Connecting you to health information that is relevant
I recently had the opportunity to assess my mother-in-law’s knee for chronic pain and swelling. Using diagnostic ultrasound the edges of the patella, or kneecap, as well as the tibia, were identified and bone spurring and damage to the outer portion of the menisci were thought to be seen. The presence of fluid in the front of the knee was also present, both clinically and via ultrasound. This was later confirmed with an MRI, chosen to see if there was a meniscal tear. Norma’s symptoms were chronic swelling and knee pain. This caused pain with walking and squatting, affecting all her daily activities.
The prevalence of knee osteoarthritis is rising in the U.S.
In a recent post the trend in the medical community has been to prescribe non-steroidal anti-inflammatory drugs and narcotics in place of lifestyle changes and physical therapy.
“The prevalence of knee OA in the U.S. has risen dramatically in recent years, from 9 million in 2005 to 15 million in 2012, and costs have increased accordingly.” Nancy Walsh, MedPage
A recent study compared the non-steroidal anti-inflammatory drug diclofenac for knee osteoarthritis and the supplement curcumin. The results showed a similar efficacy or reduction in pain BUT the curcumin group had less side effects.
“Curcumin has similar efficacy to diclofenac but demonstrated better tolerance among patients with knee OA.”
Curcumin is the active part of turmeric and has been shown to have anti-inflammatory and antioxidant effects. Curcumin performed as well as prescribed diclofenac, a strong non-steroidal anti-inflammatory, but had half as many side effects as curcumin.
“Curcumin can be an alternative treatment option in the patients with knee OA who are intolerant to the side effects of non-steroidal anti-inflammatory drugs.”
Let’s get back to our ‘patient’. Norma decided to start curcumin daily and since then her swelling has resolved and her knee pain is gone. She has normal function now and has no further limitations to her activities. Here are a few questions…
Did Norma need an MRI to confirm the clinical diagnosis of knee degenerative changes and chronic inflammation and swelling?
Could Norma have started on curcumin earlier?
Curcumin has been shown to be safe to use. Bioavailability is a concern and certain forms of curcumin, or the addition of piperine or black pepper extract, is needed to increase its absorption. Different forms of curcumin have different absorptions or bioavailability. The key is to use turmeric with higher levels of curcumin with an enhanced delivery system for improved absorption.
TIPS WHEN CHOOSING A TURMERIC SUPPLEMENT
Curcumin (or diferuloylmethane) is the active part of turmeric, a root that is part of the ginger family. It is one of three curcuminoids in the turmeric root.
Read the label
Most issues with turmeric curcumin are related to the added ingredients.
Keep it simple. Look for the least amount of ingredients.
Piperine or black pepper
Piperine or black pepper, Bioperine, increases the absorption of curcumin.
Piperine can affect some medications as well as blood platelets. Consult your doctor when picking curcumin with Bioperine or black pepper extract.
Curcumin and Fat
Curcumin is fat soluble, taking curcumin with a fatty meal can help its absorption.
Lipophilic molecules have been used to ‘coat’ the curcumin molecule and enhance absorption.
Ginger
Higher doses of turmeric can cause nausea and diarrhea. Some companies add ginger extract to reduce these side effects.
Ginger has some anti-inflammatory effects similar to turmeric.
Consult your doctor regarding the addition of Black Pepper Extract, Bioperine or piperine, with your turmeric supplement.
TREAT THE CAUSE
The knee is a biomechanical system, affected by the hip as well as the foot and ankle. An evaluation of lower extremity biomechanics, with the goal of treatment to improve joint and muscle mobility and function through manual therapy, is recommended.
TIPS WHEN ASSESSING KNEE PAIN AND SWELLING
Is there a loss of knee motion?
Loss of knee motion or extension changes our gait and knee mechanics.
This can cause continued knee swelling.
Look at knee mobility and mechanics.
Is there fluid on the knee?
Swelling on the knee inhibits quadriceps activation.
This causes increased soleus firing and calf trigger points are common.
Knee swelling can be picked up with clinical testing and through diagnostic ultrasound.
Is there a hip or ankle problem?
A sacroiliac joint problem creates a muscle firing imbalance around the hip, causing iliotibial band tension.
Stiffness to the foot joints can put abnormal strain on the knee.
Check for sacroiliac joint pain and stiffness to the ankle or forefoot.
Is there lateral thigh or IT Band tension?
Outside thigh tension is caused by a hip muscle imbalance.
This causes an outward pull on the kneecap and can cause chronic swelling due to poor mechanics.
Hip muscle firing problems occur with a sacroiliac joint injury and loss of motion.
Stop rolling your IT Band! Treat the sacroiliac joint problem.
For more on Knee Pain, Swelling and Osteoarthritis check out this link.
Dry Needling can be a great way to immediately reduce knee pain and swelling.