If you experience knee pain or stiffness, you may wonder if you have knee osteoarthritis (OA). Knee OA is a common condition that affects millions of people worldwide, especially those over the age of 50, and more so females than males.
What is arthritis? Where a bone meets a bone is a joint. ‘Arth’ means ‘joint’ and ‘itis’ means inflammation. Hence osteoarthritis means ‘joint inflammation’. In contrast to rheumatoid arthritis (RA), which is an auto-immune condition that requires primarily medical management, OA is more of a mechanical issue, at least to begin with. OA is often called joint degeneration, or degenerative arthritis. It typically happens slowly as we age or may be accelerated following trauma to a joint surface such as a fracture. The ends of bones that form joint surfaces have a smooth covering called articular cartilage that protects the bone underneath - similar to painting wood to protect it from weather. In OA, this protective covering thins and may impact how well the joint moves, extra bone can also grow to give the joint more support - these are called osteophytes or spurs.
In the knee there is articular cartilage that lines the bony ends, and the meniscus - another type of cartilage that is like a thick rubbery cushion that helps the bones move smoothly against each other. Both types of cartilage can show wear over time and as a result, there may be pain, stiffness, crunching or grinding, and finally inflammation in your knee should it get overloaded. Inflammation is a chemical irritation that hurts, tends to cause swelling and may feel warm. It tends to cause aching and night pain. Versus mechanical pain that hurts intermittently.
Our bones and cartilage are usually good at repairing themselves, but over time this regrowing of the bone and cartilage can start to become mis-shapen and no longer perfectly smooth, which may lead to worsening symptoms and a decrease in the space between the bones.
The symptoms of knee OA can vary from person to person. Here are some common signs to look out for:
Pain in your knee, especially when you move or bear weight on it
Stiffness, particularly first thing in the morning or after being still such as prolonged sitting, that starts to feel better the more you move it
Swelling, often all around the knee
A crunching or grinding sensation when you move your knee
In advanced cases altered looking knees with bowing or knocking of the joints
If you experience any of these symptoms, we encourage you to consult with a physiotherapist or osteopath, because knee OA does not necessarily mean you need surgery. Although it cannot be ‘cured’ as such, there are many treatments available to reduce your symptoms such as exercise, medications, manual therapy and weight management, to slow down the progression of the condition and manage symptoms.
Exercise, for example, has been shown time and time again to be an extremely effective way of reducing pain in patients with OA.
Both aerobic and resistance training (Dantas et al., 2021), Land-based and water-based training (Song, J & Oh, J W, 2022), or interventions that combine some of these areas such as clinical pilates, have all been shown to be helpful in reducing pain from Knee OA related issues. As well as this, the addition of manual therapies along with exercise has been shown to provide large additional benefits to pain levels in the short term (Runge et al., 2022).
It is also worth noting that many people with knee OA experience improvement in their symptoms with non-surgical treatments alone.
Surgery, such as knee replacement surgery, is typically only recommended for those who have severe symptoms that are not responding to other treatments. It should be viewed as a last resort given the risk associated with surgery itself. Many people in their older years have knee OA on X-Rays but have little to no symptoms or concerns with their knees. OA on X-Ray, even if it looks advanced, does not mean you will need a knee replacement.
In summary, knee OA is very common, affecting millions of Australians each and every day. It’s not something that needs to be feared, and should not hold you back from living your life. If you are experiencing knee pain or stiffness, consult a physiotherapist or an osteopath about your options and remember that surgery is not the only way forward. With the right treatment plan, you can get relief from your symptoms and enjoy a better quality of life, starting today.
References:
Dantas LO, Salvini TF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther. 2021 Mar-Apr;25(2):135-146. doi: 10.1016/j.bjpt.2020.08.004. Epub 2020 Sep 8. PMID: 33
262080; PMCID: PMC7990728.
Song JA, Oh JW. Effects of Aquatic Exercises for Patients with Osteoarthritis: Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 Mar 16;10(3):560. doi: 10.3390/healthcare10030560. PMID: 35327038; PMCID: PMC8955208.
Runge N, Aina A, May S. The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients With Knee or Hip Osteoarthritis: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2022 Oct;52(10):675-A13. doi: 10.2519/jospt.2022.11062. Epub 2022 Jul 26. PMID: 35881705.