Got Achy Knees?

I came across this on a massage therapist Facebook page. If you've got achy knees from osteoarthritis (not any other kind), this is helpful information.

Posted by Harriet Hall on June 11, 2013

Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older. Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur. This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients.

Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound. Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)

Exercise – strong evidence for effectiveness
Weight loss – moderate evidence for
Acupuncture – strong evidence against
Physical agents (TENS, ultrasound, etc.) – inconclusive
Manual therapy (chiropractic, massage) – inconclusive
Valgus-directing force brace – inconclusive
Lateral wedge insoles – moderate evidence against
Glucosamine and chondroitin – strong evidence against
NSAIDs – strong evidence for
Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
Intraarticular corticosteroid injections – inconclusive
Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
Growth factor injections and/or platelet-rich plasma – inconclusive
Needle lavage – moderate evidence against
Arthroscopy with lavage and debridement – strong evidence against
Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
Valgus-producing proximal tibial osteotomy – limited evidence
Free-floating interpositional device – no evidence; consensus against

This is Kelly again....I've re-organized the list, below, grouping things by the study's findings about them.

Exercise – strong evidence for effectiveness
NSAIDs – strong evidence for

Weight loss – moderate evidence for

Physical agents (TENS, ultrasound, etc.) – inconclusive
Manual therapy (chiropractic, massage) – inconclusive
Valgus-directing force brace – inconclusive
Acetaminophen, opioids, pain patches – inconclusive
Intraarticular corticosteroid injections – inconclusive
Growth factor injections and/or platelet-rich plasma – inconclusive
Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive

Lateral wedge insoles – moderate evidence against
Hyaluronic acid injections – strong evidence against
Needle lavage – moderate evidence against
Acupuncture – strong evidence against
Glucosamine and chondroitin – strong evidence against
Arthroscopy with lavage and debridement – strong evidence against

Valgus-producing proximal tibial osteotomy – limited evidence
Free-floating interpositional device – no evidence; consensus against

What I found most interesting was that weight loss only had moderate evidence of effectiveness. Doesn't mean it's a bad idea but it's not as effective as exercise (movement) and NSAIDs (such as aspirin, ibuprofen, naproxen, etc.).

And, yes, I noticed that massage therapy was "inconclusive". That, frankly, matches my experience too. I can bring some small temporary relief but I haven't been able to do any better than that with osteoarthritis.