Knee Osteoarthritis Care Issues and Measures

The three core common problems in knee osteoarthritis (KOA) care are recurring pain, progressive decline in joint mobility, and accelerated long-term degeneration. The corresponding core nursing principles are layered personalized analgesia, functional intervention of dynamic and static balance, and precise lifestyle adjustments. There is no "universal prescription" and all measures must be tailored based on the patient's degree of degeneration, daily habits, and tolerance.

Last week, I met a 62-year-old Aunt Zhang in the clinic. She had been dancing for half a year and her knees hurt so much that she couldn't walk. She applied plaster at home for half a month. The pain didn't stop and her joints became swollen by rubbing. She said that she heard from an old sister that "pain means inflammation, and you have to rub it away hard." There are two extreme views on analgesia. One is that "the medicine is only three parts poisonous, and it hurts to death and I won't take it." If you take it until you can't sleep and your muscles continue to be tense, it will aggravate the inflammatory exudation. ； The other way is to take painkillers when you feel pain, and dare to do any high-intensity activities. In the end, your stomach will be damaged and your joints will wear out even more. Objectively speaking, clinical analgesia is currently based on layered analgesia: for mild pain (which does not affect sleep and only hurts after walking for more than 10 minutes), priority is given to topical non-steroidal gels, warm compresses, or warm acupuncture and moxibustion of traditional Chinese medicine. Evidence-based evidence has proven that the effectiveness can reach more than 60%, with almost no side effects. ； For moderate pain (woke up at night, unbearable after walking for 5 minutes), you can take oral anti-inflammatory drugs for a short period of time. If you have gastric ulcer, you can choose COX-2 inhibitors, which are much less irritating to the gastrointestinal tract. ； Even if the pain is so severe that you dare not land, there is no need to talk about hormone discoloration. The side effects of low-dose intra-articular injection of hormones are much less than if you take painkillers for half a month.

After many people are relieved of their pain, they are still stuck on the road of "dare not move". There used to be a 48-year-old marathon enthusiast. After he was diagnosed with knee arthritis, he lay down completely. In less than half a year, his quadriceps muscles shrank by 2 centimeters, making him weak when he walked. When he went for a follow-up examination, he found that the joints were wearing out faster than before. There is also a lot of controversy about rehabilitation exercises. Some people say that silent squats are a knee-protecting exercise, while others say that silent squats will wear the patella. In fact, it is a matter of individual differences: people with patellar chondromalacia and patellofemoral joint disorders are not suitable for static squats. It is safer to do straight leg raises and ankle pumps while lying down. ； For people with good joint stability, as long as the angle of silent squats does not exceed 45 degrees and the knees do not exceed the toes, the joints will not be hurt at all. In the past two years, some people said that Tai Chi hurt the knees. However, a study published in "Arthritis and Rheumatism" last year also showed that gentle Tai Chi for 40 minutes three times a week can improve the mobility of patients with knee osteoarthritis better than conventional rehabilitation exercises. The premise is that they do not deliberately squat too low and the movements are not too strenuous. Oh, by the way, don’t believe the nonsense that “pain is just opening up the meridians”. The standard for rehabilitation exercise is very simple: it is appropriate for joints to be sore for no more than 1 hour after exercise. If the pain does not go away for a long time, it must have been exercised.

After solving the problems of pain and movement, the most easily overlooked thing is how to delay degeneration. After all, the essence of this disease is "aging and wear and tear" of the joints. If you don't take it seriously, it will only get worse. Don’t believe it. For people with a BMI over 28, for every 1 kilogram of weight lost, the pressure on the knees can be reduced by 4 kilograms. If they can steadily lose 5 kilograms, their pain scores can be reduced by at least 20%, which is much more effective than eating a lot of health supplements. There is also the most controversial glucosamine. Some people say it is an IQ tax, while others say that taking it is indeed useful. The current recommendations of international guidelines are actually very neutral: patients with mild degeneration and no obvious joint space narrowing can try taking glucosamine sulfate for 3 months. If it really has a relief effect, continue taking it. If it has no effect after 3 months, don’t waste money. People with severe degeneration are really useless. There are also many people who wear knee pads all year round and think they can protect their joints. In fact, they only need to be worn when they are in acute pain, walking long distances, or climbing mountains. Do not wear them every day when walking at home. Otherwise, if the muscles are not exercised for a long time, they will become weaker and weaker, and the joints will become more unstable.

I have been in the orthopedic clinic for almost 6 years, and I have seen too many patients who go to extremes. They either climb stairs or climb mountains every day to "exercise their knees", and in the end they need joint replacement.； Or he doesn't dare to move at all, and eventually his muscles atrophy and he has difficulty even going out to buy groceries. In fact, the care of knee osteoarthritis is really not that complicated. The core is to "follow your knees". If you feel uncomfortable doing a certain movement, don't force it. If a certain method doesn't work, stop in time. The good plan used by others may not be suitable for you. If you are really not sure, find a reliable orthopedic or rehabilitation doctor to take a look. It is much more reliable than searching for a bunch of folk remedies on the Internet and buying health care products blindly.