If you have osteoarthritis, surgery is rarely a first resort. There are plenty of things you can do to avoid (or at least postpone) heading into the operating room. Take care of your knees with these solutions.
No-brainers:
Weight loss. For many, weight loss is a basic but crucial way to help avoid knee surgery. Shedding just 15 pounds can cut knee pain in half, according to a recent study presented at the American College of Rheumatology’s annual scientific meeting. And should you need arthritis knee surgery later, you’ll decrease your risk of complications and reduce strain on your knees, which will make your rehabilitation go more smoothly.
Physical activity. The health of your knees depends on movement. Strong muscles support the joint and relieve pressure. Movement keeps tissues within the joint flexible, lubricated and replenished with nutrients that help healing. If you end up having knee surgery, the rehab will be easier if you start strengthening muscles before surgery. Walking is a great way to keep your knees healthy and pain free. Learn more about why exercise is so important if you have arthritis and hope to avoid knee surgery, and get some great ideas for maintaining motivation, stretching, safe moves and more.
No (or very few) side effects:
Braces. Prescribed by a doctor and fitted by a physical therapist, braces can improve the alignment of the knee, relieving pain.
Corticosteroid injections into the knee joint help to reduce inflammation, which can alleviate pain without causing side effects associated with oral corticosteroids.
Electrical stimulation may reduce pain by strengthening the quadriceps (the large muscles on the front of the thigh that help stabilize the knee joint), or it may even encourage regeneration of cartilage cells.
Hyaluronic acid injections, which supplement a naturally occurring lubricant lacking in the joints of people with osteoarthritis, may decrease pain and increase function for some people and help delay arthritis knee surgery.
Botox injections have been shown to relieve severe knee osteoarthritis pain and buy time before knee surgery.
You’ll likely take one:
Over-the-counter medications, such as the analgesic acetaminophen (Tylenol) and the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin) or naproxen (Aleve), ease pain. But several recent studies indicate that some NSAIDs may delay healing of connective tissues such as cartilage or tendons.
Prescription medications are available to ease pain and decrease inflammation. Whether they improve tissues in the joint continues to be investigated.
Dietary supplements. The National Institutes of Health is funding a study to see whether the combination of glucosamine and chondroitin helps repair cartilage. The duo has been shown to reduce pain in people with moderate-to-severe knee pain – those who need it most.
Daily supplements:
Two Flex-a-min tablets
Three 1000 mg. MSM tablets
16-32 oz. kombucha, often mixed with tart cherry juice or pineapple juice
(It takes about 1-3 months for the Flex-a-min and MSM to take affect, and about 1 month for the kombucha.)
Exercise:
3 days a week--40 minutes cardio (20 on recumbent bike, 20 on elliptical)
3 days a week--20 minutes cardio (elliptical) and 20 minutes weight lifting
(Includes recumbent bike warmup and lots of stretching each day.)
Other:
Reiki
Hemi-sync and/or healing music
EFT
Penetran lotion (absolutely the best, *everyone* I've recommended it to for arthritis has loved it)
High-raw vegan diet
I am taking Osteo Biflex and wrapping my knee with a heating pads when needed is there anything else I can do I don't want to have surgery if it is not going to help the pain!
Thank You
BADKNEEZE - is it possible for you to be fitted with braces that might aid your legs in supporting them? Also, why can't you have a patella inserted into your right leg? I mean, a prosthetic one.
I sure don't mean to play doctor, but I think it might help you to see many physicians to get many opinions as to how you might be helped. Don't forget to pray; God answers prayers, and I will pray, too, that God will lead you to find the right answers.
Getting off of addictive narcotics is possible, and the alleviation of pain so you may reach this goal ought to be pursued.
I really don't think I can wait until I am in my 60 to have knee replacement, I am only 52!
How in the world can you stand the pain for that length of time?
Need advise as what to do.
i have medial meniscal tear of posterior horn for more than 3 years .i did some physical therapy and it helped .but for last one year i am having snapping of medial hamstring tendon on walking . i have consulted many surgeons , some say that snapping of hamstring tendon is due to torn meniscus and partial menisectomy will solve the hamstring snapping also while treating meniscal tear .But some surgeons have suggested me hamstring strengthening and stretching exercise . does anyome has this hamstring snapping.
thanks and regards,
Sarf.
