It has been well documented that obesity is a major risk factor for knee osteoarthritis. In fact, the relative risk of knee osteoarthritis is increased by 4-5 times in obese people compared to non-obese people.
Nutrition is making the largest impact in the long-term management for patients with knee pain. But very few treatments or “quick fixes” offer long-term results. Too often treatment consists of “band-aid solutions” which lack the benefits of the patient. This type of scenario is best avoided, especially with the effective treatment of athletes looking to have the pain and symptoms often associated with acute injury dissipate at a faster rate. In either instance, the primary and secondary prevention of certain knee injuries is best achieved through the proper nutritional support of the musculoskeletal system. But very few treatments or “quick fixes” offer long-term results. Too often treatment consists of “band-aid solutions” which lack the benefits of the patient. In a review published by the American Journal of Clinical Nutrition, “it is generally accepted that nutrition is an important factor in the prevention and management of chronic diseases.”
A proper treatment for knee pain requires determining its source. Sometimes knee pain is a result of an injury such as a torn cartilage or a strained ligament. Other conditions are known as chronic knee pain. The construction of an effective treatment of the knee pain is based upon the determination of its cause. But very few treatments or “quick fixes” offer long-term results. Too often treatment consists of “band-aid solutions” which lack the benefits of the patient. This article is perfect. More often than not, as one tries to go about his or her everyday life such as work or fulfilling responsibilities, an individual’s pain or discomfort is a reminder of the injury which hinders one from effectively coping and ultimately treating a knee injury. But very few treatments or “quick fixes” offer long-term results. Too often treatment consists of “band-aid solutions” which lack the benefits of the patient. More often than not, as one tries to go about his or her everyday life such as work or fulfilling responsibilities, an individual’s pain or discomfort is a reminder of the injury which hinders one from effectively coping and ultimately treating a knee injury.
Nutritional Strategies for Managing Knee Pain
Lastly, an aspiring level should be to maintain a daily intake of about 1.0-1.5g/kg body weight of protein, which is a vital nutrient for building and repairing body tissue. Protein should be consumed in moderation over the day, and it does not have to be a major meat source which can have higher amounts of unhealthy saturated fat. A balanced diet will help maintain a healthy body and knee joints.
Step one in nutrition for knee pain is to maintain or reduce body weight to ease stress on the joints. This can be achieved by replacing energy-dense foods with high energy, nutrient-rich foods such as fruit and vegetables. These types of food can decrease inflammation and pain in the joints. High quality and energy-providing carbohydrates are abundant in foods like bread, rice, cereals, and pasta, which should be consumed in moderate amounts.
A basic principle to good health is found by simply balancing a diet. This means consuming adequate amounts of food in the form of nutrients and energy in order to maintain a healthy body weight. It also means achieving the correct ratio of carbohydrate, fat, and protein. Carbohydrates are the most important source of energy for the body. It is vital that the energy requirements are met and energy balance is achieved within the body weight. Excess fat or being grossly overweight will increase stress on weight-bearing joints, which can lead to damage and increased inflammation.
In order to address and manage any symptoms associated with knee pain, the focus should be on improving joint health. Your diet is for life, it is not just to treat a particular problem, but a healthy balanced diet can help to manage knee pain by keeping the joints in good condition. This can have a profound effect on how the knee feels, as we know that losing even a small amount of weight can have a big impact on symptoms.
Importance of a Balanced Diet
Fat has twice the energy content of carbohydrates and is essential for general body function, although excessive amounts will increase weight and have negative effects on health. High-fat diets, especially those containing cholesterol, have been associated with diseases such as coronary heart disease and high blood pressure, which are bad for knee health.
Protein is used by the body to repair damaged tissues, produce enzymes, and the immune system to fight diseases, again something that may be suffering in those with knee pain. Sources of protein include meat, fish, poultry, dairy products, nuts, and legumes. Muscle wasting may occur with age or inactivity, causing a decrease in strength and stability of the knee joint. Weight loss in obese patients will aid knee pain and decrease the risk of osteoarthritis, but a balanced diet is required to prevent malnutrition and further muscle loss. Osteoarthritis damage is associated with an increase in enzymes that degrade protein in the cartilage. High intakes of certain acidic fruits and vegetables can also increase these enzymes.
