When was the last time you felt pain in one or both of your knees?
For the fortunate few, this could be many years ago. But for many of us, we may have experienced some level of knee pain perhaps a few days ago, or even having knee pain at this very moment whilst reading this article.
The truth is, knee pain is very common and affects people of all ages. The knee is the joint that is most prone to injury.
In Singapore, a National Health Surveillance Survey (NHSS) conducted in 2013 found that the estimated national prevalence of knee osteoarthritis (OA) was 11%, and women were more likely to be affected than men.
Another Singapore study found that approximately 40% of elderly Singaporeans have had knee pain for five years or longer, and of these, only half consult a doctor to seek treatment. Many people live with chronic knee issues and have to deal with pain on a daily basis.
As a physician who has served in various Orthopaedics departments at hospitals before working in General Practice, I have met many patients with knee pain throughout the course of my career. As an avid sportsman, I also have friends and former teammates who have suffered severe injuries in the past and now suffer chronic knee pain.
There are too many stories to tell, but two memorable examples stand out. The first story is about Simon, whom I met a few years ago. Simon, then a University undergraduate, was a rugby player back in junior college. He recounted to me that his knee troubles first began when he experienced a sharp pain in his right knee while playing rugby. He initially ignored it, assuming it was just a sore knee from the physical demands of the regular training sessions.
However, he realised soon after that his knee would easily buckle or give way, and decided it was time to consult with an Orthopaedic Surgeon. An MRI scan revealed a completely torn anterior cruciate ligament. Simon recalled feeling devastated as this injury meant he would not be able to represent his school at the national championships. Nevertheless, he opted to undergo surgery as he wanted to still be able to play the sport he loved.
They say lightning never strikes the same place twice, but soon after Simon returned to rugby, he suffered a crushing tackle from an opponent that resulted in a re-tear of the reconstructed ligament. He went for a revision surgery, which was more complicated than the first. He had been told that his knee would never be the same again, and it was highly improbable that he would be able to return to competitive sports again.
When I spoke with Simon, he was in the recuperation process and doing physiotherapy. There was a certain stoic resignation in him, and I remembered he said something profound: “Perhaps these injuries have occurred to teach me something. I am at probably the lowest point in my life, but from here the only way is up. The stakes are pretty low right now, but the sport is my life. I’m motivated and determined and I believe that one day I will be back.”
The second story revolves around Mr A, a jovial, elderly gentleman in his early 80s, who had been working for 30 years as a cleaner at the airport. The arduous daily grind of standing and walking had taken a toll on his body. For many years, Mr A had been suffering from knee Osteoarthritis.
He told me that every morning he would wake up to excruciating knee pain and stiffness, and at the end of a long day at work, his knees would often swell up. His knees were bowed and deformed, and his X-ray showed severe joint space narrowing (i.e. bone rubbing against bone). I asked him if he had considered retiring to avoid aggravating his suffering.
He smiled at me, “How can I retire? As long as I can still walk, I need to work to earn
money for my family. Uncle doesn’t earn much as a cleaner, but every cent counts!”
He candidly explained that his only son had died from a motorcycle accident years ago, and he had two young grandchildren to take care of. I was very touched. This was a man who had endured unimaginable emotional and physical suffering, and still braved on to labor at an age that most of us would happily retire.
I committed myself to help Mr A improve his knee ailments. Surgery was not an option for him due to financial constraints, and his age put him at an increased risk. I realised that Mr A was a suitable candidate for intra-articular hyaluronic acid injection, which was a simple injection that would improve lubrication in his knee joint and provide medium term pain relief.
After careful discussion, he decided to proceed with the treatment. He returned a month later visibly more pain-free, and thanked me profusely as the treatment had worked wonderfully for him. I wished him well and felt encouraged.
Knee pain is painfully common (pun intended). Please do not ignore it! It is imperative to recognise when you are experiencing knee pain and speak to your doctor. If you have family or loved ones who are living with knee pain, encourage them to seek treatment as early as possible. You may have more treatment options and better outcomes than you imagine.