HealthExploring Alternative Therapies for Knee Pain: Options in Singapore

Exploring Alternative Therapies for Knee Pain: Options in Singapore

Seventy-eight percent of people over the age of 50 have knee pain with activity. In the US, this accounts for almost 14 million individuals. And as the number of total knee replacements skyrockets by the year 2030, this number will continue to climb. Knee pain occurs from various conditions including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. With the increase in knee pain, there have been increased efforts to find a remedy for the suffering. Numerous individuals are looking for alternative forms of medicine in an attempt to avoid invasive and costly surgical procedures. These treatments are focused on pain relief and improving function, often times they are looked at to be complementary to conventional treatments. The purpose of this paper is to explore the many alternative remedies there are for knee pain, primarily focusing on those in knee pain Singapore. A holistic approach with ancient remedies stemmed from hundreds and even thousands of years of experience offers much wisdom that can complement modern medicine. With Singapore’s vast array of cultures comes a vast array of alternative therapies. This paper will examine a number of different alternative therapies from many different cultures, weighing the cost and the effectiveness for each. In addition to the alternative therapies comes a unique culture of traditional medicine. This paper will also explore some traditional remedies for knee pain, and the various herbs and methods of healing that different cultures have used throughout the ages. Given the huge number of knee replacement surgeries, we must weigh the cost of these surgeries with their benefits. Can these alternative remedies delay the need for invasive knee surgery? What are the opportunity costs of foregoing surgery in pursuit of these alternative treatments? These are important questions for knee pain sufferers and their families as healthcare costs continue to increase. This paper does not discount western medicine in its approach. Rather, it explores the best manner of treating knee pain and leaves the judgment of what is best to the reader. In considering the high number of knee replacement surgeries, we weigh the cost of these surgeries with their benefits, considering alternative therapies as a possible means of healing knee pain. This paper will conclude with an analysis of the cost-effectiveness of alternative therapies and their efficacy in comparison to conventional treatments for knee pain.

Traditional Therapies for Knee Pain

Another form of therapy is weight management. This isn’t therapy in the traditional sense, but a reduction in body weight can greatly reduce stress on the knees and postpone the progressive damage to the joint. It has been said that for every pound lost, four pounds of stress are taken off of the knees. So for those suffering from knee pain, weight loss is an effective form of pain relief. Diets can be self-monitored, but for best results, it’s better to have a balanced diet of fats, proteins, carbohydrates, minerals, vitamins, and fiber evaluated and monitored by a dietitian.

Aerobic exercise is also recommended to those suffering from osteoarthritis. It’ll help to improve cardiovascular fitness, reduce obesity, and most importantly, it doesn’t appear to increase damage to the joint. However, care must be taken not to exacerbate the knee pain and cause increased joint damage. If pain occurs for more than 2 hours after the exercise, it’s likely the exercise is too strenuous and the type and frequency of this exercise should be changed. Swimming and cycling are good examples of aerobic fitness and are good alternatives to running or jogging.

Physical therapy in the form of exercise is also a cheaper and in many cases more effective option than medications. Structured land-based exercises to strengthen the quadriceps muscle and the hamstrings can reduce pain and improve disability. The types of exercises include isometric, isotonic, and isokinetic exercises, which all can help to improve muscle function.


The most common form of medication to provide pain relief for knee problems are non-steroidal anti-inflammatory drugs, known commonly as NSAIDs. The most common form of NSAID is ordinary aspirin, although there are a great many different varieties now available, some obtained only by prescription. The best known of these is probably ibuprofen, whilst one of the most controversial is Vioxx. Studies show that NSAIDs are more effective pain relievers than paracetamol. However, they frequently cause side effects like indigestion, and in some cases can inflame the stomach lining and cause stomach ulcers. More worryingly, they have been linked with kidney problems and in some instances they have been known to adversely affect the kidneys’ function. This could be a problem for those already suffering with kidney complications. NSAIDs work by blocking enzymes COX-1 and COX-2. COX-1 helps maintain the stomach lining; its inhibition causes stomach problems. COX-2 is produced by joints when they are injured and it also causes inflammation and pain. Drugs that inhibit COX-2 are called COX-2 inhibitors. Vioxx and Celebrex were arguably the most well-known, but Vioxx was withdrawn in 2003 due to concerns about its effect on the heart, whilst later research would show that Celebrex raised similar concerns. Newer NSAID medications work to inhibit COX-2 only, and these are referred to as “COXIBs”. An example is meloxicam. These are less likely to cause digestive problems but present the same level of risk to heart and kidneys, and not much is known yet about their long-term side effects.

