12 Oct Successfully Treating Knee Osteoarthritis
Osteoarthritis (OA) is a condition affecting joints of the body. It is more common in weight-bearing joints (knee, hip, and ankle) but also can occur in the spine, shoulders and hands. Studies have shown osteoarthritis is experienced by up to 50% of people by age 85 and 2/3 of obese people will experience it at a much earlier age.
It usually involves a breakdown of the fibrocartilage surrounding bones and leads to inflammation which is painful and debilitating. This type of arthritis is also called ‘wear and tear’ as it generally happens slowly over time. Events such as significant injuries to the knee joint, surgery or significant weight gain can increase the degeneration of the fibrocartilage leading to early-onset osteoarthritis. The picture below depicts normal vs an knee affected by osteoarthritis.
OA usually has an onset at about 50 years of age but can occur earlier, especially in joints where an injury has occurred. Most of the time the disease process is present before any outward symptoms are noticeable. It is a degenerative disease with most treatment aimed at either managing symptoms, slowing the progression or a combination of both.
Symptoms of the knee OA are quite specific. They include:
- Pain deep within the knee, especially after activity
- Stiffness in the morning or after activity
- Decrease in range of motion of the knee
- Weakness and wasting in the quadriceps muscles, particularly vastus medialis oblique
- Conservative management of OA aims to reduce inflammation and pain through the increase of blood flow and reduction of symptom-causing activities.
Overall conservative (non-surgical) treatment has been found to be the best option in most cases of Osteoarthritis. Recent changes to Medicare rebates are based on this as studies had shown that patients who received ‘clean out’ arthroscopies demonstrated the same results after 18 months as patients which only had physiotherapy. The physiotherapy group had the benefit of less downtime and no risks related to surgical complications.
Conservative treatment options include:
This assists in reducing inflammation post activity. Having a compression brace on while doing the activity and icing after can help improve blood flow and reduce post-activity soreness. This can be a great alternative rather than taking painkillers just for short-term aggravations after activity.
In some cases, activities need to be modified to avoid irritation and inflammation of the knee. This involves performing an activity as pain-free as possible to stopping when pain arises. This then provides a starting point for a gradual increase in activity duration/severity that least aggravates the knee
Rest is very important post-activity. Settling down inflammation and soreness post activity helps to slow down the progression of OA. Corrective taping can also be used to assist in unloading joint structures, click here to check out our previous blog with how to tape to unload the kneecap.
Many muscles surrounding the knee are inhibited by pain. This leads to a less stable knee which can cause more inflammation and pain. Targeted strength training of some muscles can help stabilise the knee and reduce symptoms. Your physiotherapist will work with you to develop a tailored strengthening program. This usually includes strengthening the VMO or medial quadriceps muscles and the gluteals (your butt muscles)
Non-steroidal anti-inflammatory drugs (NSAIDs) should be used sparingly when other forms of pain relief are ineffective. Always consults your GP before commencing them and never take for long periods.
GLUCOSAMINE, CONDROITIN SULFATE (and other supplements)
These supplements occur naturally in cartilage and the aim is to assist with pain relief. The clinical evidence behind this treatment is lacking. However, some patients do report a benefit so they are worth considering. Omega-3 supplementation and curcumin/turmeric are also touted and promoted as being good for joint inflammation but once again the evidence to support these is poor at best.
JOINT REPLACEMENT THERAPY – (This is the main surgical option)
This is usually a last resort where all other forms of pain relief are ineffective. It involves surgery with a recovery and rehabilitation period and can take up to 12 months before the joint feels “normal.”These replaced joints are generally seen to have a 15-20 lifespan and can be redone at a later date.
The good news is that the vast majority of patients with knee osteoarthritis can experience improvements in their symptoms and function by receiving conservative physiotherapy treatment rather than going under the knife (or scalpel to be more correct).
BodyWorx Physio offers Free Assessments. You can BOOK ONLINE or call us on (02) 49527033 and one of our friendly team will be happy to assess and construct a plan to help you experience more life, pain-free.
Written by Thomas Barton – Physiotherapist