Balanced diet means having the right amount of nutrients your body needs. Our bodies are made up of mostly water, followed by protein, fat, and carbohydrates. This is simply because we need more of these nutrients than others, not because they are any less important. Water is vital for life, but you can get it from a simple glass. Protein, fat, and carbohydrates are broken down and used for energy, something those with knee pain may struggle with due to inactivity or being overweight. Carbohydrates are the body’s main source of energy and come from foods such as bread, cereals, rice, pasta, fruits, and some vegetables, providing glucose to fuel our body.
Key Nutrients for Knee Health
Recommended dietary intake of vitamin C is 90mg/day for men and 75mg/day for women, and it can be obtained from foods such as oranges, kiwi fruit, strawberries, broccoli, and capsicum.
Vitamin C is an essential nutrient that cannot be produced by the body but has been found to be particularly important for knee health. Research shows that people whose diets are low in vitamin C are three times more likely to develop knee pain. Knee osteoarthritis is also known to progress more rapidly in people with low vitamin C levels. Vitamin C is important for the formation of collagen, a major component of cartilage. It also has antioxidant and anti-inflammatory properties. However, it’s best to get vitamin C from foods rather than taking supplements, as high doses of vitamin C supplements can be detrimental to knee health.
The essential nutrients for knee health are antioxidants and vitamins C and D. Antioxidants are substances that can prevent or slow damage to cells by breaking down free radicals in the body. The buildup of free radicals over time may be a factor in degenerative changes such as osteoarthritis. Consequently, it’s important to include plenty of antioxidants in your diet for your knees and the rest of your body.
Anti-inflammatory Foods and Supplements
Anti-inflammatory foods are a key feature of a diet aimed at preventing inflammation in the body, which will have a flow-on effect to the knee joint and preventing knee joint inflammation. The principles of an anti-inflammatory diet mirror those of strategies for knee pain and osteoarthritis; in that the aim is to increase foods that are nutrient-dense, natural, and whole foods, and reduce foods that are processed and high in saturated fats and sugars. Inflammatory foods high in saturated fats, trans fats, and sugar name a few culprits such as soft drink, lollies, cake, doughnuts, and fried foods, to name a few. Research has already demonstrated that these foods can cause an increase in the production of inflammatory mediators in the body (cytokines) and accelerate inflammation in the body. These foods are also known to cause a rapid increase in weight gain, which has a large effect on knee joint loading and increasing the risk of knee osteoarthritis in overweight persons. High intake of red and processed meats is another culprit. In a study from the Proceedings of the National Academy of Sciences, researchers found that participants who avoided red meat for just one month experienced a change in their body’s levels of inflammatory markers. The levels of substances that promote inflammation dropped after the participants stopped eating red meat and began a diet high in omega-3 fatty acids from fish oil. Changes were most pronounced among participants who identified themselves as meat-eaters before the study.
Contrary to the common perception that arthritis is an ‘inevitable’ part of aging or that it ‘just comes with the territory’ of an injury, there are cause and effect aspects to arthritis and articular cartilage damage. Staving off the inflammation in the acute or post-acute phase can prevent osteoarthritis (vs. arthritis) or further damage to the articular cartilage and decrease the chance of osteophytes (bone spurs) forming, which can have a detrimental effect on the muscle function around the knee joint. To date, there are no ‘special’ diets for knee pain sufferers, or strong evidence validating the use of certain foods and/or supplements that can reverse or prevent the onset of knee pain or inflammation. However, with well-known knowledge of how certain foods can prevent inflammation in the body, that can have a flow-on effect to preventing knee joint inflammation.