The MRI report on my left knee is not very pretty.
Degenerative change of the posterior patellar surface. Subcortical cystic formation in the medial tibial plateau near the inner condylar eminence, Subcortial cystic formation with cartilage erosion of the medial femoral condyle, Cortex appears disrupted, Free bodies in the joint space appear in the inner condylar notch region, Joint effusion, Partial ACL tear.
And in case I've lost you, here's the kicker.
Impacted fracture of the medial femoral condyle with mild marrow edema.
So, if anyone has any suggestions or ideas to help...I'm all ears!
And yes, believe it or not I work full time as a Certified Nursing Assistant in a large nursing home.
I have Mild chondromalacia patella. Which means. The condition develops due to softening of the cartilage beneath the knee cap (the patella), resulting in small areas of breakdown and pain around the knee. Instead of gliding smoothly over the knee, the knee cap rubs against the thigh bone (the femur) when the knee moves. and 5.
Avascular necrosis of both remoral condyles posteriorly. Means dead bone. I walk with a cane on the week days, can't have knee surgery and deal with the pain every day. My right knee has arthritis, were it's bone to bone and I can have surgery to help the knee. But!! I have pain once in a blue moon on my right knee. I take loads of vitamin supplements to help the pain of my left knee. I heard riding a bicycle helps, I hope to try in the fall. But, physical therapy doesn't help so, I live my life in pain until able to have the surgery. Oh, the pain started when I turned 47 years old. Taking and reading and learning how to help my knee is what I do.........
I just turned 60, and days later, had my first knee replacement. In August, I will have my other one. It's been less than 2 months, and I can honestly say, it's definitely worth it! The surgery wasn't bad, and the recovery wasn't bad as I had expected. After just 4 weeks, I was able to get up and down without pain!!! And at 6 weeks, I was able to drive again. I have (or had?) osteoarthritis in both knees, and was bone on bone. My surgeons was reluctant to do surgery on me at such an early age, plus the fact I have an autoimmune disease, which puts me more at risk of staph infection. But he knew I was in severe pain and unable to walk or stand more than 5 minutes at a time. He said the back of my knees were even worse off than the bone on bone. Those of you who are suffering from severe pain, DON'T PUT IT OFF! It's the best thing you can do for yourself, and I can't wait to get my left one done in 2 more months.
CALTRATE OVER THE COUNTER MEDS BUT I STILL HURT AN I BEEN TRYING TO LOSE WEIGHT TOO
BUT I HATE TAKING PILLS I ALL READY TAKE 5 FOR OTHERS PROBLEM BUT I LIKE WALKING WHEN I CAN AS MUCH AS POSSIBLE I WISH I COULD DANCE LIKE I USES TO DO BUT I DON'T THINK I CAN IS THERE ANY THING I CAN DO OR TAKE TO HELP PUT CARITAGE BACK N MTY KNEES WHY I CAN STILL KEEP TRUCKING AN WHY I CAN STAND MORE THEN LESS 30 MIN.W/OUT PAIN IF SO TELL ME
Tena Boehm
This was very helpful to me. Also, warm water aerobics would be soothing.
That doctor should be reported about his terrible bedside manner. It's awful to feel worse after going to a doctor.
With not one bit of bed side manner, told me I needed it replaced and that he doubts if I'd even make it through the surgery!!!! "The balls in your court lady" good day!!! And that was it!!! I have other health issues that makes it impossible for me to have surgery, unless it's a matter of life and death, and sorry but to me a new knee isn't even on that list.... Trying to find another doctor, isn't easy when you know no one to ask, but guess maybe doing the point and pick couldn't get me any worse of a one than I had (huh?/)
I'm looking for any thing that will helped with the pain and just maybe give me some of my life back again. Be it Naturalpath or what ever.
I've really been a mess since that appointment with the jerk that calls himself a specialist in the Orthopedic field of medicine.
Thanks anyone!!!
I am happy I found something. It's called Extra Strength Replenex, contact me if you want to try it, empty bottle, money back if not satisfied.
I am 39 and am facing a total knee replacement and kinda freeked out...we are just waiting for test results to make sure it is not anything more sinister than osteo as I also have an auto-immune disorder. It is good to hear people having such success and not regretting it.
I did not know if we were able to post the name of doctors who help with arthritis, since one poster did I thought it might be ok to post this information.
I took my daughter to the Dr. Magaziner Center in Cherry Hill. Dr. Scott Greenberg is the expert in giving Prolotherapy injections. You can go to the site and read about prolotherapy. Its not a drug and it works. My daughter can walk without pain and has not been on drugs for years.
You can find it under
Magaziner Wellness Center
located in Cherry Hill, NJ
I hope this helps some people as an alternative to drugs or surgery.
Go to the website and read about Prolotherapy and watch the videos.
She did not want to have this done because of her young age. I had read about how prolotherapy had been used on some professional athletes (Philly Eagles, Flyers)
and it worked fantastically.
My daughter got a few injections by the knee area. The swelling of her knees went down drastically the next day..and moreso the days following. It stopped almost all the joint pain. She can walk easily now.
She had the injections done during work hours and returned to work the same day with no side effects.
Prolotherapy is not a drug. Please check it out. We went to a doctors office in Cherry Hill NJ that uses this.
I also know of a rhumatologist on Long Island whose partner now treats with prolotherapy. It does work and my daughter's treatment lasted two years before she needed another treatment.
You can be on other meds as prolotherapy is not a drug and its not injected into a joint, just the surrounding area if you are a candidate.
I left that knee surgeon, who said I had too much cartiledge to do replacements. Fortunately, I went to a rheumatologist who did blood work and I was correctly diagnosed.
6 mos. ago I started on Enbrel. It is a wonder drug...it blocks the TNF (tumor necrosis factor?) and I've felt the best in a very LONG time. Now, my co-pay assistance has run dry and I'm not sure I want to pay $1000+/mo. for this drug. I have private insurance and the RX has been maxed out. I'm 63 and afraid to spend all my $ on this drug...yet, it does keep the damage from occurring. What to do???
a 72 year old lady who has been told that I
need a double knee replacement. I am terrified to have this done. I am taking P.T.
at the hospital where I work, have joined
the Y where I will do water exercises, but when I take any medicine the doctor
prescribes, I get sick. I am so tired of the
pain, I am about 50 lbs overweight, I need
help
He says there is a 2% increase in risk for cardiac problems or memory problems.
Any comments regarding asking to take the risk and do them both? Love and respect my MD but am in a hurry :) :)
James Graffenberg
I hate walking, but I love bicycling. I take low doses of Tramadol as needed (as well as a glucosamine powder, which doesn't seem to help, but it tastes great).
Advice please...
My 91 year old mother was told that if she did not have the knee replacements in her mid-70's she would be too old to have them. Having the pain gone after the first surgery made her want to have the other knee replacement ASAP. Unfortunately she has been having problems with her knees in the last few years; knee replacements last about 15 years and I hope to avoid or at least delay surgery. She has also had shoulder and feet surgery, but those apparently are not giving her problems.
thanks a lot
ken
Has your wife tried Sinvisc injections? They make you feel good for 6 months to a year or cortizone injectons in the knees. After she gets a bit better, do yoga excercises for legs and thigh muscles. Keep taking glucosamine+Chondriotin with Boswelia.
Boswelia is a natural product that helps with swelling around knees. If you cannot find together take a separate bottle of it. I don't do well with Calcium because I guess, I am taking lot of milk, yougurt and you don't want to take excessive Calcium unless you are deficient as shown by your blood test. Other than that, one advil keeps me good for whole day. Take it with food. Making your self active helps to condition your leg and thigh muscles and removes arthritis. Drink lots of water. If you are overweight lose weight by eating lots of vegetables, salads and fruits. Take care. I TAKE A product called EMERGEN C FOR JOINT HEALTH that has glucosamine, condriotin and vitamin C and is great in taste and dissoves in water and drink it up like an energy drink. It is working for me.
Long story short, you may find some respite from this (I have increased mobility; pain, not so much but can management with meds) and contact the manufacturer if you're in the same boat as I am. Highly, highly recommend. It's chicken combs so if you're allergic - can't do but it beats looking at chickens longingly....~^..^~
Please know that you're not alone. Betsy Isaacs for one can certainly relate to what you're going through. I hope her story offers some inspiration and hope:
http://www.arthritistoday.org/community/people-profiles/betsy-isaacs-weight -loss.php
(simply cut and paste the link above into your URL window)
All the Best,
The Editors
Arthritis Today magazine
I HAVE OSTEOARTHRITIS IN MY RIGHT KNEE
THE PAIN IS AT TIMES UNBERABLE.
