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Knee Osteoarthritis (OA)

What is Knee Osteoarthritis?

 Knee osteoarthritis (OA) is a very common chronic musculoskeletal condition which affects a number of Australian’s on a daily basis. Knee Osteoarthritis can be considered a degenerative condition (occurs via wear and tear), this condition occurs where the hyaline articular cartilage thins, develops cracks and can eventually wear away. This cartilage coats the ends of the bones inside the joints, therefore, acting as a smooth, friction-free surface to allow the joint to glide, while protecting and helping transmit the load to the underlying bone (subchondral bone). Therefore OA can result in a rough joint surface and reduce the cartilage’s ability to protect the subchondral bone, progressing into bone spurs forming in the joint, the subchondral bone can form cysts and the menisci which often develop degenerative tears. These issues can cause inflammation, pain and a range of other symptoms.

What causes knee osteoarthritis?

Knee Osteoarthritis can be developed by either exposed to higher loads than it can withstand or when the cartilage itself isn’t able to withstand relatively normal loads. Factors causing Knee OA to include the following:

  • Age – Most common for people over the age of 45.
  • Biomechanics
  • Family history of knee OA – this condition may be inherited
  • Gender – Before the age of 50, men have slightly higher rates of knee OA and after the age of 50, the rates are higher in women.
  • Heavily physical occupations
  • Muscle weakness
  • Natural leg posture – different leg positions may cause heavy loads, therefore, causing early wear and tear to the cartilage.  
  • Past history of trauma or surgery to the knee – You may develop Knee OA if you have had an incident that damages the cartilage of your knee
  • Weight – Being overweight can increase your risk of Knee OA as the knee is bearing heavy loads from body weight.

How do I know if I have knee osteoarthritis?

You may have Knee OA, you may experience the following symptoms, these will depend on the main site of OA within the knee, the severity of the OA, the amount of strength and control a person has around their knee, as well as any other conditions present within the knee:

  • a feeling of instability or giving way in the knee
  • altered joint shape and size
  • altered leg posture (eg, ‘knock knees’ or ‘bow legs’)
  • clicking, clunking, crunching or catching within the joint
  • difficulty with activities such as stair climbing and stair descending
  • the feeling of weakness in the leg muscles, especially the quadriceps (front of thigh).
  • joint swelling
  • pain with prolonged periods of walking or standing
  • reduced joint flexibility (bending or straightening)
  • stiffness in the morning or after prolonged sitting

It is common that Knee OA symptoms will fluctuate in which symptoms may get better or worse, depending on activity.  Imaging techniques such as X-ray and MRI may be used to diagnose knee OA. Treatment is dictated usually by the individual person’s symptoms rather than their scans as scans may not always indicate what symptoms you are experiencing.

How can physiotherapy help with knee osteoarthritis?

Physiotherapy is able to help people who suffer from Knee OA in many ways, although this will depend on your individual symptoms, contributing factors and lifestyle. Your physiotherapist can help you in the following ways:

  • Education about OA – It has been proven that understanding your condition will help you in actively participating in understanding pain control, coping and ongoing symptom management.
  • Prescribing an exercise program – Your physiotherapist will be able to design an individualized exercise program to help strengthen the muscles around the knee and improve how a person controls their knee position. Physiotherapy-prescribed exercise can also help delay the need for knee replacement surgery.
  • Activity modification – Teaching strategies to allow a person with knee OA to stay active and keep participating in their daily tasks.
  • Advice regarding weight control – Such as exercise programs etc.
  • Knee bracing
  • Manual Therapy – Techniques such as massaging
  • Heat or cold – Heat or cold packs may help reduce symptoms.
  • Prehabilitation – If you progress to the point of needing a knee replacement surgery, your physiotherapist can help you be better prepared for surgery and recover faster.
  • Rehabilitation – Once you receive a knee replacement surgery, your physiotherapist will be able to give you advice on post-operative rehabilitation to get you back to your required level of function.
  • Weight loss – it has been proven that by reducing body weight by 5-7.5%, many people experience a reduction in symptoms.

What can I do at home?

You must ensure you follow the instruction of your physiotherapist to ensure you manage your condition correctly. Simple exercises instructed by your physiotherapist should be completed at home, although this should not increase knee pain, consult with your physiotherapist if this is making you uncomfortable. To get the best results from the exercise program prescribed it is important that you pay particular attention to technique, leg positioning, amount of weight and range of knee movement may be required. The exercise program that will be prescribed to you for knee OA will include the following:

  • Cardiovascular exercise – An important exercise that helps maintain your overall fitness and for weight management. Such exercises include bike riding and swimming.
  • Strength exercises: These exercises concentrate on the front of the thigh (quadriceps), buttocks (gluteal muscles), calves and hamstrings. These exercises allow the muscles to be strengthened, giving an ongoing challenge and to stimulate further improvement.
  • Neuromuscular exercises: These exercises include working on coordination, balance and stability. Therefore helping to position the leg correctly reducing excessive stress and weight on the joint.
  • Stretching: Stretching may be recommended if a person has muscle tightness placing extra load on their knee, they may be shown flexibility exercises.
  • Other Strategies that may be required in more severe cases include:
  1. Lifestyle modification
  2. Pacing techniques.
  3. Simple medication
  4. Using heat or cold packs on the knee
  5. Diet modification for weight-loss

How long until I feel better?

Unfortunately, there is no cure to Knee OA hence is it a chronic condition. Although there are plenty of ways to successfully manage the condition as discussed previously. A long term plan includes strength exercise, weight management and activity modification, in conjunction with simple pain medications, this is the best way to slow the progression of OA. Moreover, a total knee replacement may be needed in some cases.

Sit to stands are a common exercise prescribed for people with knee osteoarthritis (OA). This exercise works to activate the quadriceps (front of thigh) and hamstrings (back of thigh) muscles to increase strength and improve quality of movement. 

If you would like to find out more please call us or book an appointment here.

Back to Physiotherapy for Your Knee

Reference: Australian Physiotherapy Association 2019, Your Body, viewed 19 November 2019, < https://australian.physio/>.