Knee Pain (Gonalgia): Therapy

General measures

• Depending on the disease and stage of disease:
  • Relief and immobilization
  • Sports leave
• In case of joint effusion:
  • Immobilization and rest with cooling and elevation of the joint are observed
  • (PECH scheme: “P” rest, sparing, immobilization: “E” ice/cooling; “C” compression e.g. elastic bandage; “H” elevation above heart level).
  • Later, careful mobilization can then be started.
• In case of osteoarthritis or joint degeneration – see under osteoarthritis.
• In case of trauma – care depending on the nature of the injury.
• Nicotine restriction (refraining from tobacco use) – smoking can contribute to pain in the long term; it slows healing processes, worsens blood circulation and increases the risk of, for example, degenerative processes of the knee joint
• Alcohol restriction (abstaining from alcohol consumption) – alcohol leads to non-deep sleep (reduces the important REM phases and leads to sleep-through problems). The result is not enough restful sleep and decrease in pain threshold, ie increase in pain….
• Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight.
  • BMI ≥ 25 → participation in a medically supervised weight loss program.
  • Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.

Conventional non-surgical therapy methods

• Analgesics u. Anti-inflammatory drugs (see under drug therapy).
• Infiltration (intra- and periarticular) of local anesthetics, glucocorticoids, cartilage-protective substances, etc.

Operative therapy

• When conservative therapeutic influence is insufficient:
  • Operative arthroscopy (arthroscopy) – primarily first diagnosis by computed tomography (CT) of the knee joint to examine bony structures or magnetic resonance imaging (MRI) of the knee joint to examine menisci, cruciate ligaments, ganglia.
  • Open surgery

Medical aids

• Immobilization by:
  • Bandages
  • Splints
  • Plaster
  • Orthotics (medical device made by orthopedic technician, which serves for stabilization, relief and immobilization) – in case of ligament instability.
• Shoe orthopedic measures:
  • Shoe outer or inner rim elevation – for varus or valgus arthrosis.
  • Buffer heels if necessary

Nutritional medicine

• Nutritional counseling based on nutritional analysis
• Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
  • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
  • High-fiber diet (whole grains, vegetables).
• Observance of the following special dietary recommendations:
  • Diet rich in:
    • Omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – at least once or twice a week fresh sea fish, i.e. fatty sea fish such as salmon, herring, mackerel).
• Selection of appropriate food based on the nutritional analysis
• See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
• Detailed information on nutritional medicine you will receive from us.

Sports Medicine

• Endurance training (cardio training) and strength training (muscle training).
• Suitable sports disciplines are cycling and swimming if necessary.
• Other measures are:
  • Strength building and coordination training
  • Training of the quadriceps femoris (“four-headed thigh muscle”) muscle to center the patella (kneecap).
  • If necessary, leg axis training for malpositions (varus or valgus position).
• Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
• Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

• Thermotherapy, this consists of heat and cold therapy (cryotherapy):
  • Heat therapy in the form of balneotherapy or electrothermotherapy has analgesic (pain-relieving) effects and may improve walking distance and health-related quality of life.
  • Cryotherapy is used only in active, inflammatory osteoarthritis.
• Electrotherapy
• Ultrasound therapy

Complementary treatment methods

• Acupuncture – for pain management; hardly effective for chronic gonalgia.