Osteoarthritis of The Knee – A Help Guide To Keeping Moving

Knee pain affects nearly 50% of people over the age of 50, and in 25% of those people it becomes a long-term problem although it can occur at any time of life.

The pain caused by osteoarthritis of the knee can significantly reduce your quality of life, your experiences with your family and impact on your daily activities.

Unlike some forms of arthritis (e.g. rheumatoid arthritis), which result in inflamed, swollen, hot, painful joints, osteoarthritis (OA) is different.

OA is a degenerative arthritis, where the cartilage in your joints, or in this case the cartilage in the knee, starts to break down.

You may experience some or all of the following symptoms:

 

• Pain (particularly when you are moving your knee or at the end of the day – this usually gets better with rest)
• Stiffness
(especially after rest – this usually eases once you get going)
• Creaking, crunching, grinding sensation in the knee when you move
• Swelling (caused by extra fluid in the joint), sometimes you get a hard swelling due to osteophytes (bone spurs) which is where the bone is trying to repair itself
• Your knee giving way
because the muscles have become weak or the joint structure is less stable
• Your knee not moving as freely or as far as normal
• The muscles that around the knee look thin or wasted
• The knee becomes bent or bowed

You’ll probably find that your pain comes and goes throughout the day, sometimes depending on how active you’ve been but sometimes for no clear reason. Often people find that changes in the weather, especially cold weather, make the pain and stiffness worse. The good news is, there are lots of things you can do to improve the situation.

How Do I Find Out If I have Osteoarthritis Of The Knee?

The first step is to see a medical practitioner. This could be your GP 
or an Osteopath who will assess your knee and take a history 
of your symptoms. X-rays are initially the most useful test to confirm diagnosis of OA as this will show degeneration in the joint, however they often are not needed. X-rays may show changes such as osteophytes, narrowing of the space between bones and calcium deposits within your joint.

It’s good to note that the extent of the ‘damage’ seen on a scan doesn’t necessarily correlate to the amount of pain you feel. You may have severe pain with only a small degree of joint degeneration or vice versa.

Knee pain doesn’t just come from bone, often it can come from damage in the soft tissues (e.g. cartilage, tendons, muscles) that can’t be seen on a standard X-ray, in this case you will need an magnetic resonance imaging (MRI) scan on your knee.

There’s no blood test for osteoarthritis but sometimes your doctor may check this to rule out other conditions.

So What Has Happened To My Knee Joint?

Your knee joint is where your thigh bone (femur) and your shin bone (tibia) meet. The muscles around the joint along with the small patella bone that sits between them, allow movement between the upper part of your leg and the lower part.

The surfaces of the joints are coated in cartilage, which is a hard, smooth tissue that allows the bones to glide smoothly over each other. Cartilage is also a built-in shock absorber.

A capsule that contains fluid to lubricate the joint encases the joint and the cartilage. Ligaments hold the bones together and the capsule, which is made of a tough, fibrous material, strengthens the joint.

All healthy joints and joint tissues are constantly going through a cycle of repair as part of normal life, however in osteoarthritis this repair process becomes faulty. 
It can occur for lots of reasons, but when this happens:

• The cartilage becomes rough and thin
• The bone underneath the cartilage reacts by growing thicker
• The bone at the edge of your joint grows outwards, forming bony spurs called osteophytes
• Extra fluid may be produced causing swelling
• The capsule and ligaments around the joint slowly thicken and contract making the joint stiff.

What Can I Do About It? – Actually Quite A lot!

There’s no cure for osteoarthritis as yet, but there is a lot you can do to reduce your symptoms and reduce the chances of your arthritis getting worse.

Osteoarthritis of the knee affects different people in different ways, so we can’t predict how it’ll progress.

Unless you have had a significant knee injury, osteoarthritis is mainly a slow process that develops over many years and causes small changes in just part of a joint, although it may still be painful.

Sometimes the condition peaks after a few years and your symptoms remain the same or even get easier.

