What You KNEED to Know About Knee Osteoarthritis
Did you know that it is estimated that 250 million people worldwide currently have osteoarthritis?
 |
Osteoarthritis or OA is a very common condition that affects the joints and often occurs in the knee. In fact, 85% of all cases of OA affect the knee joint. Knee OA can result in pain and disability and puts increased stress on the health care system (1). It is becoming increasingly more common with the aging population, about 25% of those aged 55 and up have knee pain, and half of these cases have enough joint degeneration to be seen on X-rays (2). |
The severity of arthritis shown on an X-ray does not dictate the severity of the symptoms someone will experience. Some people with severe osteoarthritis according to their scans, will report little to no pain, and people with mild degeneration shown on scans can experience intense pain.
The good news is, whether or not you've had an X-ray, and regardless of what it shows, you can move well, ilve well and be well with knee osteoarthritis!
Anatomy Of The Knee Joint
These structures include:
|
Bones: The knee is made up of 3 bones.
|
|
|
Joint capsule: This joint capsule contains synovial fluid. This is a lubricant for the knee and helps the knee move with less friction. |
 |
| Cartilage: The knee is covered in a thick cartilage that helps the bones slide easier but also acts as a shock absorber. This cartilage is about ¼ inch thick. |  |
Ligaments: Ligaments attach bone to bone. The knee has several ligaments, and they all help to prevent certain movements. The most important ligaments are:
|
 |
| Menisci: There are two special kinds of ligaments in the knee called the medial and lateral meniscus. They help to distribute the forces more evenly through the knee and help the femur and tibia fit together better. |  |
|
Tendons: Tendons attach muscles to bone. These also help to stabilize the knee and allow for movement. The quadriceps muscle makes up the front of your thigh. These muscles go through your patella and attaches to the bottom of your knee. When these muscles contract, the knee straightens. The hamstrings are the group of muscles at the back of the thigh. When these muscles contract, the knee bends. |
 |
So, what is Knee Osteoarthritis?
Knee OA is when the cartilage within the joint begins to degenerate, and the underlying bone begins to change. As we just learned, cartilage helps to cushion the joint and helps the bones glide during movement, so it makes sense that knee OA can cause some pain and stiffness when moving. OA develops slowly overtime and for several different reasons. Over time, the cartilage can wear down enough to cause parts of the femur and tibia to rub together. Bone spurs which are outgrowths of bone can develop from this causing even more pain and disability.
How does knee osteoarthritis occur?
There are several, modifiable and non-modifiable risk factors that can make someone more likely to develop knee OA. Modifiable risk factors are ones a person has control over, and non-modifiable risk factors are ones that cannot be changed such as age and genetics.
Modifiable risk factors (1):
- Being over-weight
- Muscle weakness
- Work that involves heavy lifting or frequent kneeling
Non-modifiable risk factors (1):
- Increasing age
- Female
- Previous knee injury
- Knee malalignment
- Family history of knee OA
How do I know if my knee pain is related to osteoarthritis?
The three most common symptoms of OA are knee pain, knee stiffness (usually in the morning and lasting under 30 minutes) closely followed by increased difficulty with daily activities (2). People with knee OA also experience some muscle weakness or joint instability (such as knee buckling) (1).
Your doctor can diagnosis you with osteoarthritis. They will look at your health history, risk factors as well as your signs and symptoms to come to this diagnosis. Your health care provider will specifically look for crepitus (joint noises) and swelling, will examine your knee for loss of range of motion and will look for any bony enlargements. Through this assessment, your healthcare provider can confirm whether you have knee OA. Although X-rays can confirm this finding, they are not necessary for a diagnosis (2).
Once diagnosed with knee OA, most people wonder, can this be fixed?
The changes in the joint cannot be reversed, but that doesn't mean your function and symptoms can't improve.
Can knee OA be managed?
ABSOLUTELY.
There are things within our control that we can do to manage the knee OA, such as targeting those modifiable risk factors.
This is where physiotherapy can help!
How can physiotherapy help to prevent osteoarthritis or prevent the disease from progressing?
1. Exercise
Physiotherapy is important to help strengthen the muscles around the knee joint with exercises. Strengthening the muscles surrounding the joint will result in less pressure on the joint itself and will relieve some symptoms of OA. Exercises will also target achieving a greater range of motion so you can move better. Other types of exercises you may find on your treatment plan include:
- Gait training
- Balance training
- Stair training
Below are some exercises commonly programmed for those with knee osteoarthritis.
2. Weight Management
Physiotherapists can also help with weight management. Extra weight on the body can put increased forces through the joints. When you take one step, your knee joint absorbs forces 2-3x times your body weight (3). This means if someone weighs 150lbs, 300-450lbs of pressure is taken through the knee with every step. Loosing even 10 lbs can have a positive impact!
Being less physically active due to knee pain can also cause an increase in weight gain, which can further cause pain, leading to even more inactivity. This can be a hard cycle to get out of and emphasizes how important moving is!
Excess body fat can also increase inflammation within the body which can be another contributor to the development of knee OA. Dietary management and exercise can reduce this inflammation and excess strain on the knees and has been shown to reduce pain and increase function (3). Working with a registered Dietician can also help with weight management.
3. Walking aids/Taping/Bracing
Your physiotherapist may also prescribe you walking aids/urban walking poles, knee braces or do some taping. Walking aids such as using a cane or urban poles can help off-load the affected knee. This reduces pressure on the knee joint can help reduce the pain. Knee braces or taping can also help reduce knee pain by keeping the knee more stable, especially in people who are experiencing some joint instability.
4. Inflammation and pain reduction strategies
The acronym PEACE and LOVE provides a supportive approach to injury/disease management. Click Here to learn more.
Will my knee OA ever require surgery?
Conservative treatment such as exercise and weight loss strategies are always the first line of treatment and often have good results. However, surgeries such as knee replacement may be an option for those who have end stage osteoarthritis, significant pain and major limitations in their daily life. Surgery is only considered if conservative management after 6 months has failed to be effective (1).
Strengthening is important whether or not surgery is in your future. The stronger you are going into surgery, the better your outcomes, which means physiotherapy and proper exercise programming are paramount for those managing osteoarthritis no matter the severity.
If knee pain is getting you down, don't suffer in silence. Get in touch and we can help!
Come work one on one with one of our Physiotherapists or Kinesiologist, or participate in the GLA:D group program (Starting at Fit For Life in February 2023!), this program is specifically designed for those with knee and hip osteoarthritis.
Our team works with you to adress your symptoms to help you move well, live well and be well with osteoarthritis!
References
- Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet 2019;393:1745
2. Zhang W, Doherty M, Peat G et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 2010;69:483–489
3. D'Lima DD, Fregly BJ, Patil S, Steklov N, Colwell CW Jr. Knee joint forces: prediction, measurement, and significance. Proc Inst Mech Eng H. 2012 Feb;226(2):95-102. doi: 10.1177/0954411911433372. PMID: 22468461; PMCID: PMC3324308.