Can you virtually improve your knee pain?

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

Follow me on Twitter @RobShmerling

If you’ve ever had significant or persistent knee pain, you know it can be a major problem. Climbing stairs or just walking around can be agony, and trying to exercise on a bad knee can be impossible.

For people with severe osteoarthritis of the knee — the type most closely linked with aging or prior injury — knee pain may be unrelenting and often worsens over time, causing disability and reduced quality of life. Osteoarthritis is also expensive: we spend billions of dollars taking care of this condition each year in the U.S. The prevalence of osteoarthritis and the costs of caring for it are rising due to our aging population and rising rates of obesity (which is a major risk factor for osteoarthritis).

While exercise, loss of excess weight, and medications can help, they tend to be only modestly effective and temporary at best. That’s why an estimated 700,000 knee replacements are performed each year in the United States. Though there are risks associated with any surgery and it’s not 100% effective, knee replacement surgery is the most reliably effective treatment for severe osteoarthritis of the knee.

A new study, a new approach

A recent study published in the Annals of Internal Medicine takes a unique approach to the treatment of people with osteoarthritis of the knee.

Researchers divided 148 people with osteoarthritis of the knee into two groups: one group was encouraged to access standard educational material from the web regarding osteoarthritis. This included information about medications, diet, physical activity, and exercises from the research website. The other group not only had access to these same materials, but also received:

  • an interactive web-based program about how to cope with pain, with eight weekly sessions lasting 35-45 minutes in which participants learned relaxation techniques, how to balance rest and activity, ways to distract one’s attention from pain, and other strategies
  • seven Skype-based sessions over three months with an experienced physical therapist. Each session lasted 30 to 45 minutes and covered home exercises to strengthen lower limb muscles. In addition to video presentations, each participant received free resistance bands, ankle weights, and a pedometer.
  • email reminders that regularly encouraged participants to take full advantage of these interventions.

The study found that after the three-month period was completed, those receiving the additional pain management and physical therapy care through the internet-based programs reported significantly less pain and better function than those receiving only the standard information. And the improvement continued for at least six months after the program ended.

As is true for all studies, this one had limitations. For example, it included patients who self-reported their diagnosis. That means that some of the study participants’ knee pain could have been due to something other than osteoarthritis. And all the patients had access to the internet and the ability to use it; the result might not apply to less educated individuals or those without regular online experience. And it’s possible that the improvement noted by those receiving online pain management teaching and online physical therapy was due to the placebo effect; after all, this group had much more attention and interpersonal interaction than the standard education group. Of course, if an intervention is reliably effective, safe, and inexpensive, it may not matter much if it’s due to the placebo effect.

What’s the big deal?

While none of the interventions in this study was particularly novel, delivering them via the internet is. Increasingly, telehealth — providing medical care from a distance through telecommunications technology — is becoming more common. And in many settings, it’s already routine. A physician can talk to a patient thousands of miles away and examine certain parts of the body (such as the skin) and take good care of a patient who might otherwise be unable to get care at all. The ECG of a patient in an ambulance can be digitally transmitted to a cardiologist well before the patient arrives in the emergency room, allowing treatment advice from a specialist much sooner than in the past. Similarly, an x-ray, CT scan, or MRI can be read by a radiologist far from where the images were obtained.

What’s next?

While this study is encouraging, we still need better treatments for osteoarthritis. After all, online education, pain management modules, and physical therapy may help, but they are unlikely to prevent the need for knee surgery if the arthritis is severe.

But the results suggesting that telehealth may be able to improve the well-being of people with osteoarthritis of the knee is only the latest example of what is likely to be the widespread application of this approach to care. Considering the millions of people worldwide who lack access to basic as well as specialized medical care, the potential for telehealth to bridge this gap is enormous.

Comments:

  1. Tania Hodder

    As a professional massage therapist I get a lot of clients with joint pain, particularly older clients with problem hips and knees. While I’ve been able to help relieve their pain and discomfort and improve mobility with my massage sessions, as well as achieve positive results with natural, topically applied analgesics (such as therapeutic grade essential oils), unfortunately, for joints that are damaged (and have been for some time) there’s only so much that can be done without surgery and joint replacement. Of my clients that have had hip and / or knee replacements (which includes my Dad) most feel like they have a new lease on life and their relief is obvious. It’s wonderful to see just how much the medical procedures (and also the ‘parts’ used) have advanced in joint replacement surgery over the years.

  2. Janie

    Does anyone have a similar experience I am about to tell? Please, please let me know. ……I had total knee replacement surgery in June, 2016; I was excited because I thought I was going to be able to take walks again….WRONG, after going through the long rehab nothing changed for except “bone one bone” was taken care of, but I am still left unable to walk up stairs, can only walk for 10 or 15 minutes, standing is kind of difficult. The pain in the knee is 24/7. Now the other knee needs to be replaced. I worked for 43 years and have never been to the doctor for any knee issues. When I stand and walk in place, the knee feels like a “rubber band” that is being stretched and released. I have mentioned this to my surgeon but he gave me his blessings to find another doctor to do the surgery on the other knee and try to fix the knee that has already had the surgery. I am 68 years of age. This is what happens when you work for 43 years full time with no “gap” in employment. Death around the corner with the stress that is building up.

  3. Jerry Forrest

    8 weeks ago today I had two full knee replacements, two days before my 80th birthday. When you wake up and see the two dressings the realization begins that the doctor has done his job and now it’s up to me to drive for success with the help of physical therapy. My sharing is when the therapist moves you to pain you must go further into the “pain zone”. Very difficult (painful!) but intime you will have moved the zone.

    Today I’m through with PT and on my own gym rouitine. When asked I describe my feelings today, “I feel like a kid with a new set of wheels”.

    Cheers Jerry

    • Esmereldan

      My mother says the same thing. She had both knees replaced, separately, 10+yrs ago. She’s 91, takes exercise and yoga classes 6x week along with water ballet 2x week. She gets every penny’s worth of her gym membership.

  4. Mrs. Dilek Cumrali

    After hyaluronic acid injection. I constantly did bycicle movements in the pool and in the sea. My knees are fine and it has been 3 years now that I did not suffer.I did not have another hyaluronic acid injection either. Another trick is not to change shoe height. I cannot wear high heel shoes. The same hight that you are comfortable with is fine. This is essential.. Good luck….Dilek

  5. Gerald Goldbach

    This story is basically bogus. Once the damage is done to your knee there are limited treatment chooses. Most narrow down to replacement.

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