacher, came to see our pain management physician, he complained of a five-year history of right knee pain. He had been diagnosed with osteoarthritis of the knee. Mr. X had already tried various treatments including simple analgesics, non-steroidal anti-inflammatory drugs, and glucosamine, without significant relief. He was concerned about the side-effects of long-term medication and was keen to explore other alternatives.
Case 4: Lifestyle Changes and Knee Pain Improvement
This patient was at his wits’ end when he visited me in 2005, wherein the last straw was when he had difficulty walking to the concert hall where he was teaching for a major performance. The 3 years were not without their own share of problems, but he adapted well and his knees gradually got better, so much so that I chanced upon him at Jurong Point where he related his experience of finding a parking lot being just too bizarre, that he had to walk too far to the shopping centre! At age 58, he is now back in Singapore and wants to resume teaching the violin. A recent visit has shown that his knees are doing much better. He is still unsure about a full return to his previous lifestyle and whether he should be taking on the hyaluronic acid injections again, but he is a much happier man compared to the first encounter.
Encounter can manage your habits for all, but that person would be taking some essential steps for his improvement against any problem that might surely affect everything in his life. To someone else, it might not be having any relevance. This is the case with a 56-year-old manager, an expert violinist who is a long-time sufferer of chronic pain in both his knees. He decided to make a difference and implemented an ambitious change in his life in 2005. He left his hectic violin teaching and conducting schedules and took a three-year break to pursue a degree in musicology and arts management in the UK. This was a radical change from his usual lifestyle and gave him ample time for his knees to recover. This was not a decision taken lightly as it involved drastic changes in his income and adapting to a life as a student in midlife. This student life, which also involved coursework and dissertations, had to be supported by a tuition job which, however, was much less taxing on his knees compared to the teaching and conducting. He had to give up his hope of a MAS degree halfway as that would entail a return to the same high-pressure lifestyle he once had. Before departing for the UK, he also took the alternative treatment of hyaluronic acid knee injections in a study comparing its effects with glucosamine.
The first few weeks of the exercises are crucial. Results will not be imminent, and doing the same exercises every day can be monotonous and fatiguing. Most of the patients resorted to painkillers to help relieve the pain brought about by the exercises. According to Jane, taking a painkiller before therapy helped her get through the exercises with less pain. Stephanie found that taking the painkiller when necessary was more effective than futilely trying to avoid them. Remember to consult the knee pain specialist before taking medication.
In conclusion, let’s examine what we learned from the patients. First, every single one of them stressed the importance of persistence. The road to recovery was not easy, and more than once they contemplated giving up. It is tough to do the exercises, especially when there is always pain and discomfort. Coupled with the fact that the results were not immediate, this made it very tempting to give up. This is where a lot of people fail.
