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Daily Living Questions & Answers

Sometimes I have trouble sleeping because my knee is bothering me so much. Is there anything I can do?

Dr. DiNubile's response:
Night pain is a very common complaint in individuals with knee osteoarthritis or inflammation. There are several theories as to why pain is amplified during the night, but no one knows the exact reason for this phenomenon.

Restful sleep is very important in maintaining overall health, so anything that routinely interferes with sleep is not good for your health. Try to determine what you may be doing earlier in the day (or even the day before) that may be provoking your knee. Sometimes this takes a little trial and error or detective work. You can then modify your activities accordingly.

Your physician may also suggest remedies that can improve your situation. Some patients benefit from heat or ice in the evening or even a little physical therapy. Others do well with an evening medication such as acetaminophen or an NSAID like ibuprofen, but I try to avoid prescribing narcotics or sleeping pills. I have had success in alleviating the night OA knee pain with the use of viscosupplement injections like Synvisc-One.

Be sure to talk to your doctor about nighttime symptoms. Be proactive — don’t take them lying down!

More Daily Living Questions

Going up and down stairs is really painful for my knees, but I live in a house with stairs so I can’t avoid them. Any suggestions?

Dr. DiNubile: Stairs can be a major challenge for anyone with osteoarthritis of the knee. This is because your knee has to work harder when ascending and descending stairs, putting more pressure on the already-worn joint surfaces. Also, individuals with knee osteoarthritis tend to have weaker supporting leg muscles which means that there is less power to negotiate stairs. Your leg muscles also act as important shock absorbers, so weaker muscles mean less protection for your vulnerable knees.

To improve your situation I would recommend daily strengthening exercises for your thigh muscles. A short course of physical therapy can be helpful in developing a program that is right for you. If you are overweight, losing even a few pounds lessens the load on your knees, especially on stairs. Also, trying not to carry heavy loads up and down all at once. Lean on the rail a little to cheat, until you get that leg strength improved.

On long car rides my osteoarthritis knee pain really bothers me.  Is there anything I can do to make it better?

Dr. DiNubile: One of the most common symptoms of knee osteoarthritis is stiffness. This occurs even in the early mild cases of knee osteoarthritis, as well as the more advanced stages of arthritis. It also seems to happen more after an individual has been sitting for a period of time, especially in a more cramped situation like a car or airplane. Remember, “motion is lotion” for your joints. The knee is no exception. Movement helps lubricate and nourish your joint surfaces. A knee joint with osteoarthritis is particularly susceptible to stiffness when it is held in one position for long periods. The solution is to try and keep moving. Take breaks as often as needed (usually every hour or so) to stop the car and move about.

I’m really excited about going on vacation to Rome next month but worried my osteoarthritis knee pain will get in the way. Is there anything I can do to prepare for my trip or anything I should avoid doing while there?

Dr. DiNubile: Vacation and travels can be rough on your joints, especially if you have arthritis. Problems can start at the airport when all too often you’re walking around carrying heavy luggage. This puts added strain on your joints. Also, once you’re in Rome, you’ll probably be walking much more than your body is used to. Pack a little lighter in terms of your carry-on baggage so that you are not lugging things around the airport. If you take prescription medications or over-the-counter pills for your arthritis, be sure to bring extras as you may not be able to get what you need in Europe. Also, bring a freezer gel pack so that you can ice your knee at the end of a long day. Try not to over do it on any one day and allow for some rest stops along the way. If you’re having a significant flare-up the week before you leave, your physician can inject cortisone into your knee that will hopefully give you temporary relief and make the trip more comfortable. For a more chronic type of pain, you should talk to your doctor about a treatment like Synvisc One. A simple injection done in the office setting can provide up to six months of knee pain relief for osteoarthritis related pain which can make your trip more enjoyable. Ideally, this would be done a few weeks before you leave so that the treatment has a chance to begin working. Have a great trip!

I have osteoarthritis in both of my knees and I work in an office all day. Sitting at my desk really makes my knees stiff. Are there any stretches that I can do to help keep the aching at bay?

