What you need to know about physiotherapy and podiatry.
Knee osteoarthritis – What is it all about?
Knee osteoarthritis (OA) is commonly referred to as a “degenerative, wear and tear” condition where the joint cartilage is “worn out”. It is frequently associated with pain and difficulties with activities of daily living. The well-known risk factors include older age, history of knee injuries and obesity. This means that younger people can also suffer from Knee OA if you had suffered from knee injuries, or if you are overweight. Age is not the cause of Knee OA but most people after the age of 65 have varying degrees of osteoarthritis when assessing their knee X-rays.
What happens as we age?
It may be surprising to know that the wearing of joints is actually a part of normal body process. However, the body is constantly trying to maintain a balance between cartilage wearing and repair. Hence it is most helpful to view knee OA as a “wear and repair” process where cells and tissues within the worn-out knee joint gets activated in an attempt to re-model and repair the worn-out cartilage such that the knee joint can continue to function and move normally.
Do all Knee OA hurt?
There are individuals with “worn out” knee joints, yet they are able to continue moving normally with little or no discomfort. They may not even know that they have Knee OA until being told by their doctor after seeing their X-rays! We can classify this as “Radiographic Knee OA”. That means that X-rays shows degenerative changes but the individual does not experience symptoms.
On the contrary, there are times when knee joint repair is less than ideal, resulting in joint changes that can cause symptoms, which include one or more of the following:
This often happens when there is insufficient time or inappropriate conditions for repair to occur before further damage happens. The process can kickstart a vicious cycle of pain that can persist for days or months. We term this as “Painful Knee OA”.
Are there other reasons why our knee gets worn out?
An interesting fact that seldom gets discussed is that our knee cartilages are living cells that respond to the load that it is being subjected to. In other words, the health of our cartilage depends on our lifestyle: If we overload and abuse it, it will deteriorate. If we do not use it enough, it will not grow strong and healthy. Joint cartilage and muscles are actually quite similar in this aspect!
I have painful Knee OA. What are my options?
Treatment designed for knee OA should be aimed at relieving pain, improving function and limiting disabilities. It must focus on relieving symptoms and improving your quality of life. Most knee OA conditions can be safely and effectively managed with an individualised exercise program and activity modification. It is widely known from clinical evidence that a customised exercise regime over 12 weeks is very likely going to reduce your pain and improve your capacity to fulfill daily tasks. An experienced physiotherapist will be able to provide you with the necessary advice and targeted exercise program that manages your condition.
Adjunct treatment such as Hyaluronic acid or Corticosteroid injections can provide pain relief while you modify your lifestyle, which often appeals to younger patients with less severe knee OA. These treatment options can be discussed with an orthopaedic specialist.
Nevertheless, operative management may be warranted for severe knee OA cases that have not responded to conservative care for a reasonable period (at least 3 months).
Can I still exercise with a painful Knee OA?
Yes. Appropriate movement and exercises are safe for knee OA patients as they help to lubricate knee joints, strengthen knee muscles and improve physical function. Exercises such as running, swimming, cycling, Nordic walking may be suitable depending on each individual’s knee OA condition. You should always have your knee OA assessed by a physiotherapist before engaging in any vigorous physical activity.
“You should stop running…running will hasten the wear and tear of your knee joint!”
Does this sound familiar?
Unfortunately, it is a widely mistaken belief that running causes knee OA. On the contrary, there is a growing body of research that shows running can confer a protective effect against the onset of knee OA in a healthy individual without knee pain. As mentioned above, our joint cartilage grows stronger and more resilient if it has been subjected to an “optimum” amount of exercise through life. It is important to note that we still do not fully understand the “optimum dosage” that provides the best protective effect against knee OA or the effect of running on progression of existing knee OA. All these require further studies. If your knee OA-related discomfort is interfering with your running, measures such as temporary reduction of training load, a progressive exercise program, cross-training, enhancing your coping capabilities with knee OA will likely be helpful in your return to running. Your physiotherapist is well-placed to determine the most appropriate method(s) in helping you regain the confidence and ability to manage your knee discomfort while running.
Nevertheless, too much rest and activity avoidance are known to worsen knee OA-related discomfort. So remember: motion is lotion and rest is not best!
Your physiotherapist will be able to assist you with exercises and appropriate lifestyle changes that can optimize your physical functions and enhance your coping abilities with OA-related discomfort. If you have an existing knee OA condition and wish to return to your favourite pastime (e.g. running), it is recommended that you consult your trusted physiotherapist for an exercise program that is individualized and suitable, which ultimately puts you in charge of your condition.