I HAVE BEEN GOING TO GET ACCUPUNCTURE TREATMENTS. THE PAIN IS COMPLETELY GONE
AFTER THE FIRST TREATMENT!! I CAN EXCERCISE AND WALK PAIN FREE!!!!!!!! IT HAS BEEN TWO MONTHS SINCE MY LAST TREATMENT I RECEIVED A SERIES OF TWELVE
I can probably attribute my OA to the past 30-35 years of downhill skiing, and back country telemark skiing. I heard about PRP injections in December 2009 and decided it was worth a try. I've had two injections so far and am back on X/C gear and skiing up to 20 kms. So far I've had great success with it and although it's only been a couple of months my knee pain has diminished from a level of 8 (out of 10) to a one or two. I don't know how long it will last (as it's relitively a new procedure) but I've got my fingers crossed.
Blaine
I HAVE BEEN HAVING THIS PAIN IN MY RIGHT KNEE FOR THE PAST 8 MONTHS. I HAD AN ARTHROSCOPY ABOUT 5 MONTHS AGO BUT STILL FIND IT DIFFICULT TO WALK, IS LIKE BONE ON BONE THING.I NEED SUGGESTION FROM ANYBODY? EITHER EXERCISE OR A KNEE SUPPORT.
THANKS
Has anyone tried it?
If you tried it, what are the results over time.
I am trying to avoid surgery and being confined to a wheel chair.
I lay on the sofa a lot as standing or walking is too painful. I only eat cereal for breakfast and a sandwich for supper but gain a pound to 3 pounds a month. If I could loose about 10 lbs, my knees would stop hurting. Please help with suggestions
works for me. I'm also doubling up on glucosmine/chro...
my doctor saids to take it - it takes time to work..... Let me know how you do. I know that knee pain is not fun. Another thing - I had a couple of co-workers found out they had tumors behind the knee cap... Like I said LOOK for another DR until you are satisfied .... you will know ... your gut feelings - go by them - never doubt yourself...
YOU WILL KNOW....... Anna
Will reducing Ca intake help as commented by
Karen. What is Quad exercise?
Arun
My surgeon was Dr. Giles Scuderi and I can't say enough about him and his team.The pre-op teaching was great and I did many muscle strengthening exercisesin preparation for the surgery which I think made a BIG difference. The surgery was aq great sucess; I have been pain free for 5 years. The first 36 - 48 hours are very difficult - painful, frightening and long but after 4 days I walked out of the hospital on my own without any devices (canes or walkers) and climbed/decended an entire flight of stairs to my second floor where my bedroom and only bathroom are. I had in-home rehab for a few weeks and then went to out patient therapy for 2 months.
I would highly recommend the surgery if your are in severe pain. The surgery will relieve it.
Hope this is helpful. Dr. Scuderi's info:
ADDRESS: 210 EAST 64TH STREET
NY, NY 10021
PHONE #: 212-434-4310
I Just turned 61, within the last 2 weeks. I had a total knee replacement done around 18 to 20 years ago. My joint in my left knee was bone on bone, no cartilage left. My ortho doctor at the time said I could suffer or do the knee replacement.
At the time I was doing exibition country dancing and minor competition with a dance group. It got so bad I had to stop dancing. I would sit and cry when I had to watch others doing what I desperately wanted to do myself.
I chose the knee replacement; the best decision I ever made. Even the pain after the surgery was nothing compared to what I went thru' for 8 years.
There have many improvements since I had my surgery, and I would still recommend it to anyone that needs it.
I know that in another couple of years I will need the other knee replaced; I will not hesitate to do it.
I hope this helps someone by hearing from me.
She suffers from RLS, but she takes medication which works well for that.
The pain is worst before it's going to rain. She can feel it coming and beats the weather man to the punch in forecasting it.
Being of small stature, we have to be very careful of side effects of some of the prescription medications. These don't appear to work well anyway and the side effects may well be worse than the original condition.
She binds her knees, puts hot patches on and loses lots of sleep nonetheless.
Has anyone any ideas of the best and least intrusive relieveing of this pain?