Physical Therapy

PT modalities can be used to initiate the initial rehabilitation and to relieve pain. Cryotherapy, or the application of cold, can be utilized to reduce pain and swelling, and can be followed by exercises targeting range of motion and strengthening. For patients recovering from surgery, especially arthroscopic procedures, mobilization and the restoration of full range of motion is a top priority, and cold therapy can be alternated with heat therapy to improve the flexibility of the joint. Ultrasound and transcutaneous electrical nerve stimulation (TENS) are alternative therapies that can relieve pain and accelerate the recovery from injuries, but may not be considered as conventional physical therapy. TENS has been shown to be more effective than NSAID medication in treating osteoarthritis of the knee and is a viable long-term therapy for the disease.

Physical therapy (PT) is a crucial technique that can be utilized to relieve knee pain and prevent the condition from worsening in the future. There are varying types of exercises and modalities that can be utilized to suit the specific needs of patients and to encourage a continued exercise regimen in the future. PT can improve knee mobility through exercises which produce a greater range of motion, and strengthening exercises can build muscle around the joint, which can greatly improve stability and give the joint more support. The decision on what type of exercises or modalities and the intensity of PT administered is dependent on the severity and cause of the knee pain and whether a surgical procedure was carried out.


There are three different types of injections: corticosteroid, hyaluronic acid, and biologic. Corticosteroid injections use a potent anti-inflammatory medication to reduce inflammation. These injections are the most commonly used and are the most effective in the short-term. The second type of injection, hyaluronic acid, is a gel-like substance that is naturally found in the fluid around the knee. Osteoarthritis sufferers have less hyaluronic acid in their knee than a healthy person, so the injection seeks to restore some of this lost lubrication and act as a shock absorber. It is said that the administration of hyaluronic acid injections can be the same as placebo injections. The last type of injection is the least understood; biologics are a cutting-edge area of medicine. These medications seek to use the body’s own natural healing mechanisms to heal damaged tissue. This can involve growth factors, cytokines, or stem cells. As this is a developing field, there are no widely accepted medications or administration techniques. Therapy can involve one type of biologic pharmacologic agent. Administration can take the form of multiple injections, or in some cases, surgeries are being developed to implant the medications directly into the knee joint.

Injections for knee osteoarthritis, the most common form of knee pain, are an alternative to the above oral medications. Because the medication is delivered directly to the knee, these injections can be more effective than pills. The injections are given in a knee pain specialist’s office.

Alternative Therapies for Knee Pain

Massage therapy as a treatment for an array of conditions has increased in popularity over the years. It is a holistic approach that incorporates many different techniques. These include deep tissue massage, which has been known to break down scar tissue from previous knee injuries, and myofascial release. This is thought to be effective due to the relief of tension in the fascia, which can transmit abnormal stress to the knee. While the majority of this treatment is safe, some techniques involving direct work on muscle insertions to the knee could exacerbate pain. This is a treatment that could be simply a hit or miss, and we encourage it to be stopped if pain is noticed to be getting worse.

Herbal remedies, although in wide use, are actually quite controversial as they are not subjected to the same scrutiny of testing as pharmaceuticals. This means their efficacy and safety are not properly proven. Some people will still opt for this treatment due to its natural form and low cost, however, doctors have little knowledge on the suitability of each herbal remedy and as such are unlikely to recommend their usage. This could mean they might interfere with medication being taken for other conditions.

Chiropractic care is centered around the belief that overall health depends in part on a properly functioning nervous system, and correspondingly, that malalignment of the spinal column can cause the nervous system to not function properly. Chiropractors manipulate the spine to restore normal movement and function. This is relatively a safe treatment for chronic knee pain. Some cases of chronic knee pain could be a result of abnormal gait or malalignment, so working on the mechanics of the lower limb could improve pain in some instances. However, some chiropractors have been known to treat the knee directly and the evidence in this case is anecdotal.

Acupuncture, manipulation, and herbal remedies have become popular treatments for musculoskeletal pain, including chronic knee pain. Acupuncture is an ancient form of Traditional Chinese Medicine which involves the insertion of fine needles into specific points on the body’s surface to cause a desired healing effect. The various effects of acupuncture on pain are peripheral, central, and autonomic nervous system effects. A study revealed that acupuncture has a morphine-like effect on stimulating the release of endorphins, which are the body’s natural painkillers. This is a very attractive option for many of our older patients who wish to avoid taking more medication. However, acupuncture is a very subjective therapy and does not work for everyone. If no benefit is seen within 5 weeks (10 sessions), we recommend stopping this therapy.


There is increasing evidence that acupuncture can provide relief for many kinds of knee pain. Because the knee is considered to be the “fulcrum” of the body, its pain can be reflected and redirected to and from other areas such as the lower back, hip, and abdomen. Often, when acupuncturists treat knee pain, they will not only needle local points but will select others according to the underlying disharmony, which is causing the pain. For example, a person with pain caused by rheumatoid arthritis will have a difference in their pulse, and the qualities of the pain will be different from a person who has an injury-related pain. Therefore, they would receive a different treatment. Using a variety of needling techniques, including the relatively painless ‘serin’ method, acupuncture can successfully relieve pain, reduce inflammation, and increase the mobility of the knee. In a study conducted in 2001, 90 patients with osteoarthritis of the knee were randomly assigned to receive either 8 weeks of acupuncture or 8 weeks of TENS or advice from a doctor to self-manage their condition (the control group). The participants who received acupuncture reported a 40% decrease in pain and a 40% increase in function from the beginning of the study, compared to the other groups, with no reported adverse effects. This study shows strong evidence that acupuncture is a more effective treatment for chronic knee pain than either TENS or advice from a doctor.

Chiropractic Care

Back pain during pregnancy is a common problem affecting a large proportion of women, particularly among those who are pregnant for the first time. In fact, statistics show that between 50-70% of pregnant women are affected by back pain at some point. The methods used to reduce this pain are varied, often impractical and times costly, for example physiotherapy, various medications and some form of rest, with results often being inconsistent and less than satisfactory. Chiropractic treatment has seen a growing number of users within the pregnant women demographic. Studies have shown that spinal manipulation is effective in reducing back pain, offering relatively quick relief compared to other standard treatments. Chiropractic treatment is becoming more and more popular in many medical circles due to its effectiveness and safety, and is recommended for pregnant women as the methods used are often adapted to have less force, and generally the woman is treated in a comfortable position using equipment like adjustable beds. This form of treatment is now widely becoming known as the number one option for spinal pain relief, being safe and natural with no adverse effects. With chiropractic care now proven to be safe and effective during pregnancy, it is worth considering for any woman seeking relief from their back pain.

Herbal Remedies

One of the few herbs that have been proven to be beneficial in the treatment of osteoarthritis is ginger. Ginger is commonly used to relieve symptoms of indigestion and especially to decrease pain or inflammation. This is very useful for patients with osteoarthritis who commonly have stomach discomfort from NSAIDs. Ginger can be taken in the form of tea, or it can be added into a dish during food preparation. A particular study using a sample size of 247 patients suffering from osteoarthritis of the knee revealed that patients who took the ginger extract twice daily had a significant improvement in pain reduction, and some achieved relatively normal movements of the knee joint. This study was carried out for a duration of six weeks.

The use of herbal remedies for medical treatment is widely practiced in Asia. India and China are the major contributors of the different herbs used today to treat many forms of ailments. Medical practitioners in the two countries have diligently documented the use of herbs and herbal combinations as medicine in the respective countries for more than 2000 years. Currently, it is estimated that 70-90% of the population of the third world depends on herbs to treat their primary healthcare needs. These herbs have recently gained a lot of attention among medical practitioners all over the world. This has led to the research and development of these herbal combinations. This is done so that the same results can be reproduced consistently across different batches of the herbal combinations manufactured in a process.

Massage Therapy

A study at the University of Illinois showed that after receiving massage therapy, participants had improved range of motion, decreased pain, and increased functionality of the knee. This form of non-traditional treatment is often given in a hospital/outpatient environment and is covered by most insurance plans.

With a therapeutic massage, patients with knee pain can visit a specialist who can spend concentrated time working on the inflamed and painful area. This is something that would be difficult to achieve in a conventional doctor’s office. In addition, many health care providers are starting to integrate massage into their treatment programs. This form of therapy is usually done by a physical therapist and is combined with other forms of knee pain treatment, such as exercise or medication.

Besides common knowledge that a massage feels good, we do know that its many health benefits are often greatly underestimated.

Choosing the Right Therapy for You

To ensure the best outcome for your knee pain, you should choose a therapy that meets your needs and conditions best. There is no hard and fast rule in doing so, and some experiments may be necessary. However, you should consider your own expectations, the therapy’s success rate, as well as any possible side effects it may have. Generally, the goals of any knee pain therapy are to decrease pain and increase function. Some people are willing to tolerate potential risks for a small chance at achieving these results, while other people are not. Therapy side effects and potential success rates can usually be obtained from the physician and should be weighed when considering any course of treatment. Another factor to consider is your own prognosis. If you are considering a knee replacement, any therapy that will delay this procedure may be considered a success. If you are trying to avoid surgery as long as possible, you will be more inclined to experiment with various forms of therapy. Therapy cost and duration are also things to keep in mind. While health is a priceless commodity, many of today’s medical expenses are substantial. You must weigh the potential benefit of each therapy with what you are able and willing to spend. By keeping in mind your own expectations and thoroughly researching any form of treatment, you should be able to choose the right therapy for your knee pain.

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