Knee Osteoarthritis: What Is It And How Do I Manage It?

Osteoarthritis (OA) is the most common form of arthritis and affects more than 3 million Canadians. It is associated with significant socioeconomic and personal burden¹. According to the Osteoarthritis Research Society International (OARSI), it is characterized by anatomical or physiological derangements such as cartilage degradation, bone remodeling, osteophyte formation, joint inflammation and loss of normal joint function². OA is typically diagnosed via radiographic imaging¹. However, certain MRI-detected findings such as cartilage damage, bone marrow lesions and meniscal damage precede radiographic findings of knee osteoarthritis (OA), potentially enabling earlier detection of OA onset³. The knee joint is commonly affected by osteoarthritis and is made up of the femur (thigh bone), the tibia (shin bone) and the patella. There is currently no cure for osteoarthritis¹. In addition, medications or procedures that restore cartilage and modify the damage caused by arthritis do not currently exist. The most successful treatment to date for knee osteoarthritis is a knee replacement (for those interested in learning more about total knee replacements, you can read the following article)⁴. That being said, identifying the ideal candidate for a total knee replacement is crucial, seeing as patients with OA inappropriately referred for this surgery have an increased risk of poor outcomes³. Therefore, more conservative interventions are needed to slow the progression of knee osteoarthritis or decrease its associated symptoms⁵.

Early Signs of Knee Osteoarthritis¹ 

  • Joint stiffness: usually present after long periods of not moving the knee joint. Stiffness is temporary, lasting 30 minutes or less.
  • Joint swelling: Swelling may be visible at the knee joint, causing reduced range of motion.
  • Joint pain: Pain is typically worse after physical activity or exercise, and decreases with rest. As the disease progresses, pain may be present with daily activities such as walking and going up and down the stairs.
  • Crepitus: cracking sound that occurs when bending and extending the knee.

Risk Factors for the Development of Knee Osteoarthritis

  • Being overweight/obese: Excess weight will put extra stress on the weight-bearing joints of the body, including the knee joint. Losing weight will decrease the loading at these joints, and may prevent or delay the need for surgery in the future¹ ⁶.
  • Age: The likelihood of having knee osteoarthritis increases with age. It may begin at a younger age but is not detected because the person is not experiencing any symptoms at the time¹ ⁶.
  • Family history: There is a genetic component to the development of knee osteoarthritis¹.
  • Female gender
  • Previous knee injury: People who have experienced previous joint injury may have already experienced damage to the structures in or around the knee joint such as the cartilage, muscles or ligaments. This previous injury may render the knee joint less stable, altering the biomechanics at the knee joint. The latter will ultimately how the knee is loaded and may contribute to the development and/or progression of knee osteoarthritis¹ ⁶.

How to Manage Your Knee Osteoarthritis¹ ⁷ ⁸

Exercise (aerobic, strengthening and flexibility): According to the OARSI guidelines for the non-surgical management of knee osteoarthritis published in 2014, small but clinically relevant short-term benefits of land-based exercise for pain and physical function in knee⁹. The duration and type of exercise programs varied widely, but interventions included a combination of strength training, active range of motion exercise, and aerobic activity. Results were generally positive among land-based exercise type, and did not significantly favor any specific exercise programs. However, a moderate effect size was demonstrated for the effect of strength training on reducing pain and improving physical function compared with controls. Strength training programs primarily incorporated resistance-based lower limb and quadriceps strengthening exercises. The OARSI guidelines also suggest strong favorable benefits of t’ai chi for improving pain and physical function in individuals with knee OA⁹. Overall, strengthening for the knee joint will provide additional stability, providing protection for the knee joint. Ensuring optimal flexibility is important to maintain a full range of motion and to help reduce pain and stiffness at the knee joint. Moreover, performing regular aerobic exercise will keep the heart healthy and keep your weight under control. Other forms of exercise often suggested for patients with knee OA include Tai Chi and Yoga.

Weight management: Being overweight or obese is one of the most important risk factors for the development and progression of knee OA. Moderate weight reduction programs have demonstrated reductions in both pain and physical disability for overweight participants with knee OA⁹.

Heat: Will help relieve pain and stiffness by decreasing muscle spasms and tightness, improving range of motion at the knee joint.

Cold/Ice pack: Will help relieve pain by controlling swelling and inflammation, which may be a limiting normal range of motion at the knee joint.

Orthotics/knee braces: Help promote proper biomechanics at the knee joint. Knee braces also provide additional stability, providing further protection to the knee.

Physiotherapy: A physiotherapist will be able to provide a variety of interventions based on your impairments, such as manual therapy to optimize joint range of motion, myofascial release to increase flexibility, exercise prescription to optimize strength and flexibility, and taping to promote proper biomechanics at the knee joint, among others.

Protect your knees: Know when to take breaks. When exercising, make sure your joints are positioning correctly to ensure proper biomechanics. Avoid excessive repetitive high-impact activities such as running. Moderation is key. Cycling or aquaform are also great alternatives. Lastly, the use of an assistive device such a cane or walker may be beneficial to further reduce loading at the knee joint.

When is Surgery Recommended?¹⁰ 

  • Severe knee pain or stiffness that limits activities of daily living and transfers (standing up, walking, stairs, etc.)
  • Moderate to severe knee pain at rest (day and/or night)
  • Knee deformity (varus or valgus)
  • Chronic knee inflammation that is not responsive to medical treatment
  • Failure to respond to other medical treatments (anti-inflammatories, corticosteroids, lubricating injections, physical therapy, etc.)

Written by:
Anthony Teoli MScPT
Registered Physiotherapist

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If you have any questions or concerns regarding your knee osteoarthritis, please consult your doctor and/or physiotherapist. If you have any questions or concerns regarding the content of this blog post, you may contact me directly at infophysiotherapy10@gmail.com.

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DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. The content of this blog is a resource for information only. This blog was created to serve as an information resource for both the general population and health professionals. For any further questions or concerns regarding knee osteoarthritis, please consult your doctor or physiotherapist.

References

1. The Arthritis Society. (2015). Osteoarthritis: Causes, Symptoms and Treatments. The Arthritis Society. Retrieved from: https://arthritis.ca/getmedia/baab0788-483c-4494-9d40-630bc1d4a3e0/Osteoarthritis-Causes-Symptoms-and-Treatments.pdf?ext=.pdf

2. Osteoarthritis Research International. (2015). Standardization of Osteoarthritis Definitions. OARSI. Retrieved from: https://www.oarsi.org/research/standardization-osteoarthritis-definitions

3. Moyer, R. F., & Hunter, D. J. (2014). Osteoarthritis in 2014: Changing how we define and treat patients with OA. Nature Reviews Rheumatololgy, 11(2): 65-66.

4. Bombardier, C., Hawker, G., & Mosher, D. (2011). The Impact of Arthritis in Canada: Today and over the Next 30 years. Arthritis Alliance of Canada, 1-52.

5. Stafinski, T. & Menon, D. (2001). The Burden of Osteoarthritis in Canada: A Review of Current Literature. Institute of Health Economics, 1-20.

6. Silverwood, V., Blagojevic-Bucknall, M., Jinks, C., Jordan, J. L., Protheroe, J., & Jordan, J. P. (2015). Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis and Cartilage, 23(4): 507-515.

7. Page, C. J., Hinman, R.S., & Bennell K. L. (2011). Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, (14): 145–151.

8. Osteoarthritis Research International. Non-Surgical Management of Knee Osteoarthritis. OARSI. Retrieved from: https://www.oarsi.org/sites/default/files/library/2014/pdf/patientsumfinal.pdf

9. McAlindon, T. E., Bannuru, R. R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S, M,, Hawker, G. A., … Underwood, M. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22(3): 363-388.

10. Foran, J. R. H. (2011). Total Knee Replacement. American Academy of Orthopaedic Surgeons. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00389

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