Dear Doctor, 

I have a problem with my knees, especially when I am climbing steps. Sometimes I feel the bones crack. A friend of mine advised me to eat silver fish daily to lubricate my joints. Will this help?

Fred

Dear Fred,

Climbing stairs is a movement which puts extra weight on the knee joint because the knee has to be lifted up slightly with each step. Walking straight on a plain surface does not cause this strain. Therefore anything affecting the knee joint or its surrounding supporting structures can cause pain while climbing stairs.

Knees that pain while climbing stairs can be due to several reasons. In a young adult, it can be due to patellofemoral syndrome. This term is used to describe different conditions, where the knee cap or its connection with the thigh bone is stressed. In case of muscle wasting or weakness, the knee cap may be pulled towards the stronger side. This displacement puts the knee joint under stress, causing pain. Irritation of the patellar tendon due to overuse can lead to painful knees while climbing stairs. This can occur in sports persons who do not do warming up exercises, long distance runners, etc. people. Excess body weight puts a burden on knees leading to knee pain, aggravated by climbing.

As age advances, degeneration sets in the knee joint due to constant weight bearing over the years. Its lubrication is reduced, and spikes of bone (osteophytes), start forming within the knee joint. These interfere with free movement of knees while walking, causing pain. Pain while climbing is the earliest feature of osteoarthritis.

This usually occurs after 60 years or so. But after trauma, any disease affecting knee joint, with over use of knee joint, it can start early.

Any injury or infection of the knee joint or its supporting structures can cause pain. It can be part of gout or any arthritis.

Diagnosis of the cause of knee pain can be done clinically, supported by X-rays, arthroscopy (visualizing the inside of the joint) and blood tests. Treatment of the cause helps to reduce the pain. The other form of treatment is use of pain killers, cold compression and surgical interventions when needed as repair of injuries or knee replacement in severe osteoarthritis. Splinting the painful knee/knees by using knee-cap or crepe bandage is also useful as it helps in taking the body’s weight off the knee. This should be worn while walking. Squatting should be avoided as it stresses the knees, augmenting the pain. Eating silver fish or any fish is useful in knees pain. Fish is rich in omega 3 fatty acid and lean protein. It helps in reducing excess body weight and also reduces ongoing inflammation. Thus it helps in reducing pain.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital