Medically-Guided Knee Pain Assessment Tool

Knee Pain Assessment Tool: Video Transcript

Intro:

The knee pain assessment tools that we have developed really have two parts. One is the more scientifically proven scale, which is the Lysholm Scale, with a score out of 100, that talks about knee pain and function, 100 being a great score, 0 being a very low score.

And then similarly we have a self-help score. The goal here is to encourage you to really get involved in self-help and that score is also out of 100, again 100 being you’re doing everything that we want you to do for self-help to try and help your knee get less painful and more function out of that knee, living with knee arthritis, managing it, taking charge of it, and minimizing pain, maximizing motion, and minimizing your dependence on anti-inflammatories.

The Lysholm scale is a standardized knee outcome questionnaire. It is what we use to assess the outcomes of our interventions to see how effective they are, and its been proven in clinical trials that this particular scale works for measuring knee pain and function with a score out of 100, 100 being a great score, 0 being a very low score.

The Lyscholm scale is, in general, in the last week or so, how has your pain been or how much instability do you have, not necessarily at that given instance but we want to get a gestalt for the last week or two how your knee has been doing and that’s the focus behind the Lysholm Scale.

We have a self-help score, and that score is also out of 100, again 100 being your doing everything that we want you to do for self-help, the diet, the exercise, the supplements, the modalities like ice and trying to keep your weight in check. The more you invest in self help, the more you adhere to self help, and the more compliant you are with self help, I think hopefully you will see the benefits with a better and improved Lysholm Score.

But I recommend before you start any self help regimen, that you will discuss this with your doctor, get their approval, its always smart to do that, especially if you’re starting some supplements or even if you’re starting an exercise regiment.

Limping:

How bad is your limp when you get up and start walking? Is it severe? Is there no limp? Because that’s an important function type of a question that is a part of the Lysholm Scale.

Support:

Do you use support to walk? Do you use a cane? Do you use a crutch or any assistive device to walk to take some pressure off of that painful knee? Its also important in letting us know how functional you are and what your requirements are, what other aides you need to keep your knee pain at bay and to maximize function.

Locking:

A lot of times, in people with either arthritis or meniscal tear, their knee, as they’re moving through a motion of walking, will just lock in one place, and they have to wiggle it out of place. That obviously causes pain and discomfort so locking is a very important part of the scale that really relates to pain and function.

Instability:

It’s important to know if your knee is unstable when you’re going down the stairs or when you’re walking rapidly. The knee is a very mobile joint; it has tremendous motion in it. So inherently, any joint with a lot of motion is not a very stable joint, so it lacks “x” amount of stability in order to get the motion, so there’s always a balance. The more motion a joint has, the less stability. The less motion the joint has, the more stability, knee being inherently a less stable joint with lots of mobility.

Pain:

Pain is obviously a very important part of the Lysholm Scale. The less pain, hopefully the more function, the more ability to do stairs or walk. As opposed to the old dogma, “no pain, no gain,” in the Lysholm Scale, no pain is all the gain.

Swelling:

Swelling is a very important part of measuring knee function, because swelling is two things, first of all there’s discomfort from the swelling itself to the person. Swelling can also inhibit important muscles, especially the quadriceps muscle, that we need for knee stability and to take pressure off the knee so you have less pain. So swelling is a very important part of measuring how functional the knee is.

Stairs:

How much difficulty are you having going up and down the stairs, or is it very easy to do stairs. The kneecap experiences significant loads when we do stairs and it’s a very important measure of pain and function.

Squatting:

Squatting is what I call the gold standard for measuring knee function and pain, I mean doing a squat places the maximum loads on the knee and the kneecap. So to me, the ability to do a squat without pain is sort of the gold standard of where we want every knee to be despite having arthritis.

Diet:

Our modern diet is so full of inflammatory foods, processed inflammatory foods. Having unprocessed raw vegetables and fruits is very important to have in your diet along with what we call Omega-3 fatty acids, which are found in things like avocados and fish. It’s important to have those because they have a potent anti-inflammatory impact, and the lower the level of inflammation in the body, hopefully the lower the knee pain. Also I'm a big believer in blueberries, or any dark berries really, because not only do they have a powerful anti-inflammatory impact but they also have something called bioflavonoids, which have been proven to reduce pain in knee arthritis.

Exercise:

Before you start any of these exercise therapies, you should really get it cleared with your doctor. Different people tolerate different types of exercise. Exercise therapy has been clinically proven; proper exercises improve knee pain, especially from arthritis. And there are many reason for this: you’re reactivating the muscles that were shut down by pain and when you activate the muscles, not only do they take the pain or the stresses off the joint, because the muscles take up the stresses, but muscles also are primary shock absorbers, so the more tone the muscles are the better they are able to absorb the shock, and the less stress on the joints. So it’s important to do the proper exercises, walking on an even surface, whether it’s on a treadmill or outdoors with minimal ups and downs. Now some people absolutely cannot tolerate walking because they have so much knee arthritis pain. In those people I try and switch them to either a stationary bicycle, because on a bicycle the weight is on the bike, or get into the water and do aqua therapy - which can also be very important. And you should combine that with simple things like a simple leg stand, five to ten seconds, five repetitions on each side, because that restores the balance and the strength. But as a general rule of thumb, walking thirty minutes a day is one of the best things you can do for your knee if you can tolerate it. If not, switch to a bicycle or aqua therapy.

BMI:

BMI or body mass index is a measure of height versus weight, and its calculated based upon those two variables. If you have a BMI in the normal range, it’s very healthy, not just for your knee, but also for your general health. Even if you’re slightly overweight or somewhat overweight and you’re BMI is higher, for every one pound you lose, you will take four pounds of pressure off your knees, so that’s an instantaneous four hundred percent return on your investment. So it pays for you to lose every pound if you’re overweight not just to lose the BMI but also to take the pressure off the knee, you’re knees will love you for every pound you take off if you’re overweight.

Supplements:

The supplements for knee arthritis that have some data are: fish oil, a couple thousand milligrams, 2000 milligrams has been really shown to decrease pain and stiffness in knee arthritis. Again, you have to check with your doctor because fish oil can thin your blood. Also, glucosamine chondroitin sulfate. There’s very good data on it on two big clinical trials that showed, for moderate or more knee arthritis pain, they actually had significant pain relief compared to placebo. If it’s just for mild knee pain they weren’t shown to be any better than placebo, but for moderate or severe, they were. So I recommend glucosamin chondroitin and a recent trial that came out called STOPP, S-T-O-P-P trial showed that the chondroitin sulfate in the glucosamin chondroitin may actually slow down the loss of cartilage, and slow down the process or progression of arthritis, so its important to have that supplement. And there’s some early data on things such as curcumin, that’s a turmeric extract, that curcumin may have very positive effect on arthritic knees, 500mg of curcumin a day.

Icing:

Icing is very important especially after exercise as a modality, because its been shown to reduce inflammation and pain and that is a very important tool in managing knee arthritis and to minimize your dependence on anti-inflammatories.