Lifestyle Changes to Support Knee Health
Exercise is good. It is an important part of staying healthy. It keeps you fit and makes you feel better both physically and mentally. In the long-term, regular exercise can be beneficial in symptomatic relief and slowing progression of knee osteoarthritis. There are different types of exercises which provide different benefits. These include range of motion and strengthening exercises, aerobic and general fitness exercises, and recreational and competitive exercises. Range of motion and strengthening exercises help to maintain or improve muscle strength, which is important in stabilizing the joint and shock absorption. Walking, stationary cycling, and swimming are examples of aerobic and general fitness exercises. These activities are low impact and safer for knees. Studies have shown that strengthening the quadriceps muscles and aerobic fitness both decrease progression of knee osteoarthritis. Recreational and competitive exercises such as golf, tennis, and badminton are higher impact and increase the chance of joint injury as well as disease progression. When this happens in the weekdays, simple preparation of meals and carrying of additional food and clothing may feel like a chore. This can cause an inclination to buy food rather than prepare food at home. This is an important time to remember healthy eating principles.
Maintaining a healthy weight — or losing weight, if necessary, is critical for minimizing pain and preventing worsening of knee osteoarthritis. Excess weight increases stress on the knee joint. Even a small weight loss can be helpful. It is known that reducing body weight can decrease painful symptoms. A substantial body of research is emerging that shows an association between weight loss and a slowing of knee joint damage. To assess if your weight is within a healthy range, a healthcare provider can measure your BMI and waist circumference. Ideally, try not to exceed your activities of daily living energy expenditure on high fat or high sugar foods. If you are not sure what your energy expenditure is on a daily basis, a dietitian can help calculate the amounts of different food types and provide education on appropriate portion sizes depending on your level of activity.
Weight Management
Considerable evidence outlines the relationship between increased body weight and knee osteoarthritis. A dose-response relationship has been shown in many studies between an increase in body weight and symptomatic knee osteoarthritis, showing that people who are overweight are 2.5 – 3.5 times more likely to have knee osteoarthritis than people in the lower weight range. High body weight is also associated with an increased prevalence and worsening of knee pain and knee osteoarthritis. Weight loss has been shown to reduce the risk of incidence or progression of knee osteoarthritis.
The main message is subjection and is used throughout the essay. Moderate weight loss improves the symptoms of osteoarthritis in the knee, reduces pain, and increases activity levels. It is particularly important to prevent the development or progression of disease in the uninjured knee of people with knee osteoarthritis, people who are overweight and lose 11 pounds than have an increase in knee osteoarthritis. High weight imposes multiple injurious mechanical effects on the knee. Systematic reviews of people who are overweight, including international patients.
Exercise and Physical Activity
Health and knee specialists recommend choosing exercises carefully to help stay active and better manage your knee osteoarthritis. This means choosing activities that are easier on the joints, as well as strengthening the muscles around the joints through their full range of motion. Regular exercise keeps the joints moving, restores and preserves flexibility, strengthens the muscles, and increases endurance. Avoid staying in one position for too long, as this can stiffen the joints, and try to move in a gentle way for 5-10 minutes at a time. For improving the force on the knees and hence symptoms, losing even a small amount of weight can help. For example, losing only 8 pounds can take 16 pounds of pressure off the kneecaps. And remember, while exercise is important, so is rest. Osteoarthritis sufferers need to strike a balance between the two, alternating between activity and rest so as not to be overactive during the times when they feel good, and not become deconditioned during the times when they don’t.
Joint-Friendly Habits
When standing for prolonged periods, try to put equal weight through both legs. If you normally stand with your weight more through one leg than the other, it can cause misalignment in the long term. This can make one leg stronger and more developed than the other and may increase the risk of knee injury. Using a footstool to raise one foot slightly when standing for long periods can also reduce the pressure on your knees.
The way you sit and stand can have a real impact on your knee health. How many times have you felt discomfort or pain in your knees after sitting slouched or tilted to one side for a prolonged period of time? Correcting your sitting posture can help reduce the pressure on your knee joints. Sit upright with your back straight and your feet flat on the floor. Avoid low, soft seats as they make it harder to maintain good posture. Use a small cushion or lumbar roll to support the natural curve of your lower back. Try to change your sitting position at least every 30-45 minutes as this reduces the build-up of pressure on your knee and leg joints.