Dr. DiNubile: It is very typical for osteoarthritis to cause stiffness in your joints if you’ve been inactive or sitting. I believe your joints are sending you a message that they were meant to move.

Over the years I’ve learned a lot from my patients, including providing me with some interesting quotes that are appropriate for your situation. One active, elderly lady (who actually rode her bicycle to her doctor visits) always reminded me “when you rest, you rust.” Another mature athlete would always tell me “motion is lotion.”

My recommendation is that you try to take breaks and get up and move around. Walking should help promote the natural lubrication within your joints. Also, gently straighten and bend your knee four or five times every hour or so when you’re at your desk so that things don't stiffen up unnecessarily. Use your lunch break to get some exercise — but if that’s not possible be sure to schedule your exercise either before or after work. It is a critical component of keeping your joints healthy.



PLEASE NOTE: The views presented herein are solely those of Dr. DiNubile, Orthopaedic Surgeon. Sanofi does not endorse Dr. DiNubile or his book, FrameWork. Dr. DiNubile is a paid advisor for Sanofi. Be sure to consult with your own doctor before starting any exercise program or health regimen.

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Dr. DiNubile is an Orthopaedic Surgeon specializing in Sports Medicine in private practice in Havertown, Pennsylvania, and is a Clinical Assistant Professor of the Department of Orthopaedic Surgery at the Hospital of the University of Pennsylvania. Dr. DiNubile has been chosen in "Best Doctors in America" as well as "Guide to America's Top Surgeons."

He is the author of the bestselling book, Framework—Your 7 Step Program for Healthy Muscles, Bones & Joints (Rodale) and is Executive Producer and host of the award winning national PBS television special, Your Body's FrameWork.

Indication

Synvisc-One® (hylan G-F 20) is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen.

Important Safety Information for Synvisc-One

Before trying Synvisc-One, tell your doctor if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to SYNVISC or any hyaluronan-based products. Allergic reactions, some which can be potentially severe, have been reported during the use of Synvisc-One. Should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, and should be used with caution when there is swelling of the legs due to problems with venous stasis or lymphatic drainage.

Synvisc-One is only for injection into the knee, performed by a doctor or other qualified health care professional. Synvisc-One has not been tested to show pain relief in joints other than the knee. Tell your doctor if you are allergic to products from birds – such as feathers, eggs or poultry – or if your leg is swollen or infected.

Synvisc-One has not been tested in children (≤21years old), pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child.

Talk to your doctor before resuming strenuous weight-bearing activities after treatment.

The side effects sometimes seen after Synvisc-One include (<2% each): pain, swelling, heat, redness, and/or fluid build-up in or around the knee. Tell your doctor if you experience any side effects after treatment with Synvisc-One.

 

View the Complete Prescribing Information for Synvisc-One

 

Indication

SYNVISC® (hylan G-F 20) is used to relieve knee pain due to osteoarthritis (OA). It is for patients who do not get enough relief from simple painkillers such as acetaminophen, or from exercise and physical therapy.

Important Safety Information for SYNVISC

Before trying SYNVISC, tell your doctor if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to SYNVISC or any hyaluronan-based products. Serious allergic reactions have been reported. Should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, or circulatory problems in the legs.

SYNVISC is only for injection into the knee, performed by a doctor or other qualified health care professional. SYNVISC has not been tested to show pain relief in joints other than the knee. Tell your doctor if you are allergic to products from birds - such as feathers, eggs or poultry - or if your leg is swollen or infected.

SYNVISC has not been tested in children (≤21years old), pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child. Talk to your doctor before resuming strenuous weight-bearing activities after treatment.

The side effects sometimes seen after SYNVISC include pain, swelling, heat, redness, and/or fluid buildup in or around the knee. These reactions were generally mild and did not last long, but in rare occasions these side effects were more severe. The most commonly occurring adverse events outside of the injected knee were rash, fever, nausea, and headache.

View the Complete Prescribing Information for SYNVISC

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Important Safety Information: SYNVISC and Synvisc-One are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee.