The Effect on Living Standards
During the third stage of knee arthritis, a patient usually cannot bend their knee all the way through and can find it problematic to extend their leg fully. Towards the end of this stage, a patient will also have great difficulty squatting. Furthermore, when bending their knee more than 90 degrees, they will find it very painful indeed. This can have a dramatic effect on a person’s standard of living. In Thailand, in rural areas in the north, where families often enjoy sitting on the floor when having meals, this issue can be a real hindrance in day-to-day life. Whether people choose to sit with a posture of sitting with the two legs tucked back to one side (pub-piab) or sitting with both legs crossed (kud-smarti), it will still prove exceptionally difficult to sit for a long period of time and will certainly be more problematic than it was in the past. A person who is suffering in this particular way will often need to pause during their meal in order to stretch out the leg and relieve the knee pain. Other issues arise when visiting the temple and siting in the pubpiab posture. Whilst listening to the monks saying the prayer, it can become very difficult to sit for long periods of time. Therefore, during such an enlightening moment when complete focus is craved, this could produce unwanted negative thoughts and could even result in a person privately wanting the prayer to end more quickly.
Elderly people who are living in town will often not be aware of the problem as quickly as their upcountry counterparts. This is due to the fact that in their daily life they do not usually put as much strain on the knee. Unfortunately, some will only realise the problem exists when the arthritis has reached stage 4, or even stage 5, already.
On long distance journeys, when needing to use the toilet, the elderly will often require a sitting-type toilet as the squatting type cannot be used anymore due to the fact that they cannot bend their knees. This is one of the reasons they are often reluctant to go out. Although in Thailand sitting toilets are becoming more and more common, they are still outnumbered by squatting-type toilets, particularly in rural areas. One method of countering this problem is by using a portable sitting post with a tripod, which can be placed on top of the squatting toilet and used to sit on. Younger, more able family members can help to carefully attach the tripod, taking appropriate care to secure it and also wiping around the toilet floor as it can often be very slippery when wet.
When elderly family members are staying at home, it’s important to modify the restroom to meet their specific needs. If present, any squatting-type toilets need to be removed with new, sitting-type toilets installed in their place.
Additionally, the restroom should be modified further to ensure its safety. As sitting for long periods of time can result in blood not circulating to some parts of the legs (and therefore making it difficult to stand) the restroom should also be equipped with a hand rail. This is very important as, when standing up, the leg could have difficulty supporting the weight of the body, resulting in the individual staggering and falling down to the floor. If this does occur more problems are created due to the fall. For example, a problem often seen from this is a broken hip bone or broken vertebrate (sagging down of the spinal cord). Another area to consider is the emotional effects to the person after the fall and their loss of confidence. Holding on to a hand rail for a while will help individuals gain strength and consequently provides more safety, drastically reducing the risk of an accident. The position of the hand rail should be in proportion with the elderly person’s height, within the distance of their reach and should help facilitate them to sit down and standup. This can be installed by a family member at home, providing they have the correct materials and tools. For an example of how the hand rail should be attached, it would be beneficial to refer to a hospital toilet for the handicapped.
It’s worth noting that there are some occasional exceptions. One of the elderly who I am sure does not have knee arthritis is Luang Por Koon. We often see him sitting in a squatting position with a cigarette in his hands. We have to accept that, although he is advanced in his years, his knee joints are still in good shape and strong as he can sit with the knees fully bent without any sign of pain. However, this is a unique case and it is quite extraordinary!
Taking all the above points into consideration, if you want to continuously be able to squat for a long time, you need to ensure that you take good care of your knee joint today.
Wish you well and no knee pain.
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk