Knee Osteoarthritis

Knee Osteoarthritis

What is knee arthritis?

Osteoarthritis is the most common form of joint disease and the knee joint is one of the most commonly affected.

When you have arthritis in the knee, the cartilage that covers the ends of the bones gradually becomes rough and thins. The bone underneath the cartilage become thicker and can form body spurs which can affect movement.  The joint may produce more fluid and swell up and the joint space reduces. The capsule thickens, and inflammatory processes try to repair the damage. The damage can cause instability in the knee causing the symptoms to become more persistent over time.

knee-1

What are the signs and symptoms?

Signs and symptoms vary depending on individual factors and the severity of the arthritis but mainly include:

  • Pain in the knee
  • Stiffness, which is worse with inactivity
  • Crepitus (a grinding sensation in the knee)
  • Swelling of the knee joint and surrounds
  • Occasionally the knee may give way

What causes it?

Arthritis of the knee is most commonly caused by a combination of factors such as:

  • Increasing age
  • Obesity
  • Previous joint injury
  • Genetic predisposition

How is it diagnosed?

Knee arthritis is most commonly diagnosed through its signs and symptoms.

Occasionally an X-ray may be taken to confirm the diagnosis, rule out other disorders or to determine the severity of the arthritis. A reduction of joint space is a sign of osteoarthritis in the knee.

knee-2

How does physiotherapy help to treat knee osteoarthritis?

Physiotherapy can help treat osteoarthritis through conservative management, prehabilitation before surgery or rehabilitation after surgery. Research shows that completing a strengthening program before surgery can improve strength and function in patients with severe osteoarthritis.

There are many treatments available and may include a combination of those listed below:

1. Manual Therapy:

Manual therapy including joint mobilization, combined with an exercise program has been shown to reduce pain and joint immobility.

2. Soft Tissue Massage:

Massage and trigger point release has been shown to improve pain, reduce stiffness and improve range of movement and function.

3. Hydrotherapy (stretching, strengthening, aerobics):

Hydrotherapy in the form of pool exercises can include stretching, strengthening and aerobics. It has been shown to improve walking and relieve hip and knee pain in patients with knee arthritis.

Hydrotherapy is mainly used when pain restricts land-based exercise and as a preparation for progression to a land-based exercise program.

 

pool

4. Weight loss:

Overweight individuals have a higher rate of knee osteoarthritis. The force through the knees is 3-6 times the bodyweight therefore more mass causes increased stress through the knee joint leading to early onset and/or progression of knee OA. Physiotherapists can prescribe a weight loss exercise program to help you in reaching your goals. Weight loss has been shown to reduce pain and improve walking speed

5. Electrotherapy/ Transcutaneous Electrical Nerve Stimulation (TENS):

The use of TENS for knee arthritis has been shown to increase the pressure pain threshold at the knee which research shows reduces pain at rest and while walking. TENS can be a valuable addition to your home exercise program.

6. Taping:

Kinesiology taping is a great way to relieve pain and support your knee you in your daily activities while you strengthen the muscles around the knee.

knee-pain-physio

7. Exercise Program:

A functional strengthening program that is individually prescribed is great at reducing symptoms, especially if you are regularly reviewed and exercises are progressed in a clinical setting, such as a physiotherapy clinic, to keep you on track.

8. Orthotics:

Orthotics may be used if the arthritis is found in the medial knee compartment. A wedged insole can help reduce pain in mild to moderate arthritis.

orthotics-braces-physio

What does the research say about knee surgery?

Over the long term, patients who undergo knee surgery versus those who receive conservative management do not have significant benefits in pain or function.

Wriitten by Body Rhythm Physiotherapist Kornelia Molenda.

 References:

Arya, R., & Jain, J. (2013). Osteoarthritis of the knee joint: An overview. Indian Association of Clinical Medicine, 14(2), 154-162.

Atkins, D., & Eichler, D. (2013). The effects of self-massage on osteoarthritis of the knee: A randomized, controlled trial. International Journal of Therapeutic Massage and Bodywork, 6(1), 4.

Bhatia, D., Bejarano, T., & Novo, M. (2013). Current interventions in the management of knee osteoarthritis. Journal of Pharmacy & Bioallied Sciences, 5(1), 30-38. doi:10.4103/0975-7406.106561

Brignardello-Petersen, R., Guyatt, G. H., Buchbinder, R., Poolman, R. W., Schandelmaier, S., Chang, Y., . . . Vandvik, P. O. (2017). Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open, 7(5). doi:10.1136/bmjopen-2017-016114

Deyle, G., Allison, S., Matekel, R., Ryder, M., Stang, J., Gohdes, D., . . . Garber, M. (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: A randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical Therapy Journal, 85(12), 1301-1317.

HANDI. (2013). Taping for knee osteoarthritis. Australian Family Physician, 42(10), 725-726.

Hinman, R., Crossley, K., McConnell, J., & Bennell, K. (2003). Efficacy of knee tape in the management of osteoarthritis of the knee: Blinded randomised controlled trial. British Medical Journal, 327(7407), 135.

Lee, K., Yi, C., & Lee, S. (2016). The effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion. Journal of Physical Therapy Science, 28(1), 63-66. doi:10.1589/jpts.28.63

McDonald, S., Page, M., Beringer, K., Wasiak, J., & Sprowson, A. (2014). Preoperative education for hip or knee replacement. Cochrane Database of Systematic Reviews(5).

Perlman, A., Sabina, A., Williams, A., Njike, V., & Katz, D. (2006). Massage therapy for osteoarthritis of the knee: A randomized controlled trial. Archives of Internal Medicine, 166(22), 2533–2538. doi:10.1001/archinte.166.22.2533

Swank, A., Kachelman, J., Bibeau, W., Quesada, P., Nyland, J., Malkani, A., & Topp, R. (2011). Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. The Journal of Strength & Conditioning Research, 25(2), 318-325. doi:10.1519/JSC.0b013e318202e431.

Vance, C., Rakel, B., Blodgett, N., DeSantana, J., Amendola, A., Zimmerman, M., . . . Sluka, K. (2012). Effects of transcutaneous electrical nerve stimulation on pain, pain sensitivity, and function in people with knee osteoarthritis: A randomized controlled trial. Physical Therapy Journal, 92(7), 898-910. doi:10.2522/ptj.20110183

Images:

https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-knee/