Author: Physician Patricia Wang | September 2021 | Zhongjing TCM
Knee pain is a common complaint seen in the primary care sector, and is prevalent in the elderly. The knee is the largest joint in the human body and one of the most complex. Being one of the weight-bearing joints, it absorbs a large amount of pressure as we carry out our day to day activities. For example, when running and climbing stairs, the pressure on the knee is about three times the weight of your body. This is one of the reasons why the knee joint is prone to wear and tear damages.
According to an article “骨关节炎患者，有何运动选择？” published in Lianhe Zaobao on 27 April 2021, more than 600,000 people in Singapore suffer from joint pain. And among these cases, knee osteoarthritis is the most common condition, accounting for more than 10% of the total population. Pain itself is not necessarily a bad thing. It can often serve as a reminder to pay attention to our body.
Common Types of Chronic Knee Pain
Degenerative Knee Pain (Primary Osteoarthritis)
With the knee experiencing long-term physical stress, the cartilage in the knee joint gradually wears away over time. As the cartilage wears away, it can lead to formation of bone spurs, joint deformation and deterioration of the connective tissues that hold the joint together. These physical changes result in joint pain and stiffness, which can then affect the mobility and function of the knee joint. This is more commonly seen in people over the age of 50.
Post-Traumatic Knee Pain (Post-traumatic Arthritis - Secondary Osteoarthritis)
This type of knee pain develops as a result of a physical injury. Injuries to the knee can result in damage to the cartilage, bone or surrounding structures, thereby changing the mechanics of the joint and causing it to wear out more quickly. This gradual degeneration of the cartilage can sometimes occur without any superficial appearance of the initial injury. Cartilage degeneration can then result in bone spurs and cartilage calcification. It is characterized by joint pain and decrease in joint mobility. It can occur in any age group but it is more commonly seen in young adults.
How does TCM view chronic knee pain?
In TCM, knee pain is classified under ‘’Bi Syndrome”. It refers to a syndrome characterized by the obstruction of Qi and Blood flow in the meridians due to the invasion of external pathogenic Wind, Cold, Dampness and Heat. This results in pain, heaviness, soreness, numbness and swelling of joints and limbs, often accompanied by reduced range of motion in the affected joint, joint stiffness, and joint deformation in severe cases.
Common causes include obesity, improper walking habits, repetitive squatting and exposing the knees to cold environments. Symptoms include pain and swelling in the affected knee, grinding or popping sound with movement of the knee, joint stiffness, feeling cold at the knees and reduced range of motion. The knee joint is the least stable when in a slightly flexed position. At this position, any external blow from the medial or lateral aspect of the knee can easily result in injuries to the medial and lateral collateral ligaments.
Before treatment, we need to first determine if the pain is caused by physical trauma. We need to exclude any possible fracture, dislocation, or injuries to the meniscus or cruciate ligaments. In such scenarios, patients might need to undergo surgical procedures to repair the fracture or damaged meniscus or ligaments. TCM treatments are more suited for chronic knee pain that happens due to gradual degeneration, presenting with varying degrees of cartilage damage and/or reduced joint space. Treatments like tuina and acupuncture are administered with the aim of slowing down the progress of the condition.
TCM Treatments
Based on clinical experience, many cases of knee pain are not due to problems with the joint itself, but rather problems with the quadriceps muscle.
The quadriceps femoris is located at the front of your thigh. The Latin translation of ‘quadriceps’ is four headed. It is actually a group of four separate muscles: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. They are among the largest and strongest muscles in your body. Contracting these muscles allows you to extend your knee, to perform tasks such as walking, running, jumping, rising from a chair or lifting a heavy object. The quadriceps also play an important role in maintaining the stability of the knee joint.
Having weak or tight quadriceps can both result in knee pain. When the quadriceps are not functioning properly, the knee has to take more load and it becomes more prone to degeneration or injury over time. Chronic knee pain due to problems with the quadriceps usually presents as pain in the knee when climbing stairs. Treatment for this type of knee pain is not complicated and it is usually pretty effective. Tuina or acupuncture is usually performed on the tender areas or muscle knots located on the quadriceps. Selected acupoints around the knee are also usually used, such as Xue Hai, Liang Qiu, Du Bi, Nei Xi Yan, Zu San Li and Yang Ling Quan etc.
Quadriceps Strengthening Exercises
It may be instinctive to stop exercising when you are having knee pain. However, inactivity can actually worsen your symptoms. Resting will cause the muscles around the knee to weaken, making the knee less able to bear your weight, which results in greater pain. Participating in appropriate low-impact exercises can strengthen the muscles around the knee, allowing the knee to better absorb impact, improving knee pain and stiffness. These exercises include walking, swimming, cycling and water aerobics. Working out in the pool is the best choice of exercise for individuals with knee pain because the buoyancy of the water supports your body weight, and therefore results in less stress placed on your knees. Remember to warm up before any exercise routine. Avoid exercises or activities that require you to have your joint fixed in the same position for long periods of time.
You can try these quadriceps strengthening exercises to ease your knee pain.
Straight Leg Lifts
Lie down on a yoga mat (avoid doing this on the bed). Straighten the lower limbs and slowly raise one leg off the floor at about 30 degrees. Hold the position for 10 seconds, then slowly lower it down. Rest for a moment and repeat. Do 2 to 3 sets of 10-20 repetitions for each leg, or until you feel slight soreness in your thighs. If you find it difficult to hold in this position, you can also bend your other knee and place it on the ground for support.
Leg Extensions
Sit in a chair with a backing. Place both feet flat on the floor with your knees naturally bent. Extend one leg as high as possible and hold the position for 10 seconds, then slowly lower it down. Rest for a moment and repeat. Do 2 to 3 sets of 10-20 repetitions for each leg, or until you feel slight soreness in your thighs.
Wall Sits
Place your feet firmly on the ground, shoulder-width apart. Make sure your knees and toes are pointing forward, and your back is flat against the wall. Slide your back down the wall while keeping your core tightened and bending your knees, like you are sitting down on a chair. Lower your body down slowly until your knees are at a 90-degree angle. If this is too difficult for you, you can increase this angle and sit at a higher height. Hold this position between 20-60 seconds, to the best of your ability. Repeat 2 to 3 times. You can slowly increase the duration or sit down lower (to a maximum of 90-degree angle at the knees) as you become stronger. It is important to keep your form, rather than aiming to hold for a long duration. One way to check your form would be to see if you can see your toes in line with your knees. If you cannot see your toes, it would mean that your ankles are too close to the wall. This would put pressure on your knees, rather than the quadriceps muscles, and this can worsen your knee pain condition.
Food Therapy for Chronic Knee Pain
Winter Melon and Chinese Barley Soup
Ingredients: Winter melon 500g, Chinese Barley (Coix Seed) 50g
Directions:
- Soak Coix seeds for 4-5 hours or overnight.
- Remove the skin and seeds from the winter melon, and cut into around 1.5cm chunks.
- Add Coix seeds and water into a pot and bring it to a boil.
- Lower the heat and simmer until the Coix seeds puff up or the water turns slightly white.
- Add the winter melon chunks and bring the pot to a boil again.
- Lower the heat and simmer until the winter melon turns soft.
- Season with salt to taste.
This soup can be taken once a day.
This soup helps to strengthen the Spleen, and clear Heat and Dampness. It is suitable for individuals with Heat and Dampness type of chronic knee pain.
Chinese Barley and Rice Beans Porridge
Ingredients: Rice beans 30g, Chinese barley 30g, Water 500ml
Directions: Both barley and rice beans take a long time to soften, and it is pretty inefficient to cook for such long periods of time. Hence, I would recommend two ways to cook this dish.
First method: Add both beans into a pot of water. Bring the pot to a boil and turn off the heat. Allow the beans to soak for half an hour. Bring the pot to a boil again and simmer for another half an hour.
Second method: Place both beans in a thermal flask. Pour in 500ml of boiling water and leave it overnight. This method is easier and more energy efficient as well.
This dish can be taken once a day.
This dish is commonly used to remove Dampness from the body. It is suitable for those with Dampness type knee pain.
Tips to Age-proof Your Knees
Exercise regularly but avoid high-impact exercises
Avoid high-impact exercises or activities that place a huge burden on your knees like climbing stairs, jumping and lifting of heavy objects. Engage in low-impact aerobic exercises regularly like walking, jogging and swimming. These aerobic exercises help to strengthen the knee, increase joint motion and function, enhance balance and flexibility, and control body weight. This eventually slows down the degeneration of the cartilage in the knee joint, preventing or delaying the onset of knee arthritis.
Maintain a healthy body weight
Being overweight adds extra burden on your knees, making it more prone to degeneration. When participating in sports or activities that require jumping, sudden stops and quick turns, the pressure on the knees can reach 4-5 times the weight of your body. When overweight, this pressure is then greatly increased.
Avoid wearing high heels
Wearing high heels increases pressure on the toes and forefoot, and also causes significant stress on the ankle and knee. To maintain balance while wearing heels, the pelvis tilts forward. This unnatural posture works your knees harder, which can contribute to joint degeneration and knee osteoarthritis. Choose flat-soled shoes that offer support to increase stability and reduce the impact on your knees.
Avoid setting your air-conditioner on extremely low temperatures
Having our knees exposed to cold environments or direct wind (either from the fan or air-conditioner) can also result in knee pain, soreness and weakness in the knees. Wind and cold can enter the knees in such conditions and slow down Qi and Blood flow in the meridians, resulting in pain over time.
Have sufficient sun exposure
Sun exposure is the main source of vitamin D for the human body. The body needs vitamin D to absorb calcium and phosphorus. This can help to prevent or slow down osteoarthritis and osteoporosis. You do not need to stay in the sun for a long time. Aim to get 5-30 minutes of sun exposure, twice a week. The UV levels are at their highest from 11am to 3pm, so it is advisable to be in the sun between 8am to 11am or 3pm to 6pm.
