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  1. #1
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    Unhappy Yet another knee pain thread

    Well, I posted a while back about twinging pain in my knees to someone elses thread so here goes.

    I have noticed more pain build up recently over the last two or so months, I don't know what could be casusing it becasue I am not a doctor or physio.

    I have taken the following precautions from my end to see if it anything I can do to sort it out:

    • Stopped playing on concrete sports centre floors
    • Change my trainers every 5-6 weeks in case the sole is compacting
    • Wear different kinds of badminton trainers, not the same ones all the time
    • Stop jumping up as much to take things early in the rear court
    • Taken the Glucosinamine and Condrinin suppliments
    • Rested for a couple of weeks
    • Put on tubed bandage after playing to compress knees
    • Ibuprofen tablets before playing
    • Pain killers before playing


    After last week where my knees were sore after Monday night baddy for two days I bit the bullet and made up my mind to go and see the doctor and just happened across a self diagnoisis site, yes I know not to believe any of them without consulting a trained professional but it was informative and showed me that there can be a whole multitude of things wrong so it is better to be safe than sorry.

    For my part I have not even carried out any of the tests and will leave the diagnosis to a doctor, no point in looking at the worst case scenario and convincing myself I'll never walk again

    So the time has come to go see the doctor tomorrow to refer me to a specialist and use the private medical insurance the work provides to try and get an MRI scan to see what is wrong before it gets worse, that much I have gleamed from this site and others with sore knees although opinions vary in what I should do, most say the MRI is the only thing to tell you what is wrong so there can be no miss-diagnosis and others say just go and see a physio.

    I think I am going about it the right way!

    I will let you know how things progress

  2. #2
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    Lose some weight; try putting a cushion under your knees when you're having a pillow-biting session , haha.. . Good luck getting an MRI scan on the NHS; I told you how long I had to wait to see a consultant about my injury.

  3. #3
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    Sorry to know this.

    It has to take 1500mg Glucosamine(G) per day continuously for a period of around 4weeks-8weeks to see the effects.

    Also, if you take G + Bromelian(B) and calcium(C) together, it will be quicker.

    I have prescribed the B+C+G to over 150 individuals from the age of 24 to 80+. At least 85% success rate on degeneration or sports injury. My patients include my son's coach, my wife, Mom in law.....

  4. #4
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    Default Reviewed data; Cochrane database

    Glucosamine therapy for treating osteoarthritis

    ABSTRACT


    Background
    Osteoarthritis (OA) is the most common form of arthritis, and it is often associated with significant disability and an impaired quality of life.

    Objectives
    To review all randomized controlled trials (RCTs) evaluating the effectiveness and toxicity of glucosamine in osteoarthritis (OA).

    Search Strategy
    We searched MEDLINE, Embase, and Current Contents up to November 1999, and the Cochrane Controlled Trials Register. We also wrote letters to content experts, and hand searched reference lists of identified RCTs and pertinent review articles.

    Selection Criteria
    Relevant studies met the following criteria: 1) RCTs evaluating the effectiveness and safety of glucosamine in OA, 2) Both placebo based and comparative studies were eligible, 3) Both single blinded and double-blinded studies were eligible.

    Data collection and analysis
    Data abstraction was performed independently by two investigators and the results were compared for degree of agreement. G√łtzsche's method and a validated tool (Jadad 1996) were used to score the quality of the RCTs. Continuous outcome measures were pooled using standardized mean differences. Dichotomous outcome measures were pooled using Peto Odds Ratios.

    Main Results
    Collectively, the 16 identified RCTs provided evidence that glucosamine is both effective and safe in OA. In the 13 RCTs in which glucosamine was compared to placebo, glucosamine was found to be superior in all RCTs, except one. In the four RCTs in which glucosamine was compared to an NSAID, glucosamine was superior in two, and equivalent in two.

    Reviewers' conclusions
    Further research is necessary to confirm the long term effectiveness and toxicity of glucosamine therapy in OA. Most of the trials reviewed only evaluated the Rotta preparation of glucosamine sulfate. It is not known whether different glucosamine preparations prepared by different manufacturers are equally effective in the therapy of OA.

    This record should be cited as:
    Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine therapy for treating osteoarthritis. The Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002946. DOI: 10.1002/14651858.CD002946.

    REVIEWERS' CONCLUSIONS

    Implications for practice
    There is good evidence that glucosamine is both effective and safe in treating osteoarthritis. The long term effectiveness and toxicity of glucosamine therapy in OA remains unclear. As well, it is not known whether different glucosamine preparations prepared by different manufacturers are equally effective in the therapy of OA.



    Implications for research
    Despite the several RCTs, there are still a number of questions that remain unanswered regarding the use of glucosamine therapy in OA. These areas represent areas for further research. First, what is the long term efficacy and safety of glucosamine. Second, are the different glucosamine preparations sold by different manufacturers equally effective in the therapy of OA? What is the relative purity and content of glucosamine in these different preparations? Is GS equally effective to GH? Most (75%) of the RCTs reviewed in this analysis tested the Rotta preparation exclusively. Third, is glucosamine helpful for all patients with OA involving different joints and at different stages of severity? Fourth, is the dose and route of administration of glucosamine important in maximizing efficacy and minimizing toxicity? Fifth, how does glucosamine work in the treatment of OA? Sixth, further prospective long term studies are needed to assess whether glucosamine can indeed modify the progression of OA.

  5. #5
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    Pharmacotherapy for patellofemoral pain syndrome

    ABSTRACT


    Background
    Patellofemoral pain syndrome (PFPS) is common among adolescents and young adults. It is characterised by pain behind or around the patella and crepitations, provoked by ascending or descending stairs, squatting, prolonged sitting with flexed knees, running and cycling. The symptoms impede function in daily activities or sports. Pharmacological treatments focus on reducing pain symptoms (non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids), or restoring the assumed underlying pathology (compounds containing glucosamine to stimulate cartilage metabolism, anabolic steroids to increase bone density of the patella and build up supporting muscles). In studies, drugs are usually applied in addition to exercises aimed at building up supporting musculature.

    Objectives
    This review aims to summarise the evidence of effectiveness of pharmacotherapy in reducing anterior knee pain and improving knee function in people with PFPS.

    Search Strategy
    We searched the Cochrane Musculoskeletal Injuries Group and Cochrane Rehabilitation and Related Therapies Field trials registers, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2003), PEDro (up to January 2004) , MEDLINE (1966 to January 2004), EMBASE (1988 to January 2004), and CINAHL (1982 to January 2004).

    Selection Criteria
    Controlled trials (randomised or not) comparing pharmacotherapy with placebo, different types of pharmacotherapy, or pharmacotherapy to other therapies for people with PFPS.

    Data collection and analysis
    The literature search yielded 780 publications. Eight trials were included, of which three were of high quality. Data were analysed qualitatively using best evidence synthesis, because meta-analysis was impeded by differences in route of administration of drugs, care programs and outcome measures.

    Main Results
    Four trials (163 participants) studied the effect of NSAIDs. Aspirin compared to placebo in a high quality trial produced no significant differences in clinical symptoms and signs. Naproxen produced significant short term pain reduction when compared to placebo, but not when compared to diflunisal. Laser therapy to stimulate blood flow in tender areas led to more satisfied participants than tenoxicam, though not significantly.

    Two high quality RCTs (84 participants) studied the effect of glycosaminoglycan polysulphate (GAGPS). Twelve intramuscular injections in six weeks led to significantly more participants with a good overall therapeutic effect after one year, and to significantly better pain reduction during one of two activities. Five weekly intra-articular injections of GAGPS and lidocaine were compared with intra-articular injections of saline and lidocaine or no injections, all with concurrent quadriceps training. Injected participants showed better function after six weeks, though only the difference between GAGPS injected participants and non-injected participants was significant. The differences had disappeared after one year.

    One trial (43 participants) found that intramuscular injections of the anabolic steroid nandrolone phenylpropionate significantly improved both pain and function compared to placebo injections.

    Reviewers' conclusions
    There is only limited evidence for the effectiveness of NSAIDs for short term pain reduction in PFPS. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. The anabolic steroid nandrolone may be effective, but is too controversial for treatment of PFPS.

    This record should be cited as:
    Heintjes E, Berger MY, Bierma-Zeinstra SMA, Bernsen RMD, Verhaar JAN, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003470.pub2. DOI: 10.1002/14651858.CD003470.pub2.

    SYNOPSIS


    Drugs used to treat the symptoms of patellofemoral syndrome have little evidence base

    Patellofemoral pain syndrome is common among adolescents and young adults. The most common symptom is pain surrounding the kneecap when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or athletic activities. This review of pharmacological interventions showed that non-steroidal anti-inflammatory drugs (NSAIDs) may reduce pain in the short term, but overall pain did not improve after three months. There is conflicting evidence on the effect of glycosaminoglycan polysulphate. The anabolic steroid nandrolone may be effective, but associated risks demand extreme caution if used for patellofemoral pain syndrome, particularly in athletes.

  6. #6
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    Exclamation So what does it mean?

    OK I'll try to summarise the very main issues for everybody's benefit

    In Osteoarthritis, glucosamine works but...
    1) which preparation is best? Most studies used only this form "Rotta preparation of glucosamine sulfate"
    2) what are long term side effects?
    3) what dose is best?
    (The review was done in the year 2000)


    In patellofemoral pain syndrome, it works but...
    1) you need the injections
    2) only 84 patients have been studied overall
    3) knee function improved at 6 weeks, no difference at 1 year
    4) more studies needed in this area (e.g. does oral form work?)
    (This review done in 2004!)
    Last edited by Cheung; 11-29-2004 at 07:36 PM.

  7. #7
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    Wink Bottom line

    Dill,

    If you have osteoarthritis, go ahead and take glucosamine - use the rotta form (whatever that is).

    Anything else seems rather superfluous.

    (there may be even more updated data but I don't have the time and resources to go and search out every study)

  8. #8
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    Dear Dill,
    Thanks for Cheung's Quote. Very helpful for the effectiveness.

    Don't be scarced by Quote. Please note the following:

    1 If you look at the Quote, you note that there are only very limited niumbers of "open questions". I dare tell you, most of the docto'rs prescribed drugs get 2 to 3 times of open questions and uncertainty and yet have another 2-3 more "confirmed" side effect than Glucosamine.

    2 If you study more carefully on the "Quote", nothing serious had been spotted. It's always valid to say "we don't know the long-term effect". We can't wait untill everything is cleared,which may take another 1000 years when we discover that taking a certain drug or drinking water from the sky will have bad impact to our X-generation, before treating a daily pain. You want to play badminton, right??

    3 I will recommend www.puritan.com to buy cheaply top quality Glucosamine. Product no. is 11822. Puritan is GMP. and also they ship worldwide.

    4 Please try take Bromelian and Calcium, and double up the initial G for faster action. I have enough sample for B+C+G.

    Best regards and get well soon.


    Quote Originally Posted by Cheung
    Glucosamine therapy for treating osteoarthritis

    ABSTRACT


    Background
    Osteoarthritis (OA) is the most common form of arthritis, and it is often associated with significant disability and an impaired quality of life.

    Objectives
    To review all randomized controlled trials (RCTs) evaluating the effectiveness and toxicity of glucosamine in osteoarthritis (OA).

    Search Strategy
    We searched MEDLINE, Embase, and Current Contents up to November 1999, and the Cochrane Controlled Trials Register. We also wrote letters to content experts, and hand searched reference lists of identified RCTs and pertinent review articles.

    Selection Criteria
    Relevant studies met the following criteria: 1) RCTs evaluating the effectiveness and safety of glucosamine in OA, 2) Both placebo based and comparative studies were eligible, 3) Both single blinded and double-blinded studies were eligible.

    Data collection and analysis
    Data abstraction was performed independently by two investigators and the results were compared for degree of agreement. G√łtzsche's method and a validated tool (Jadad 1996) were used to score the quality of the RCTs. Continuous outcome measures were pooled using standardized mean differences. Dichotomous outcome measures were pooled using Peto Odds Ratios.

    Main Results
    Collectively, the 16 identified RCTs provided evidence that glucosamine is both effective and safe in OA. In the 13 RCTs in which glucosamine was compared to placebo, glucosamine was found to be superior in all RCTs, except one. In the four RCTs in which glucosamine was compared to an NSAID, glucosamine was superior in two, and equivalent in two.

    Reviewers' conclusions
    Further research is necessary to confirm the long term effectiveness and toxicity of glucosamine therapy in OA. Most of the trials reviewed only evaluated the Rotta preparation of glucosamine sulfate. It is not known whether different glucosamine preparations prepared by different manufacturers are equally effective in the therapy of OA.

    This record should be cited as:
    Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine therapy for treating osteoarthritis. The Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002946. DOI: 10.1002/14651858.CD002946.

    REVIEWERS' CONCLUSIONS

    Implications for practice
    There is good evidence that glucosamine is both effective and safe in treating osteoarthritis. The long term effectiveness and toxicity of glucosamine therapy in OA remains unclear. As well, it is not known whether different glucosamine preparations prepared by different manufacturers are equally effective in the therapy of OA.



    Implications for research
    Despite the several RCTs, there are still a number of questions that remain unanswered regarding the use of glucosamine therapy in OA. These areas represent areas for further research. First, what is the long term efficacy and safety of glucosamine. Second, are the different glucosamine preparations sold by different manufacturers equally effective in the therapy of OA? What is the relative purity and content of glucosamine in these different preparations? Is GS equally effective to GH? Most (75%) of the RCTs reviewed in this analysis tested the Rotta preparation exclusively. Third, is glucosamine helpful for all patients with OA involving different joints and at different stages of severity? Fourth, is the dose and route of administration of glucosamine important in maximizing efficacy and minimizing toxicity? Fifth, how does glucosamine work in the treatment of OA? Sixth, further prospective long term studies are needed to assess whether glucosamine can indeed modify the progression of OA.

  9. #9
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    Quote Originally Posted by Cheung
    Dill,

    If you have osteoarthritis, go ahead and take glucosamine - use the rotta form (whatever that is).

    Anything else seems rather superfluous.

    (there may be even more updated data but I don't have the time and resources to go and search out every study)
    1 With my over 150 closely monitor cases in the last 6 years, I have used only a few formular but mainly the G sulfate.

    2 However, over last 3 years we used Glucosamine Hydrochloride 1500mg(puritan product 11822). It works same good as G sulfate but much cheaper(this is supposed to take life-long, if you find something effective but expensive, it's not too good.) Also, with 1500mg per pill, you just need to take it once-per day.(initially take 2 per day will be faster to see the effectiveness)

    3 For your easy of mind you may consider and can search Glucosamine Sulfate in the puritan.com. Trust me: this is the cheapest in the World. GMP

    Red

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    I think Dill is not old enough to have osteoarthritis (he may feel old enough though).

    I put up both reviews for sake of completeness. Note, I haven't put up any studies regarding use of glucosamine in anterior cruciate repair, meniscal injury. That doesn't mean to say they don't exist. They might do - it would time to search them out. If they don't exist, one possibilty is that they have not been published due to a 'lack of an effect'. i.e. the researchers were unable to prove a benefit and therefore decided not to publish the results.

    This effect is called 'publication bias' - studies which show differences are more likely to be published.

    Dill, if you have any doubts, ask your GP about "Evidence Based Medicine' and "Glucosamine". I think most young GPs will be conversant about EBM (older ones less likely).
    Last edited by Cheung; 11-29-2004 at 07:57 PM.

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    Quote Originally Posted by Cheung
    OK I'll try to summarise the very main issues for everybody's benefit

    In Osteoarthritis, glucosamine works but...
    1) which preparation is best? Most studies used only this form "Rotta preparation of glucosamine sulfate"
    2) what are long term side effects?
    3) what dose is best?
    (The review was done in the year 2000)
    For my over 150 subjects,
    1 I used Glucosamine Hydrochloride for extensively(over 100). Works equally good.
    2 My MOM in law has been taking for 6+ years, so far no side effects. But no one knows.
    3 Based on my trials: best is initial month to double(3000mg) the normal dosage of 1500mg .

