Knee pain is the most common musculoskeletal problem in the elderly, and its prevalence increases with age. Frequent knee pain affects approximately 25% of adults. It also leads to physical disability and decreased quality of life (QOL). Osteoarthritis (OA) is a leading cause of knee pain and physical disability in the elderly.

Osteoarthritis is the most common form of arthritis among older adults. It is a degenerative joint disease that happens when the tissues that cushion the ends of the bones within the joints break down over time. These changes usually develop slowly and worsen gradually, causing pain, stiffness, and swelling. In some cases, people living with this disease are no longer able to work or perform daily tasks. OA is characterized by the breakdown of joint cartilage. Damage to the cartilage and bones limits movement and may cause pain.

Knee replacement / Arthroplasty

Knee pain derived from OA is a key symptom influencing the decision to seek medical attention. Among those with knee osteoarthritis, knee pain is a major reason for knee replacement. Knee replacement, also called knee Arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap.

Risk factors in knee replacement

• Replacement Joints Wear Out Requiring Additional Surgery
• Deep Vein Thrombosis (DVT)
• Anesthesia Complications
• Infection
• Artificial Joint Becomes Loose or Dislocates
• Differences in Leg Length
• Allergic Reactions
• Nerve Damage
• Damage to Tendons and Ligaments
• Knee Stiffness and Loss of Motion
• Wound and Bleeding Complications
• Persistent Pain
• Increased Risk of a Heart Attack

A Buildup of Toxic Metal Ions in the Blood

Risk factors of other commonly used Allopathic treatment

Commonly used medicines and treatments for OA include

1. Corticosteroids

They are a class of medications that help to suppress the immune system and reduce inflammation. Corticosteroid injections can cause dangerous side effects for some people, especially those who receive repeated injections.

Side effects may include:

• osteoporosis of nearby bone tissue
• osteonecrosis, which is the death of bone tissue
• a temporary flare of pain and inflammation in the joint
• joint infection
• nerve damage
• thinning or lightening of the skin and soft tissue around the injection site
• allergic reaction
• elevated blood sugar levels in some people with diabetes

2. Viscosupplementation

These types of injections are sometimes called hyaluronic acid (HA) injections.

According to the American College of Rheumatology (ACR), the most common side effects of HA injections into the knee are localized pain, warmth, swelling, and difficulty moving the knee. These side effects are usually temporary.

Other common side effects, according to the ACR, include:

• bleeding
• blistering
• rash or hives
• burning or coldness
• stinging or itching
• skin discoloration
• A feeling of pressure in the knee
• joint infection

3. Plasma-rich platelet injections

Plasma-rich platelet (PRP) therapy is a process that involves injecting the person’s blood platelets into the knee joint. This releases growth factors that may stimulate cells involved in tissue repair. After-effects may consist of local pain, headache, gastritis, stiffness, bleeding, syncope, tenderness, dizziness, nausea, tachycardia, and injection site bruising and/or swelling

What’s knee pain in Ayurveda?

Knee pain can be equated to Janu sandhi gata Vata mentioned in Ayurvedic classics. It is one of the most common Vatavyadhi, which can be co-related with Osteoarthritis.

Sandhigata Vata is the imbalance or vitiation of Vata and this vitiated Vata disturbs the normal state of the Kapha in all the joints.

Sandhigata Vata is characterized by symptoms such as Sandhishoola (joint pain) and Sandhishopha (swelling of the joint). There is a role of many environmental, dietary, and lifestyle factors in the pathogenesis of Sandhigatavata (Osteoarthritis). All these factors lead to Vataprakopa and affect the individual health a lot.

What’s the alternative in Ayurveda?

While modern medicine offers knee replacement surgery as a solution, Ayurveda provides natural alternatives that emphasize holistic healing and rejuvenation. Ayurveda provides an effective solution for knee replacement surgery as it tackles the root cause with Herbs and Panchakarma therapies.

Here we explore the various Ayurvedic external treatments for knee issues recommended in specific cases, including Dhaara, Choornakizhi, Lepam, Upanaham, Agnikarma, Raktamoksham etc.

1. Dhaara

Dhaara is an Ayurvedic treatment that involves pouring warm medicated water (Danyamladhara), oils(Pizhichil), milk (Ksheera dhara) or herbal decoctions(Kashaya Dhara) over the affected knee joint. This therapy helps reduce inflammation, and muscle spasms, soothe pain, and improve joint mobility. The continuous stream of healing liquids has a calming effect on the nerves, promoting relaxation and nourishment to the affected area.

