Knee pain in the middle to late decades of life is a common complaint amongst patients presenting to osteopathic clinics across the globe. Osteoarthritis (OA) is a common cause of knee pain in this age group of people. Research suggests approximately 654 million people aged 40 years and over were living with knee OA in 2020 around the world. This comes at an incredible cost to healthcare services worldwide, with figures in the billions of dollars!
What is osteoarthritis?
Osteoarthritis is just one of a number of forms of arthritis… Essentially a disease which affects the joints in our body. OA is the most common form of arthritis, with Rheumatoid Arthritis (RA) being the second most common form. This blog will focus on OA, a potentially debilitating disease that most commonly affects the weight-bearing joints of the body (i.e. the knees, hips and lumbar spine), but can affect any joint in the body where the joint surfaces are covered in cartilage.
The characteristics of OA include loss of the cartilage that covers the ends of bones that come together to form joints. The underlying and surrounding bone, as well as other joint structures (including joint capsules and other tissues) are also susceptible to degenerative changes that ultimately lead to poor functioning of a joint. The process usually occurs over a long period of time, often starting early in life (interestingly with little to no symptoms at all) and progressing into the latter years. The severity of the disease varies from person to person with some people only experiencing mild symptoms throughout their life. Other people experience more severe symptoms and may require joint replacement surgery as a last port of call to ensure they can continue to live their life as pain-free as possible.
Osteoarthritis of the knee can affect either of the two main joint components of the knee… The joint between the ends of the thigh bone and the shin-bone (called the tibiofemoral joint), and the joint between the thigh-bone and the knee-cap (called the patella-femoral joint).
There are certain factors associated with higher rates of knee OA. These include:
- Age: Rates of knee OA increase in the elderly
- Gender: Females slightly out-do the males with this one, being approximately 1.5 times more likely to develop OA
- Trauma: A trauma to the knee can increase your likelihood of developing knee OA
- Obesity: Rates of knee OA increase with higher levels of obesity
- Smoking: Smoking is associated with higher rates of knee OA
Signs and symptoms
The signs and symptoms of knee OA include:
- Reduced range of motion
- Difficulty performing functional movements including squatting and kneeling
Pain associated with tibiofemoral OA commonly affects the inside region of the knee first, where the two bones meet at the joint line. Patella-femoral related pain is often felt deep behind the kneecap. Pain will vary from one person to another, and the severity of pain does not necessarily relate to the severity of degeneration. Although if you speak to a person who is about to have a joint replacement surgery (i.e. their joint has degenerated to the point of needing a surgical intervention to keep the person functioning well), they will likely tell you that the pain is extremely debilitating.
Pain and stiffness are regularly felt first thing in the morning and late at night. OA tends to respond well to movement of the joints, and so people often find their pain and stiffness improves once they are up and moving, for it to return once their day has finished and they are relaxing at night.
So, you’ve been diagnosed with knee OA. What to do? Call your osteo… Ta-dah!!!! Given we love teaching you how the human body moves (we study human biomechanics at uni), we’re good at picking up how the body should and shouldn’t move. There are no magic pills for treating OA of the knee, and no practitioner can claim to treat the disease itself, as there is unfortunately no cure for OA. It is a progressive, degenerative disease, but there are ways of stunting the progression of this condition if the risk factors leading to its presence are attacked head on.
Poor movement resulting from daily postural repetitive strain, or an old injury that wasn’t resolved are major factors in the maintenance and development of OA in the knee. Poor movement or dysfunction occurring in the low back, hip or ankle can all lead to excessive load being placed through the knee joints, which can exacerbate the disease process. This is where we come in.
We can assess how you move and work out what is causing the excessive loads through the knee and then develop a plan to improve range of motion and flexibility, strengthen muscles and return you to (hopefully) pain-free daily activities. We will use a combination of education, soft tissue manipulation, joint mobilisation and progressive exercise programs to restore life to your body. Returning to efficient movement patterns after years of neglect, poor movement and a deconditioned body part will take time, but with determination from both you and your practitioner, it can happen.
As previously mentioned, some cases of knee OA can end up requiring surgical intervention to replace either part of or the whole joint. The good news is, if you do have to go through this process, we have your back (well… in this case, your knee) and can help you through rehab and recovery. Many people who have a knee replacement return to full daily activities and live a long and pain-free life.