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Novel Remedies for the Aching Knees of Summer
By VICKY LOWRY
The start of summer is a busy time for Dr. Robert S. Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical Center in Manhattan. That is when his waiting room swells with patients who want to see him about their knees.
"The complaints of knee pain are directly proportional to the change in seasons," Dr. Gotlin said. "People run more in the spring and summer, and the pain usually comes from upping the mileage. It's hard not to overdo it when the weather is so nice."
Knee pain, Dr. Gotlin added, "is catching up to back pain as the No. 1 physical disability seen by sports medicine physicians."
Overdoing it, as Dr. Gotlin put it, is a major cause of sore knees and can lead to osteoarthritis. Knee pain can also result from torn ligaments, supporting excess weight and mechanical problems like having one leg shorter than the other or misalignment of the knee.
In the most severe cases, surgery may be necessary. But in recent years, more non-surgical treatments have become available, including new drugs that can be injected, applied topically or taken as pills.
The first course of action for a sore knee, experts say, is to turn to familiar home remedies for sports injuries, including ice, heat and over-the-counter anti-inflammatory medications like ibuprofen to reduce swelling and control pain. Doctors often recommend icing the knee in several short sessions at a time for the first 24 to 48 hours.
"I tell my patients to ice twice a day, for five minutes at a time, five minutes on, five minutes off, for a total of 15 minutes with the ice on," Dr. Gotlin said, adding that a bag of frozen peas can cover the knee or an icepack can be placed on a thin sheet of fabric to avoid freezing the skin.
After two days, patients can try heat, preferably moist heat like a hot-water bottle or a warm soaking in the tub, to relax tissues and increase blood flow.
If the pain does not go away in a few weeks, then it is probably time to see a doctor, who may prescribe stronger drugs, nonsteroidal anti-inflammatory medications like Vioxx, Bextra or Celebrex to reduce swelling quickly.
Vioxx and its pharmaceutical cousins are not the only pills that runners and other active people use for pain. In the last 10 years, glucosamine and chondroitin, two substances that occur naturally in the body and are sold as nutritional supplements, often combined in one tablet, have gone from being largely ignored to being widely recommended for treating osteoarthritis of the knee. Unlike traditional anti-inflammatory medications, glucosamine and chondroitin are thought to work against osteoarthritis by decreasing the rate of cartilage destruction involved in the disease and possibly increasing the formation of new cartilage.
The federal government is financing a major study on the effectiveness of the supplements, to be completed in 2005. A variety of other, smaller trials have found positive results, and anecdotal accounts of their ability to relieve arthritic pain abound.
"Dogs don't lie," said Dr. William Cabot, an orthopedic surgeon in Atlanta. "My friend had a golden retriever with arthritis. Homer couldn't even get up off the floor. At the end of several months of taking glucosamine, he was jumping up on the bed. That tells me it works."
One drawback to glucosamine-chondroitin combinations is that they take a while to have an effect, at least four to six weeks of taking up to 1,500 milligrams a day, Dr. Cabot said. "That's why a lot of people just stop using it," he added.
A common spice could turn out to offer quicker relief, but its effectiveness is not yet proven. Ginger, whose active ingredient is an oil called gingerol, has been used to treat the common cold and motion sickness. In a recent study conducted by researchers from Miami Veterans Affairs Medical Center and the University of Miami, patients with osteoarthritis of the knee who took ginger extract had a noticeable reduction of knee pain on standing, as well as an increase in knee function.