2. Choornakizhi

Choornakizhi, a pottali made out of herbal powders is a form of fomentation. It reduces inflammation, joint stiffness and pain. It also aids in improving the circulation and flexibility of joints.

3. Lepam

Lepam involves the application of herbal paste directly on the affected knee joint. The medicinal properties of the herbs penetrate the skin, promoting healing and reducing inflammation. Lepam is particularly effective in cases of osteoarthritis and chronic knee pain.

4. Upanaha sweda/upanaham

Upanaham is a specialized Ayurvedic treatment where medicated herbal poultices are applied to the affected knee joint wrapped in medicinal leaves and then covered with a cloth bandage. This method aids in reducing swelling, relieving pain, improving circulation and promoting tissue repair.

5. Agnikarmam

Agnikarmam is a form of heat therapy where salaka (a kind of iron rod) is heated and kept over painful areas in a controlled manner. This therapy helps to alleviate pain and stiffness by relaxing the muscles around the joint.

6. Raktamoksham

Raktamoksham is a therapeutic procedure that involves controlled bloodletting to remove excess impurities from the bloodstream. This can be done with leeches (Jaloukavacharanam) or with needles (Siravyadham). This treatment is considered in cases where knee pain is associated with vitiation of Raksha (e.g. varicose veins) in the body.

7. Janu Vasti

In the context of knee issues, Janu Vasti (localized oil pooling on the knee) is employed. It involves creating a reservoir of medicated oil over the knee joint, which helps in nourishing the affected area.

8. Pichu & bandage

Pichu is a procedure of placing a piece of cotton soaked in medicated oil on the affected knees after evaluating the stage of the disease condition. Bandaging with the same is also an effective treatment. It is helpful in pain reduction and is a nourishing and rejuvenating therapy.

9. Shashtika shali pinda sweda

A bolus/ pottali made out of medicated red rice and milk (Navarra) is used in this. It is a form of fomentation therapy. It improves muscle strength and rejuvenates and re-energises the body. Adding meat along with this bolus also has added benefits in degenerative conditions.

Treatment for knee OA at SSANH

Knee Pain treatment at SSNAH usually lasts for about 14-21/28 days depending upon the severity of the conditions. Most patients get considerable relief in 14 days though patient-to-patient variation may be present.

On evaluating the condition of the patient, specific treatment is planned. Knee pain may be due to Osteoarthritis or it can be rheumatic pain, inflammatory pain, etc.

Proper understanding of the cause of knee pain is of prime importance in SSANH. A further treatment plan is drawn based on that. Both external and internal treatment protocols aid in successful treatment.

The primary aim is to reduce the inflammation present in the knees followed by pain relief. By the end of the treatment schedule strengthening treatments are provided. This prevents further damage and recurrence of the condition. Moreover, the quality of life of the patient becomes much better.

Post the inpatient treatment, oral medications and lifestyle modifications with strengthening exercises are advised. On regular follow-ups evaluation of the improvement of the condition is done and advice is provided accordingly.

Do’s and don’ts

The recommended diets and regimens are

• Wheat
• Black gram
• Red rice
• Grapes
• Dry Jujube
• Hot water/Warm water
• Sitting in sunlight
• Diet and regimens to be avoided include
• Barley
• Cold Water
• New fermentation products
• Dry Meat
• Excessive thoughts mental stress and anxiety
• Staying awake late at night
• Holding of natural urges
• ï†Excessive Walking and such exercises

Ayurveda offers a treasure trove of natural therapies that can complement or even replace knee replacement surgery in specific cases. These treatments focus on addressing the root cause of knee issues, promoting overall joint health, and improving the quality of life. However, it is essential to consult a qualified Ayurvedic practitioner to determine the most suitable treatment plan tailored to individual needs. By embracing Ayurvedic alternatives, one can embark on a journey of holistic healing and rediscover the joy of pain-free mobility.

In conclusion, the best Ayurvedic treatment for knee pain in Calicut offers a holistic approach to alleviating discomfort. With a focus on restoring balance within the body, experienced practitioners can personalise herbal therapies, dietary adjustments, and exercises. Embracing this ancient tradition could lead to a future free from knee pain, allowing you to live life fully. For the finest Ayurvedic treatment in Kerala for knee pain, Calicut shines as a destination known for its skilled practitioners and dedication to holistic well-being.