Advice from your Physical Therapist: How to Improve Osteoarthritis

Osteoarthritis of the Knee

Julie Hamlin, Student PT

knee

If I’ve learned anything during my third physical therapy clinical rotation, it’s that people have knee pain!  I am doing my affiliation at an out-patient orthopedic clinic, and I’ve had the chance to work with many diagnoses and post-operative conditions.  A majority of the patients I’ve seen on a daily basis were middle-aged folks with knee pain.

WHAT IS KNEE OA?

Knee OA, or osteoarthritis, is the most common form of knee arthritis.  It is a progressive disease characterized by the gradual wearing away of the cartilage that serves as a cushion for the bones in a healthy knee joint.  As this cartilage degenerates in an arthritic knee, bones begin rubbing together causing pain.  A doctor can diagnose this disease by taking an x-ray, which will show decreased space and potentially bone spurring at the knee joint.

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Symptoms of knee OA may start as a gradual increase in pain at the knee joint, particularly during walking or some other weight-bearing activity.  Decreased flexibility and a sensation of stiffness around the knee are also common symptoms.  Knee buckling, catching, or overall feelings of weakness are all ordinary characteristics of knee OA.

WHAT CAUSES KNEE OA?

There are many factors that increase your risk of developing knee osteoarthritis.  According to the Centers for Disease Control and Prevention2, risk factors that cannot be changed include age, gender, previous injuries, and heredity.  Symptoms of knee OA begin around age 50-60, with women being more susceptible than men.

There are other risk factors that can be modified before symptoms appear.  Carrying additional body weight puts increased stress on all joints, causing additional wear and tear over time.  In addition, performing repetitive knee motions over time, for example for your occupation, can also increase your risk for developing OA of the knee.

HOW CAN I MANAGE MY SYMPTOMS?

There are several options for symptom management to be tried during the early stages of knee osteoarthritis.  Weight loss, strength training, and exercise should be performed initially before opting for surgical treatments.

Weight Loss

Although not all people with knee OA are overweight or obese, it continues to be a risk factor for cartilage degeneration in the knee.  Dietary and activity level modifications can be made under the supervision of a professional in order to lose body weight which would take some of the load off the joints for decreased pain.

Strength Training and Exercise

Recent studies3 have shown that strengthening of hip musculature improves alignment at the knee, thus resulting in decreased pain.  Strengthening the muscles at the hip and surrounding the knee absorb some of the stress from the knee joint.  In addition, cardiovascular exercise can also be beneficial.  In particular, swimming, biking, and using the elliptical machine will provide optimal benefits without the continuous pounding of the pavement, which may cause an increase in knee pain.  A physical therapist is trained to provide appropriate and safe exercise prescriptions for pain relief for those with developing OA.

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Drugs

Cortisone injections are performed to alleviate pain and inflammation in the knee joint.  Cortisone is an anti-inflammatory steroid, which works immediately, but relief is short term.  These act as a band aid and do not directly affect the cause of the problem.  Many times doctors will prescribe physical therapy in addition to the cortisone injection.

NSAIDS (Non-steroidal anti-inflammatory drugs) can also provide some relief in pain.  These should only be used temporarily, because they can have side effects with long term use.

Surgical Options

Surgery may be a necessary option if dietary and activity modifications have been previously tried.  Arthroscopic chondroplasty and total knee replacements are two of the more common procedures.  Should conservative measure fail to reduce your knee pain, the most appropriate surgical option for you should be determined with your doctor.

  • Arthroscopic Chondroplasty .  This is typically the first surgical procedure performed for knee OA.  Using an arthroscopy to view the knee joint on a monitor, the surgeon smoothes out old cartilage, allowing healthy cartilage to grow in its place.  Post-surgical outcomes are typically good4 following this procedure.
  • Total Knee Replacement.  The ends of the tibia and femur (the two bones which make up the knee joint) are resurfaced with metal, and a spacer is placed for a smooth gliding surface.  Typically patients use some sort of assistive device for a few days to weeks, in addition to starting a physical therapy regimen.
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