‘A quiet epidemic’: Why so many Canadians experience knee pain
At some point, you’ve probably heard someone in your life complain about “bad knees.” Painful knees may prevent some people from running or lifting heavy objects, but what’s the root cause of it?
Dr. Najam Mian, a physical medicine and rehabilitation specialist in Vancouver, told Global News people who often feel knee pain may see swelling and mechanical features like clicking, catching and locking.
“Often, patients feel restricted in their abilities to perform household or recreational activities and are scared to push their knees due to fear of causing further damage to their knees,” he said.
Mian, who is also a clinical assistant professor at the University of British Columbia, added that along with back pain, knee pain is one of the most common presenting symptoms in musculoskeletal, sports medicine and chronic pain clinics across the country.
“There can be various anatomic sources of knee pain,” he added. “These can include the internal structures of the knee like menisci, ligaments and cartilage, the muscles surrounding the knee and the nerves that supply the knee.”
Dr. Paul Wong, chief of orthopaedics at Michael Garron Hospital in Toronto, told Global News that knee complications in Canada are becoming a “quiet epidemic.”
“When people think of disease, they think of heart problems or diabetes, but they’re kind of stabilized,” he said. “What we see in the practice is that arthritic problems keep growing higher and higher each year… much higher than what we expected.”
Wong added that following C-sections, knee replacements are the most common inpatient surgery in Canada, and as a practising knee surgeon for more than 20 years, he has seen these surgeries double.
Why do I have knee pain?
There are several reasons a person could be dealing with knee pain.
“Knee pain can be experienced due to acute tissue injury, such as when someone twists their knee and tears a ligament,” Mian said.
But more commonly, he explained, knee pain is often the result of “inappropriate biomechanics” leading to increased force on the knee like patellofemoral pain syndrome (or runner’s knee) or knee conditions like osteoarthritis.
Janie Wilson, a professor with the department of surgery at McMaster University’s School of Biomedical Engineering in Hamilton, Ont., added that osteoarthritis is the most common chronic joint disease.
“Knee osteoarthritis is a progressive disorder that typically gets worse over time, marked by increasing pain and functional disability,” she said via email.
“Osteoarthritis represents both the physical disease, which is characterized by changes in the structure of the knee joint (less shock-absorbing cartilage, changes to the surrounding bone, etc.), but also the illness, which is the pain, aching, swelling and stiffness that affect the person’s ability to function and their quality of life.”
Osteoarthritis can also be idiopathic, she added, meaning there is no known cause, but the condition could be linked to age, obesity, sex or joint deformity or injuries.
“The pain associated with osteoarthritis can differ among individuals, and the exact source of osteoarthritis pain remains a focus of research,” she continued.
Knee pain could also be a result of sensitization of the nervous system after an injury, Mian added.
“Most knee injuries can be evaluated and initially treated by an allied health-care practitioner such as a licensed physiotherapist,” he continued. “It is important to seek a physician assessment if you have features of infection such as fevers or chills, features of inflammatory conditions such as multiple swollen joints and rashes, have severe unrelenting pain or knee pain lasting more than three months.”
Anterior cruciate ligament (ACL) tears are often seen in athletes, he added.
“These can cause significant emotional distress due to the long downtime from sport and can predispose to development of earlier knee osteoarthritis,” he said. “Some ACL injuries require surgery with months of post-operative rehabilitation.”
What are the treatment options?
Depending on the type of pain — and injury — you have, treatment options for knee pain can vary.
Acute knee injuries can be treated with resting, icing, compression and elevation — also known as the RICE method — and the addition of rehabilitation, Mian said.
For chronic knee pain, there are several approaches to pain management, he added. There are physical strategies that include working with a physiotherapist or sticking to a home-based exercise program. Psychological strategies include mindfulness techniques, learning about hurt versus harm and counselling to reduce fear of movement.
There are also medications like acetaminophen and anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs like Advil and Motrin provide some symptom relief, Wilson said, however they are not effective in changing the course of the condition and can often present undesirable side effects.
“A cortisone shot is an example of a drug delivered directly to the joint, which can provide patients with symptom relief for up to four to six months,” she said.
Wilson added that studies have also shown physical activity and exercise are the most effective treatment options.
“Weight management has also been shown to improve symptoms of pain, and it has been shown that exercise combined with weight loss doubles the benefit of symptom management,” she said.
Then there are the surgical options.
“Cartilage in the knee joint has very limited healing capacity, and so if there are holes or pitting in the cartilage, there are some surgical repair procedures that can be used for treatment,” Wilson said, adding that the percentage of cases that fall into this category are small.
In Canada, there are more than 60,000 knee-joint-replacement surgeries performed every year, she said.
“This surgery aims to remove pain and restore function of the joint by replacing the ends of the bones with a typically metal-on-plastic articulation and, at times, realigning the joint for more distributed forces through the joint,” she said. “Because of the growing incidence of osteoarthritis in Canada, wait times of joint-replacement surgery can be significant as hospitals try to keep pace with the demand.”
What can we do to protect our knees?
While Wong can’t explain why more Canadians are getting more knee-based surgeries or experiencing more knee pain as a whole, he says it could be multiple factors.
About 80 per cent of his patients who are getting knee-replacement surgeries or dealing with knee pain are immigrants, he said, and for Asians, for example, it could be cultural as many Asian communities kneel to pray.
Other factors can include genetics and obesity but also trends in society.
He added that more people take part in marathons now than they did decades ago, or play sports like soccer and tennis. This is often when you see injuries related to the knee, he added.
But this is not to imply that working out will cause knee pain. Mian said there are numerous muscles around the hip, knee and ankle that strengthen and support the knee joint.
“It is extremely important to maintain conditioning of these muscles in order to prevent injury and to rehabilitate after a knee injury,” he said.
“Often, when people develop chronic knee pain, their natural reaction is to stop exercising… unfortunately, this leads to further weakness and psychological fear of movement, which in turn leads to increased chronic pain.”
This cycle can become difficult to break so regular exercise is important.
“In general, we should always maintain some combination of aerobic, strength-based and stretching-based exercises a few times a week,” Mian said.
Wong added that we should also stop treating knee pain as an old person’s issue, and Wilson noted that awareness of joint health is important overall.
“Because osteoarthritis was historically referred to as a ‘wear-and-tear’ disease, this has installed a fear of overuse in some individuals,” she said. “However, the best evidence shows that the more physically active we are, the better our joint health.”