Do you hear your knee as you climb or descend a flight of stairs? Do you feel knee pain as you rise from your chair or squat to plant a perennial? If so, you may be experiencing symptoms of osteoarthritis (OA) of the knee. Knee OA – or degenerative joint disease of the knee – is one of the top five causes of disability among baby boomers and their parent’s generation. It’s as prevalent as cardiovascular disease.
Knee Anatomy and OA Mechanism of Injury
The knee is the largest joint in the body. It is a complex structure consisting of three different joints. The knee is made up of the connections of the femur (thigh bone), the tibia (large shin bone), the fibula (small shin bone), and the patella (knee cap).
OA occurs when the soft cushion-like substance called cartilage between the bones at the joint surfaces become worn. However, the knee cap to counteract stresses contains the thickest layer of cartilage in the body. The rubbing of the bones together may create bony growths called osteophytes or bone spurs. As the knee cartilage continues to wear down and is less able to absorb the shock and stress placed on the knee, bones increasingly begin to grind more against each other. Knee OA can be progressive and worsen with time especially if you are 45 or older.
Not all knee joint pain is due to OA. Symptoms of a condition called patellofemoral pain syndrome may mimic knee OA. Many people can have knee pain from faulty joint movements, overuse injuries, muscle imbalances, meniscal tears, and ligamentous injuries.
That aside, with education and some preventative measures, you can avoid knee OA and its resulting pain and disability.
Knee OA Causes
There are numerous causes of knee OA. Contributing factors are:-Obesity, increased weight creates more pressure on joints such as the knee.
- Knee injury: trauma to the knee or repeated falls on the knee. For example, sports injuries causing ligament and cartilage tears can change the mechanics of knee function thereby creating more wear and tear on the knee joints.
- Jobs and sports that involve excessive repetitive kneeling, squatting and lifting of heavy weights may be a risk factor. Sports with high impact or sequences of standing or running then pivoting on the foot – like tennis, football, basketball, and soccer – may, overtime create more stress on the knee.
- Women over 50: postural alignment of the hips relative to the knee may create more stress on the knee joint.
- Heredity may play a factor as there may be evidence linking genetic predisposition to developing degenerative changes of the knee.
- Increasing age: the cushiony protective surfaces of joints become thinner with time.
- Illnesses: gout, metabolic disorders, and some congenital conditions may negatively affect the knee.
Signs and Symptoms:
Several classic signs and symptoms include:
- Knee pain (usually the first symptom). People complaining of knee OA experience pain that is generally worse with weight-bearing and is better with rest. They often have morning stiffness, tenderness around the knee joint, and feel a grinding motion in the joint called crepitus.
- Swelling in the knee
- Decrease in knee range of motion
- Limping often is observed with gait analysis.
- Atrophy of the quadriceps muscle (the front thigh muscle)
- Weakness with strength testing of the muscles that surround the kneeThe hip should also be examined as the hip can also refer pain to the knees.
The treatment for knee OA is individualized depending on the age of the person, causes of the degenerative changes and the level of degenerative change. Initially pain is directed at pain management. Over the counter drugs such as aspirin or ibuprofen can be very helpful for pain relief. Patients may need to see their physician for stronger prescription medicines such as cox-2 inhibitors, and opiates.
There is good research documented that indicates that glucosamine and chondroitin sulfate may also be a benefit.
Physiotherapists are trained to recognize and treat OA. They can also educate you on how to prevent progression of symptoms. A Physiotherapist can:
1) Design a program to strengthen and stretch the quadriceps, hamstrings and buttock muscles. Muscle balance facilitates optimal knee function to reduce stresses on the knee. Quadricep (the big front thigh muscle) weakness and other muscle imbalances of the lower extremity may predispose you to OA.
2) Administer manual therapy techniques which can improve joint mobility, reduce pain and decrease stress on the knee joint.
3) Provide modalities such as ultrasound, laser, and interferential to help with pain relief and give advice about the use of heat and cold on the knee. Many physios are trained in acupuncture which has been observed to help with knee OA symptoms.
4) Apply therapeutic tape which may correct poor knee mechanics.
5) Give useful information about walking aids such as a cane, recommend appropriate foot care and other ideas to minimize the stress on the knee and adopt good body mechanics.
6) Suggest appropriate activities to minimize knee symptoms. Provide guidelines for specific gym, swimming or walking programs to maximize function, minimize symptoms and provide advice about your current regime and maintaining a healthy body weight.
7) Refer you back to the family physician at the appropriate time in the event you need additional medication or surgical intervention.
For more information, please contact Pamela Honeyman – Physio in Your Home,
(519) 304-2440 Brantford; (416) 723-5693 Toronto