Knee Osteoarthritis
Osteoarthritis (AKA OA, degenerative arthritis, Arthrosis or Osteoarthrosis) is a degenerative disease that is characterized by the gradual decrease in cartilage on the bone surface. Cartilage is the substance protects your bones and helps cushion them with activities. The breakdown of cartilage can sometimes causing pain, swelling and can affect overall mobility. This results in a decreased ability of shock absorption for the joint and will cause ‘bone on bone’ which is the sensation of the bones rubbing together.
Osteoarthritis is often referred to as general ‘wear and tear’. As a result of this degenerative process, the bony surface of the joint thickens and new bone (bony spurs) is laid down as the body tries to stablise the joint. Often this is painless process, but these can occasionally encroach on structures such as ligaments and the joint capsule itself. When this happens it can result in inflammation and pain. In progressive and long standing cases the cartilage can be completely worn away and consequently changing the shape of the joint due to wearing patterns and the presence of spurs.
Risk factors for knee osteoarthritis
- Over 40 years old
- Slight genetic component (but does not guarantee)
- Being overweight
- If you’ve had previous joint injury – ligaments tears, meniscus damage, previous surgeries
- Have worked in physically demanding jobs
- If your joints have been adversely affected by another joint disease such as gout or rheumatoid arthritis
Stages of knee osteoarthritis
- Stage 1 – ‘Doubtful’ There is typically minimal disruption to the joint, having about 10% cartilage loss
- Stage 2 – ‘Mild’ The joint space begins to narrow, cartilage starting to breakdown and the body starts to create osteophytes (bone building blocks)
- Stage 3 – ‘Moderate’ there is moderate joint-space reduction. Gaps in the cartilage begin to expand until they reach the bone
- Stage 4 – ‘Severe’ the joint space is greatly reduced, over 60% of the cartilage is already lost and the osteophytes (bone spurs) are large.
Symptoms
- Most common symptom of knee osteoarthritis is stiffness of the knee joint
- Some people will get experience swelling, there is no particular pattern and can change day to day
- Tenderness to touch.
- Crepitus (a grating sound can occur on movement of the joint
- Pain levels can vary from anywhere to mild to debilitating which makes it difficult to do simple daily activities.
- OA pain often isn’t consistent, you can have good days and bad days, and sometimes weather dependent!
- It is important that if you have any joint pain to get it seen to by one of our fantastic osteopaths or your local GP for assessment to rule out other causes of the pain, or if OA is suspected then early management can commence
Management
Often people’s largest concern with the diagnosis of OA is the thought of needing a partial or full knee replacement. Although in some cases this may be necessary to live as near normal life, a great amount of research has gone in to finding the best management strategies for these conditions to prevent the need for surgical intervention.
There have been good results with exercise, diet and nutrition, weight loss, and sometimes using bracing to help manage symptoms and improve joint health. This has been found to be as effective as a knee replacement in the early stages and can help aid in delaying or even preventing surgery.
The decision on if surgery may be required will usually be made by your orthopaedic specialist. Typically this only occurs after a failure of the above mentioned less invasive treatment strategies, particularly if the person shows no willingness to lose weight (if necessary) and their response to medication is less than ideal.
Exercise
There are many forms of exercise we can use to help strengthen the knee to help with OA pain such as :
- Range of motion and stretching the joints to try and achieve better mobility
- Aerobic/endurance exercises- these are a double whammy for OA sufferers, not only can it help strengthen the joint and surrounding muscles but it’s good for our heart and lungs, increasing stamina and reducing fatigue, which can also aid in weight loss. Aerobic exercise can include cycling, walking, jogging and swimming
- What if aerobic exercise hurts too much? – Aquatics! Performing exercises in water decreases the weight load through the joint and therefore reduces strain. Aquatic exercises don’t involve swimming, it can be as easy as walking up and down the pool in water at shoulder height.
GLAD program
GLAD is an education and exercise program developed by researchers in Denmark particularly for people suffering from knee and hip osteoarthritis. Research from this program has shown symptom progression reduces by 32%. Other positives include less pain, reduced need for painkillers and less time needed off work! For more information on this, go to https://gladaustralia.com.au/
But what do we believe is the biggest game changer……..our SHOCKWAVE machine.
A pilot study published in the Journal of Surgical Research (Zhoa, et al, 2013) showed that our shockwave machine reduced knee pain on a visual analogue scale from 7.56 (out of 10, with 10 being the most ridiculous pain you can imagine) to 3.83. That is a nearly 50% reduction in pain levels over a 12 week trial period. They concluded that the shockwave machine we have in our clinic “is effective in reducing pain and improving knee function, with better results than placebo during a 12 week trial”. Furthermore, there were no adverse effects found during or after the shockwave treatment……meaning that the absolute worst case scenario is there is no change.
We love this machine and what it has helped our clients achieve. Whilst the study didn’t include any of the above mentioned non-invasive management plans, we still strongly believe that these should be practiced in addition to the shockwave treatment.
Remember that unlike other clinics that use shockwave, we have no additional charges on top of our normal consult price for a shockwave treatment!
For more information on how shockwave works check out our earlier blog here!
Dr Cameron Bayliss
B Hlth Sc, B App Sc (Osteo)
Zhao, Z., Jing, R., Shi, Z., Zhao, B., Ai, Q., & Xing, G. (2013). Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial. Journal of surgical research, 185(2), 661-666. https://www.ncbi.nlm.nih.gov/pubmed/23953895