    Fianlly, Cheung is from the Medical Professions. Trust him. I'm just Yung Doctor(Yellow-Green Doctor) who happens to be interested in Medical researching on Alternative Treament.

    Red

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    Quote Originally Posted by redkingjoe
    Fianlly, Cheung is from the Medical Professions. Trust him.
    Aaargh, famous last words....


    I'm just trying to balance out the background evidence for taking glucosamine for everybody's benefit. Note, anything I wrote was based on the most up-to-date review evidence.

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    Quote Originally Posted by Cheung
    I think Dill is not old enough to have osteoarthritis (he may feel old enough though).

    Dill, if you have any doubts, ask your GP about "Evidence Based Medicine' and "Glucosamine". I think most young GPs will be conversant about EBM (older ones less likely).
    1 I read a very lenghty report on soft bone problems from Business. What I read from the Business Week says that we start to lose soft bone from around "mid-20." as we are losing the abilities to manufacture them.

    2 I thought Dill got Post traumatic kind pain or overuse of the joint, like what a sports always been facing. Either way, G will help with 85% chance of success.

    3 True that many Doctors does know well about G.

    4 Please Trust Cheung. I'm only a CPA. People in Church and sport club call me "Yung Doctor(in Chinese)".

  14. #14
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    Exclamation Pain is my game

    Hi there,

    I'm kinda like you, I've lived with my dodgy knees for over 12 years now. Finally I decided what I wanted to do something about the pain but I find out there's nothing I can do.

    X-rays and ultrasounds have turned up negative. Yes I do agree MRI is the only way to NOT misdiagnose, but I haven't turned there yet. I have seen a doctor who specialises in prolotheraphy. He immediately diagnosed my problem. He used some big words that I'll most probably get wrong, so I won't even try.

    Have a read at www.prolotheraphy.com, www. prolopain.com and www.proloinfo.com

    It might or might not work for you. I'm still waiting for my first doses of the injections.

    Regards

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    Quote Originally Posted by redkingjoe
    4 Please Trust Cheung. I'm only a CPA. People in Church and sport club call me "Yung Doctor(in Chinese)".
    hmmm.. no one's doubting Cheung's word. nor preferring yours to his...

  16. #16
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    Default Knee injury, what are the best treatment?

    Quote Originally Posted by Cheung
    OK I'll try to summarise the very main issues for everybody's benefit

    In Osteoarthritis, glucosamine works but...
    1) which preparation is best? Most studies used only this form "Rotta preparation of glucosamine sulfate"
    2) what are long term side effects?
    3) what dose is best?
    (The review was done in the year 2000)


    In patellofemoral pain syndrome, it works but...
    1) you need the injections
    2) only 84 patients have been studied overall
    3) knee function improved at 6 weeks, no difference at 1 year
    4) more studies needed in this area (e.g. does oral form work?)
    (This review done in 2004!)

    Dear all B'forum members,

    Hope you can give me some ideas.

    I sprained my leg and my knee cap was dislocated. I pulled it back n not sure whether it is at the right place. Doctor said I need two months to recover however it already 1 month but I can still feel the agony pain each time I try to walk.

    Any remedies to this knee problem beside MRI scan or physiotherapist?

    Thanks

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    Thanks everyone and Ynexfan for your rather humerous input I'll try to remember it next time I spank you on court (again)!!!

    The only reason I took the Glucosinamide was to make sure I have tried everything possible in MY power to make sure I have given everything a chance, as for the tablets, I have been taking them since before the summer and around the 7 months area and they give me no benefit in the long term.

    That is my opinion, not medical fact, I am not a doctor! Just my opinion based on me.

    Everyone has their own ideas, that much I guess but who is right, who is wrong? That is why I'm going to get an MRI so I will know without going round 20 physios and coaches who know about this kind of thing, pitting one against the other is usually how these things end up and I want definitive answers not heresay and constant physio!

    Before I spend time getting the knee and leg muscles stronger I want to know that I'm not damaging the legs further by doing exercises which will make me worse but in many peoples opinion help.

    As for being too young for Osteoathritis, I'm 28 with the knees of a 65 year old

    A report when I get back from the docs will follow. But only if I can remember what he said

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