In addition to making changes to reduce the risk of knee pain, there are also ways to change your everyday habits that can help you take care of your joints. These habits involve looking at how you perform daily tasks and making simple changes to help relieve the pressure on your knees and prevent further injury.
Seeking Professional Guidance
When osteoarthritic knee pain becomes severe, it can be very disabling and costly. It is important to consult a bone or joint specialist (orthopaedic surgeon) who is trained to diagnose and treat knee arthritis. A surgeon can provide a wide range of treatment options including exercises, medications, and injections, as well as the most advanced surgical procedures to help alleviate pain and improve mobility. A surgeon can help you decide what the best course of action is in managing your knee pain based on the severity of your arthritis and your personal goals. This decision may depend on many factors including your age, activity level, overall health, and the specific anatomic changes in your knee. If you decide to see an orthopaedic surgeon, you may be referred to one by your knee pain specialist, however, it is advisable to do some research and find one who specializes in treating your specific condition. Ask your doctor, friends and family, and consider seeking a second opinion.
Consulting a Knee Pain Specialist
A key point to remember when consulting these healthcare professionals is that the goal should be an integrated approach to managing your knee pain. This means that these professionals should communicate and work together to ensure the most effective care. Step one in this process would involve each professional assessing their role in managing your knee pain and how they will coordinate and cooperate with other professionals to achieve the best results for you. To give a simple example, a recent study has shown significant benefits of weight loss and exercise on knee pain in osteoarthritis. In this case, the physiotherapist, dietitian, and general practitioner should be in communication to best manage a patient’s exercise program and weight loss.
If your knee pain or osteoarthritis requires more specialized treatment, your physician may refer you to a rheumatologist. A rheumatologist is a physician who is an expert in the treatment of arthritis and other diseases of the joints, muscles, and bone. There are also a number of other healthcare professionals who might be recommended by your physician to meet your specific health needs. These may include physical therapists, occupational therapists, dieticians, and professional complementary medicine providers.
Physicians are frequently the first type of specialist to be contacted about knee pain. Before consulting a specialist, it may also be beneficial to consider going through an orthopedic clinical assessment. This entails a series of physical tests and inquiries about the knee pain to effectively diagnose the condition and determine the most suitable course of treatment. This is important because an accurate diagnosis provides the most appropriate treatment to resolve the condition and prevent future occurrences. If surgery is not an immediate consideration, your orthopedic specialist may send you back to your physician with recommendations to treat any specific conditions and possibly some general advice on how to improve your knee health.
Accessing Nutrition Services in Singapore
In conclusion to the topic on the role of nutrition in managing knee pain, we understand that nutritional management is often underestimated with regard to knee pain patients. However, a multi-disciplinary approach involving your physiotherapist, occupational therapist, doctor and a dietitian, will definitely help you get better relief and improvement to your knee condition. By paving the new initiative to develop dietetic standards in Singapore, this will be good news to all knee patients as they can be assured of better nutrition care and greater improvement to their knee condition. This will also ensure that nutrition services provided to patients are safe, effective and of a high standard. Last but not least, it’s time to take big steps for small changes to better manage your knee condition!
A joint force by three government bodies, the Singapore Nutrition and Dietetics Association (SNDA), the Health Promotion Board (HPB) and the Health Sciences Authority, has led the development of the Singapore Standards of Dietetic Practice for dietitians in Singapore. This will definitely ensure that dietetic practices are being done in a systematic and professional manner, ultimately leading to better service and client satisfaction. This initiative will also be a regulating tool for all dietitians and nutritionists to uplift the standard of nutrition care in knee pain Singapore. With that, “We will definitely see better management of nutrition-related health problems in local patients and the community,” said Ms Christine Ong, a member of the development team.
