Pillar 2: Control the Pain
Self-Help Interventions for Short Term Pain Relief
The treatments in this section focus on treatments you can do for yourself. You can use the treatments as often as they help and are practical in your life and context. Where applicable, we link you to videos that help to provide further practical detail, and simple products that are affordable for most. Remember, these treatments are for short term relief. For long term relief, see Pillars 3 and 4 (Reduce the Load and Make it Strong).
Simple Movement Exercises ★★★★
Why start here when you were expecting ice, heat medications? Because it is so important, it is easy and it is well proven. We are not talking about a several months long program here (although that will definitely have benefit too and is covered in the 4th Pillar). But it is important to understand just moving the knee can provide immediate relief. We realize for many people this sounds counter-intuitive as they feel like they want to protect the knee, but I can’t tell you how many times I’ve put a knee OA patient on the bike with low resistance and their pain reduced by 2-3 levels on the pain scale. in 5 minutes. Here are a couple of simple pain relief exercises you can try or immediate relief.
As an added bonus, the exercise videos are from a British website so they sound smarter :).
Simple Knee Range of Motion
Use a slider, small ball, or towel to gently move the knee between fully bent and fully straight.
If it hurst at the end of movement, just go until the edge of the pain
the more irritable and painful your knee is, the more you will want stability. A slider on the floor can keep you more stable than a ball
In the clinic, we use a gliding disc like this when the client is in pain to allow for more stability while we work on the movement
Knee Dangling
this exercise essentially distracts the painful joint surfaces away from each other, kind of like we do sometimes with a traction machine for the low back
note that this video oscillates the knee faster than we would prefer, particularly if your knee is quite painful
Some people may get relief from the weight of the leg alone, but we find most that they need to add 5-10 lbs of ankle weight to get enough traction to distract the joint. The easiest way to do this is to buy 2 5lb ankle weights. A good quality reasonably priced set can be found here.
Light Cycling
if you have access to a stationary bicycle, try using this with minimal resistance for 5-10 minutes
The movement at the knee will typically decrease pain nerve firing and act as a pump to reduce the swelling in your knee. The knee should feel less painful
Biking is an excellent long term knee OA management aid in the long term. If you interested, here is a good option for home can be found here.
A smaller under desk version such as a Cuubi can also get the same pain relief effects and can be found here
Off the Shelf Topical NSAIDS ★★★☆
Topical Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) are applied directly to the skin over the painful / affect part of the knee, many people find short term relief with these medications. Topicals reduce the risk of stomach issues or cardiovascular risks of oral inflammatories. Although it does not work for everyone, it is often recommended as a first treatment for OA of the knee due to its low risk profile.
The most common topical prescribed is Diclofenac. Diclofenac is available as an over the counter as Voltaren. This may be tried at home for knee osteoarthritis. However, most people will find they need a stronger form and this is only available by prescription from your family physician. Excellent further information on topical NSAIDs is available from The Arthritis Foundation.
Thermal Agents (Heat or Ice) ★★★☆
You’d think with a condition that has inflammation in its title (“itis” means inflammation), we would be using a lot of ice in the treatment of knee osteoarthritis. However, in general in practice, and in most of the guidelines, heat is generally more effective with the condition. There is some grey area though, so use either to find out what works best for you. If you take simple measures to protect your self from burns (heat or ice), neither should hurt you and you can experiment for yourself.
If you find heat most effective, it is a good idea to invest in a high-quality electric digital moist heat pack. Moist heat is generally more effective than dry heat, but a hydrocullator to produce moist heat is too expensive and impractical for most people to use at home. The digital moist heat pack draws some moisture out of the air and provides a nice at-home solution you can use at low cost everyday. We also frequently use these packs in clinic. Heat is often applied for 20 minutes at a time to the affected area. With digital moist heating packs, be sure you have the ability to feel hot / cold properly so you do not burn yourself.
For a great digital moist heat pack, link here to the Theratherm Digital Moist Heat Pack we use in clinic.
If you do prefer cold, a simple freezer ice pack may do the job. Apply the ice to the painful area for 10-15 at a time, with a protective barrier between your skin and the ice. Check your skin frequently to ensure you are not getting an iceburn. If cold therapy is quite effective for you and you have extended benefit funding, you might consider a motorized cold therapy unit such as the Ossur Cold Rush. Cold therapy units provide both compression and cold and can be used over an extended period of time for more effective cold therapy effects. If you are interested in obtaining one of these units, we can assist you in getting approval. Contact orthotics@fusionphysiochilliwack.com for more information.
Compression Bracing ★★★☆
Modern braces generally work through multiple mechanisms. In our experience, the best mild to moderate OA braces provide compression, stability, warmth, swelling control, massage of the joint, and probably some degree of joint control through ‘proprioception’ (feedback to the nervous system). For moderate to severe knee OA, ‘unloader’ braces are strongly recommended, however, we will discuss those in more detail in Pillar 3 - Reduce the Load.
Generally, guidelines probably have a bit to go in terms of catching up to the newer OA braces as there is little differentiation of old versus new versus unloading braces. However, they don’t work for everybody, and so we maintain this as a 3-star rating.
The most generally successful brace we have seen and used for mild to moderate Knee OA is the Bauerfeind Genutrain. This brace has had quick and fairly dramatic results for many of our patients and combines all of the above features including a medical-grade compressive knit, lateral and medial rigid plastic stability stays, and a massaging joint line pad. The compression is said to better activate the body’s own stability system, providing more stability than trying to control by splinting.
You can watch a short video to see what the Genutrain looks like to the right, or read more detail about it here. As it is a our most highly successful brace recommendation, we do stock it at FusionPhysio for patient convenience.
The Genutrain can be a bit tricky to fit, so we do recommend a quick bracing appointment with one of our physiotherapists. You can also get a version that increase the stability with the Genutrain S versions. Contact orthotics@fusionphysiochilliwack.com if you are interested in obtaining a Genutrain brace. These braces are covered by most extended benefit plans and we can assist you in checking coverage.
Mobility Aids (Cane or Walking Poles) ★★★☆
Nobody really likes to use a cane but it can make a big difference, particularly if you are going through a rough patch with your knee. Using a cane is really the most basic form of “unloading” the knee joint - a concept we discuss in detail in pillar 4.
Using a cane is perhaps not as straightforward as it seems though. Many people’s natural inclination is to use their cane on the same side as their sore knee. But actually, you should use the cane on the opposite side as your sore knee, and then step with both the sore leg and the cane at the same time. This allows your weight to stay more centred over your body, and to give your sore knee some offloading support.
It is always best to get an adjustable cane. A good option is an adjustable cane, and one option can be found here. In terms of the height of the cane, there should be a slight ankle of 10-20 degrees at your elbow when you hold the cane at your side.
Good ol’ Bob and Brad give a good overview of how to measure and use your cane in the video here.
Supportive Footwear ★★★☆
Although not frequently covered in the guidelines, this is really a common sense recommendation for most people. In general, it is our experience that footwear that provides a stable base for the lower extremity to function from can only help those with knee issues - although the direct relationship of footwear to Knee OA pain has not been covered by the guidelines. This is therefore given a 3 start recommendation based on our experience as physiotherapists. Particularly, you should consider avoiding worn-out shoes, shoes marketed solely on ‘cushioning’ and ‘memory foam’, skate shoes, and flats. A high-quality runner with some degree of stability is usually the best and helps the most with the biomechanics of the knee. See our Community Partners page for recommendations on local shoes retailers that can help you get good footwear.