The surgeon wanted to do a total knee replacement on me. I refused since I was only 48. Instead, he prescribed a great knee brace - the Unloader, by Generation II, now part of the Ossur Company. The brace moved the pressure in my knee to the outside, where I had more cartilage. I wore the brace from 2000-2005, and even did many backpacking trips while wearing the brace.
Finally, in 2005, it became too painful to walk, even with the brace. Evidently, all my cartilage was gone.
In June of 2005, I had a total knee replacement of my right knee. My recovery was rapid and I have had virtually no pain since the surgery.
Early in 2009, I my left knee started having symptoms similar to those that began in my right knee in the late 1990s. An MRI showed break-down of cartilage inside my left leg. I was fitted for the same kind of brace I wore on the right knee.
By wearing the brace, I hope to be able to put off total knee replacement of the left knee for 5 years or more. I am scared of getting replacement knees, "revisions," since they are not as successful as the original TKR.
How can I strengthen my quads so I can avoid surgery on my left knee as long as possible?
Has anybody had a second artificial knee implanted? How did the surgery go? How well do second knees work?
Thanks,
Susan
Seattle
and the last 4 months i've been given a shot
of a steriod plus put on Predisone 10mil. daily plus last month a muscle relaxer to help with cramps in fingers,thighs,calfs,ankles,and feet.At any event knee surgery will offer a little relief so maybe I can walk and jog a little.Also I hope to maybe have some back surgery in the future by the Laser Spine Institue so I can go into retirement in 1 and half years to 2 years at 62 and a half/63years of age and have some time travel and invest my time in my grandchildren.I dodn't want to have to many things go wrong with me to fix up at retirement.If my health got bad then I'd suffer because I would'nt then be able to have all these needed operations.I know about injections in my knees,wrists,ankles,back,and feet;they all help for a while.So I'm opting for early surgery in stead of waiting till I'm disabled and can't work any more.
on one side. The surgeon is suggesting a partial knee replacement? Is there an alternative treatment? Is there an alternative? Is it better to have surgery early
or is it better to delay as long as possible?
Thank you for your advice.
Re. your comments 1 June.
I haveosteoarthritis/bone on bone in my left knee. I really cannot get my head around having total knee replacement surgery and am interested in anything that will delay this.
I am going to try Synvise but being in the UK am not sure if my doctor will agree to do it.
I found this information on the Centeno Clinic website. www.centinoclinic.com
Hope it helps.
Regenerative injection therapy (RIT) or
prolotherapy is a natural healing
alternative to drugs or surgery.
RIT prompts your body to naturally heal
damaged and degenerated tissues. It
involves a series of simple injections into
the injured area, once a month for 3-6
months. This is not a steroid, which
blocks healing, but substances that heal
and strengthen the ligaments and joints.
The goal of RIT is to increase your
activity level. More activity will allow
your muscles to increase their tone and
further protect the joints and nerves from
injury.
How does it work?
RIT works by prompting your body’s
natural repair mechanisms to heal damaged
or degenerated tissues. While most of our
daily injuries heal completely, severe
ligament tears,
degenerated and worn out tissues, and
tissues with a poor blood supply (such as the
knee) don’t usually mend themselves. RIT
first starts by injecting a proliferant into the
damaged area. This inflammation causes
your body to release it’s own natural growth
factors in the injured tissue. These go to
work immediately, directing your body’s
natural healing mechanisms to repair painful
tissues. The first stage of healing usually
takes about a week, but the tissue continues
to strengthen for 4-6 weeks after an
injection.
What can be treated?
Research has shown that RIT is very
effective for knee pain, low back pain, tennis
elbow and arthritic hand pain. Our own
experience shows that it’s also effective for
ankle pain, shoulder pain, elbow pain, neck
pain, upper back pain, and hip pain.
Prolotherapy, I was wondering if she has
found out anything on this proceedure which is also called regenerative injection therapy - no surgery. I am trying to find out more information on this proceedure, looks like it's been around about 10 years,
they swear it works, no down time etc. They use your own blood (kind of like stem
cell) and treat your blood and then inject into the knee. You need 4 treatments over one week and it encourages regrowth of the
cartlidge. Does anyone know anything about this proceedure? Has anyone had it?
thanks,
There is a web site re: prolotherapy at getprolo.com. There are testimonials and doctors listed. I don't know anyone personally who has had it. So far I have tried oxygen-ozone injections here in Ohio, but didn't get much relief from it. I have had the Synvisc series without much help. Most relief came from cortisone injections. I also am trying to lose weight(difficult) and exercise. My ortho. dr. recommends stationary recumbant bike which is all I can do. I may try prolotherapy before I give in to surgery.
I go to the gym and use the pool all the time can anyone tell me how to do qued strengthheing exercises. I have oa in my knees and from reading all your comments it seems that quad strengthing exercises helps. Thanks
IS THIS OPERATION worth the trouble.
I had both of my knees replaced in the same surgery in 2005. I am happy that I selected this procedure. The rehab at home was difficult and long, but now I have no knee problems. My primary recommendation is to ALWAYS do all of the exercises that the physical therapist tells you to do, and all will be well.
Entonces a donde recomendas que yo valla para mi osteoartritis y artritis reumatoid infantil.Yo tengo 24anos con dolor en mis coyonturas. El doctor dice que no tengo cartilago en mi rodilla y que tendre que operar me un dia. Pero no aguanto mas el dolor. Yo ago natacion y trato de mantener me saludable.
It means so much to me that my story helped you. My doctor is Thomas Chambers in Myrtle Beach, South Carolina. He is an orthopedic surgeon that also is the team doctor for a minor league baseball organization under the Atlanta Braves. Traveling to SC may not be an option for you but finding a doctor with similar credentials is a good start. Go to your local hospitals website or to a major hospital in your area.Once you get basic info on a doc then research/google him/her. Your local arthritis foundation could be a good source of information.The most reliable source is word of mouth. The first doctor I went to was one I googled and his info was impressive...needless to say, that didnt help much. I found out about my doctor through asking questions during my RA infusions. I just came out and asked each person I saw if they had an ortho surgeon and what their experiences were.I gathered a wealth of info.Let me know how things go.
Kelly, you have given me hope. I am 40 and have had severe pain in my left knee for almost 20 years (three surgeries); and now my right knee for overcompensating for my left knee. Last Dr wanted to do a "clean up" to help minimize my pain. I did some research and have found that that kind of surgery is pretty pointless. I have about 15% cartilage in my left knee and 25% in my right. All I keep hearing is no one will do knee replacements until I'm 50; although they generally agree I need them now. Can you recommend your doctor? Where is he located? I am in NM. Thanks.
There are many meds your doctor can give you such as celebrex and mobic for the imflammation. He can also prescribe physical therapy to strengthen the ligaments, tendons, and muscles you use to walk and bend. Remember, if your doctoe doesnt effectively help you seek a second opinion.
Kelly
Thank you so much for your kind words. I love to hear success stories! My knee replacement is scheduled for April 20th and I'm ready because I too have had pain for well over a year. Pain to the point of being almost debilitating. I just want to get back walking again. I have started some in-home therapy the hospital has suggested prior to surgery, so hopefully, that will work in my favor. I'll let you know!
Thanks again
Any suggestions? I would not like to have surgery but this is getting worse very rapidly.
Thank you all!
Carlos
Deb
Thanks for the optimistic report on your sister's knee replacements. I have heard of a couple horror stories, but have to say, the successful reports outweigh the bad.
I'm sorry to hear you are having so much pain..that's where I'm at right now. Surgery can't come soon enough!
Thanks again,
Janice
Louis
http://www.bonesmart.org/public_forum/index.php
suministrado un totorial indicativo de las
medicinas de ùltima generaciòn junto con la
docificaciòn apropiada para un buen mejora
minto.
Pero ademàs,la informaciòn exacta para su
adquisiciòn, habida cuenta que en Latinoamerica
no se consiguen algunos de esos medicamentos,
para la Artrosis preferentemente.
Cordialmente,
Carlos A.Salazar .
I also take glucosamine/chondroitin supplements, but I know that it's the quad exercises that are the critical factor.
I don't see any mention of strengthening the quads. I was reading an article in a magazine regarding the increase in knee replacement surgery. I read the article after having knee replacement surgery while I was using the exercise bicycle at the therapist office . There was a man in therapy because his knees hurt. They were showing him exercises to strengthen his quads and his pain was going away.
Walking can be very painful on it's own. I wonder why therapy to strengthen your muscles that strengthen the knee are not promoted after the first visit to the doctor?
J
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