If you have severe osteoarthritis your cartilage can become so thin that it no longer covers the ends of your bones. They start to rub against each other and eventually wear away. This can alter the shape of your joint, forcing your bones out of their normal position.

In addition, the muscles that move your knee gradually weaken and become thin or wasted. This can make your knee unstable so that it gives way when you put weight on it.

Osteoarthritis doesn’t lead to other types of joint disease and won’t spread through your body. However, deformity caused by osteoarthritis in your knee may mean you put more pressure on your other joints, which could result in more wear and tear in those joints.

It is very possible to manage it and find a happy equilibrium between ‘exertion and exacerbation’. Your Osteopath or Sports Therapist will tell you it’s very important to keep your joints moving. You need to find the right balance between rest and exercise – little and often is usually the best approach.

Changing your lifestyle can greatly reduce your risk of your osteoarthritis getting worse.

Regular exercise is very important; protecting your knee from further injury and keeping to a healthy weight will all be a great help.

Seeing an Osteopath or Sports Therapist on a regular basis too will be a significant help, not only to show you the right exercises to do, but also help prevent wear and tear in your whole body.

Exercises are aimed at maintaining and improving the range of movement of your knee, easing the stiffness, as well as strengthening the surrounding muscles. The stronger the surrounding muscles, the better support your knee will have during movement. A therapist can also help make sure you’re moving in a way that doesn’t make the condition any worse, which often happens as a result of pain.

Osteopaths may also use massage therapy, ultrasound or sometimes acupuncture especially during times of a ‘flare-up’ to reduce pain. Manual techniques help loosen the joint and surrounding tissues.

Swimming or hydrotherapy, cycling, elliptical/cross trainer and gentle walking are all good exercise with reduced impact on your knee. Losing even a small amount of weight through exercise or diet can make a big difference to the strain on your joints.

Over-the-counter painkillers and non-steroidal anti-inflammatory drugs can often help ease the pain caused by osteoarthritis.

Day-To-Day Tips:

 

• Walking is very important for osteoarthritis; it helps reduce the pain, increased muscle and bone strength. Start gradually, you may ache initially but this should ease with time, try 10/15 minutes a day for about 3 to 5 days and then try to increase the time. Go for a walk 5 to 6 days a week and keep it up.
• If you then find you want to do something a bit more strenuous – studies have shown that running doesn’t increase the risk of osteoarthritis, provided you build up gradually and wear the right shoes. Read more in my blog http://www.osteopath4all.co.uk/running-jogging-bad-joints/
• Nordic Walking Technique is a brilliant way to get out walking even with badly arthritic knees. If you are interested I can train you in Nordic Walking, just ask!
• Wear low-heeled shoes with soft, thick soles (trainers are ideal). Thicker soles will act as shock absorbers.
• If necessary use a walking stick to reduce the weight and stress on your painful knee.
• Only use the handrail for support when climbing stairs if the knee is too painful or you feel unsteady. Otherwise try not to hold on so you have to use your leg muscles.
• Don’t keep your knee still in a bent position for too long, it will stiffen up. Have lots of walking breaks if sitting for long periods at home, work or in the car.
• Learn to relax your muscles and let the tension out of your body.
• Use heat/ice packs to help eases pain and stiffness. Use ice if it’s swollen and heat if it’s just stiff. But not directly on the skin or you may get burnt.
• Knee braces for osteoarthritis are available to help get you moving but shouldn’t be left on all the time, check with your Osteopath or Sports Therapist first on the right one for you.

Try everything you can to help yourself first.

If you still have severe pain and substantial mobility problems speak to your doctor, treatments may include a steroid injection into the knee, this may improve pain for weeks or months. If things still haven’t improved after an injection then a knee replacement operation may be the way forward. A locking knee may need an operation to wash out loose fragments of bone and other tissue.

New therapies, which aren’t yet available in the NHS, but are available in private practice in the UK, include Hyaluronic acid injections to help lubricate the knee joint and Stem cell therapy to help repair knee cartilage these are particularly useful in those who have early osteoarthritis and can help slow the wear and tear process down.

Above all …..move it, move it!!!

Debbie Crumpton