Osteoarthritis of the knee part 1

Written by: Taylor Post BA-Kin, CAT(C)
                   Athletic Therapist 

 Arthritis is a disorder involving painful inflammation of one or more joints. While the term arthritis represents hundreds of different conditions, there is one that is far more common, especially in adults over age 50. Today we focus on the signs, symptoms and treatment of osteoarthritis of the knee. 

Osteoarthritis (OA) is the most prevalent form of arthritis. It is often described as a “wear and tear” or degenerative type of an injury, but this may not be completely accurate. Recent studies show that this painful condition may also be linked to the body’s failure to repair joint damage. In either case, osteoarthritis is characterized by the breakdown of the cartilage along the surfaces of the joint and the bone underneath. This causes the protective spaces between the bone surfaces to become very rough and increasingly narrow. If left untreated, the joint space eventually becomes so small that the bone ends up rubbing against bone. The knee is the most common lower-limb joint to be affected by osteoarthritis. 

While each individual is affected differently, symptoms of osteoarthritis often include; knee pain, heat, swelling and stiffness. During an assessment, a physician or other medical professional will also assess joint range of motion, joint stability and gait changes (limping/ trouble bearing weight). X-ray’s are ordered to confirm the presence and location of OA within the knee(s). Degenerative changes are most commonly found on the medial (inside) of the knee or under the patella (knee cap). It is less common to occur on the lateral (outside) part of the knee.  
Unfortunately there is no cure for osteoarthritis. However, there are a few treatment options that can help manage pain and help keep people active and doing what they love. Most treatments are non-surgical but more invasive procedures can be necessary in severe cases. Here we focus on lifestyle changes and options for bracing and supports. 

- Lifestyle Changes 
Some small changes in an individuals’ daily habits can help slow down the progress of osteoarthritis. Limiting certain activities that aggravate knee pain, such as running or stair climbing may be necessary. That being said, a person with knee OA should still be as active as possible without irritating the knee excessively. Low impact exercise (swimming, cycling etc.) can help lubricate the joint and maintain range of motion, while strength training can keep the muscles surrounding the knee strong.  

Maintaining a healthy weight can also be beneficial. Due to the load bearing nature of the joint, any excessive body weight leads to increase deterioration and strain on the knee structures. A healthy diet and regular exercise are both great places to start for any weight loss program. 

- Knee Bracing and Supports 
Wearing a knee brace can help support the joint and even prevent osteoarthritis from getting worse. In most cases, an “unloader” knee brace is most appropriate. This type of brace shifts body weight away from the affected side of the knee and helps maintain joint space. With a prescription from a doctor, braces for OA can often be covered through Manitoba Health, or through private insurance plans. In addition to a knee brace, some people may use a cane or a walker for additional support while walking. 

- Medication 
Several medications can help deal with the pain and inflammation that comes with knee OA. Physicians will work closely with patients to discuss the pros and cons of each one, and to determine what dose will be both safe and effective for them. Over the counter pain relievers and/or non-steroidal anti-inflammatory drugs (NSAIDS) are often the first option, for conservative treatment. 

- Corticosteroid Injections 
Oral medications may not always work or may cause too many side effects. In this case an injection of medicine directly into the joint may be more effective. Steroid injections usually only provide short-term relief, and more than one injection may be needed over the course of a year. 
 
- Athletic and Physical Therapy 
Both Athletic Therapists and Physiotherapists are great resources to help with knee pain caused by osteoarthritis. Manual therapy can help to reduce the pain, swelling, and stiffness in the joint. They can also prepare an exercise program with OA friendly exercises and stretching to keep the knee strong and maintain mobility. 

- Surgery 
Surgical intervention (arthroscopy, partial or total knee replacement etc.) is often seen as a last resort. Surgery is usually only recommended for individuals with severe osteoarthritis in multiple compartments of the knee, or for those whose pain causes disability and is not relieved with nonsurgical treatment. 

If you have persistent knee pain it is important to seek medical advice, before it affects your quality of life. Osteoarthritis can be very painful and make certain activities of daily living seem almost impossible to perform. Without treatment it can lead to lost work time and a serious disability for many people. However, with the right knowledge and lifestyle it is a condition that can be managed. A diagnosis of osteoarthritis does not need to stop you from living a fulfilling and productive life.
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To book an appointment with Taylor please email her at [email protected] subject: athletic therapy appointment.