Ghutnon Ka Dard (Knee Osteoarthritis) in Pakistan: Causes and Treatment That Works

Knee pain is treated in Pakistan as an inevitable part of getting older, which is why so many people accept it for a decade before doing the one thing that reliably helps. Global Burden of Disease data for Pakistan shows knee osteoarthritis contributed over 61% of new osteoarthritis cases, with age-standardised prevalence rising 17.9% between 1990 and 2021 — and a clear sex gap: 7,179 per 100,000 in women versus 4,645 in men ("Burden of Osteoarthritis in Pakistan and Its Provinces From 1990 to 2021," PMC).

At a glance

• Knee OA is over 61% of Pakistan's new osteoarthritis cases; prevalence up 17.9% since 1990
• Women carry roughly 1.5× the burden of men
• A study of middle-aged Pakistani adults found knee OA in 56.7% of those sampled
• Exercise is the single best-evidenced treatment — better than any supplement, and it is free
• Rest and avoiding movement make it worse, not better
• Every kilogram lost takes several kilograms of load off the knee with each step

Ghutnon mein dard kyun hota hai?

Osteoarthritis mein ghutne ki haddiyon ke darmiyan mojood narm gaddi (cartilage) ghis jati hai. Nateeja: haddi haddi se ragarti hai, sozish hoti hai, aur dard shuru ho jata hai. Yeh "sirf umar" ka masla nahi — bohat se qabil-e-ilaj asbab hain:

• Zyada wazan — sab se bara aur sab se qabil-e-tabdeeli sabab. Chalte waqt har qadam par ghutne par jism ke wazan ka kai guna zor parta hai
• Umar aur aurat hona (menopause ke baad khatra barh jata hai)
• Purani chot — ligament ya meniscus ka phatna
• Aisa kaam jis mein baar baar baithna, ukroon baithna ya bhaari wazan uthana ho
• Zameen par baithna, palathi mar kar baithna aur ukroon baith kar kaam karna — ghutne ko intehai kharch par le jata hai
• Pathon ki kamzori, khas taur par ran ke aage wale pathay (quadriceps)
• Warzish ki kami — jo cartilage ko ghizaa dene wali harkat rok deti hai

Symptoms

• Pain worse with activity — stairs (seerhi charhne mein dard), standing from the floor, walking distances
• Morning stiffness that eases within about 30 minutes (longer stiffness suggests inflammatory arthritis instead)
• Grinding or crackling (ghutne mein awaz aana)
• Swelling after activity
• Reduced bend; difficulty squatting or sitting cross-legged
• Giving way, or a knee that locks

Fever, a hot red swollen knee, or many joints involved symmetrically points elsewhere — septic arthritis, gout or rheumatoid arthritis — and needs prompt medical assessment rather than physiotherapy.

Treatment — in the order the evidence supports

1. Exercise (the actual first-line treatment)

This is counter-intuitive and it is the most important paragraph here: strengthening the muscles around the knee reduces pain more reliably than resting it. Weak quadriceps mean the joint absorbs load the muscle should have. A physiotherapist builds a progressive programme — typically straight-leg raises, quadriceps sets, glute bridges, step-ups, and stationary cycling or swimming for low-impact conditioning.

Programmes fail when they are done for two weeks and abandoned. Expect six to twelve weeks before judging.

2. Weight loss

The most effective structural change available. See our guide to safe weight loss; even 5–10% makes a measurable difference to knee pain.

3. Modify how you load the knee

Use a chair rather than sitting on the floor where you can; a raised toilet seat; avoid deep squatting and kneeling; supportive cushioned footwear rather than flat chappals for walking; a stick held in the opposite hand for significant pain.

4. Medication

Topical NSAID gels first — effective for knee OA with far less systemic risk. Oral NSAIDs in short courses, with caution if you have kidney disease, reflux or heart disease. Paracetamol has modest effect. Long-term oral NSAIDs bought over the counter for years are a common and avoidable cause of kidney and stomach damage here.

5. Injections

Steroid injections can give weeks to a few months of relief in a flare; they are not a long-term plan and repeated frequent injections may harm cartilage. Hyaluronic acid and PRP have mixed evidence — discuss honestly rather than assuming they are advanced simply because they cost more.

6. Surgery

Knee replacement is genuinely effective for end-stage arthritis with severe pain and disability — but it is for when the above has been tried, not instead of it. Arthroscopic "washout" for straightforward osteoarthritis is not supported by current evidence.

What about calcium and supplements?

Osteoarthritis is a cartilage and joint problem, not a calcium deficiency, so calcium does not treat it — although vitamin D deficiency is worth correcting for bone and muscle health in its own right, and is extremely common here. Glucosamine and chondroitin have inconsistent evidence at best; they are not a substitute for exercise.

When to see a doctor

See a orthopaedic surgeon or physiotherapist if knee pain has lasted more than a few weeks, limits your walking, or wakes you at night. Urgent if the knee is hot, red and swollen with fever, if it locks or gives way repeatedly, or after a significant injury.

Find care: browse physiotherapists near you on DoctorOS — filter by city, distance and rating, and book without a phone call.

Frequently asked questions

Ghutnon ke dard mein chalna chahiye ya aaram?

Chalna chahiye. Yeh sab se bari ghalat fehmi hai — log dard ke dar se harkat chhor dete hain, jis se pathay kamzor hote hain aur dard aur barh jata hai. Halka phulka chalna, cycling aur pathon ki warzish sab se moassar ilaj hai. Sirf shadeed sozish ke chand din aaram ki zaroorat hoti hai.

Kya calcium ki goliyan ghutnon ke dard ka ilaj hain?

Nahi. Osteoarthritis cartilage ke ghisne se hota hai, calcium ki kami se nahi. Calcium haddiyon ki kamzori (osteoporosis) ke liye ahem hai, jo alag bimari hai. Ghutne ke dard ke liye asal cheez warzish, wazan kam karna aur physiotherapy hai.

Is knee replacement worth it?

For end-stage disease with severe pain, it is one of the more successful operations in medicine — most people get substantial pain relief and function. It is not appropriate for mild-to-moderate arthritis, where exercise and weight loss do better with none of the risk.

I'm only 40. Can I have arthritis?

Yes. A Pakistani study of middle-aged adults (mean age 49) found knee OA in 56.7% of those sampled. Previous injury, obesity and heavy occupational loading all bring it forward — which is also why acting early is worth more at 40 than at 70.

Sources

• "Burden of Osteoarthritis in Pakistan and Its Provinces From 1990 to 2021: Findings From the Global Burden of Disease Study" (PMC)
• "Prevalence of knee osteoarthritis and quality of life among middle aged adults of Pakistan" — 56.7% in a sample of 300, mean age 48.96
• "Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies," eClinicalMedicine

For practitioners: if you're a physiotherapist, orthopaedic surgeon or rheumatologist in Pakistan, list your practice free on DoctorOS and start taking bookings from patients who are searching for exactly this kind of care.

Cover image: Blausen 0597 KneeAnatomy Side by BruceBlaus (Blausen.com staff, 2014), licensed under CC BY 3.0.