Comprehensive Guide to Managing Knee Osteoarthritis by Bunbury Physiotherapists

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Article by Damon Jones

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Published in 2024

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Knee Osteoarthritis in Bunbury

Knee Osteoarthritis Blog

“Bone on bone”, “joint wear and tear”, “missing cartilage”: these are all common phrases said by clients when discussing knee osteoarthritis in the Bunbury Physio clinic. These phrases unfortunately can be quite misleading and contribute to an increased fear of exercise and activity avoidance, which further contributes to the pain and physical limitations associated with knee osteoarthritis. The purpose of this article is to explain knee osteoarthritis, why it occurs, and what can be done about it; so if you have someone who is experiencing knee pain, or has been told or uses these misleading phrases, please read on!

What is knee OA and what are the common signs and symptoms?

Knee Osteoarthritis is a chronic (long term) degenerative disease that is commonly found in the aging population, with an increased risk for people over the age of 60. However, it is important to note that despite the close relationship between age and osteoarthritis, osteoarthritis does not result from aging, but from its own disease processes resulting in a change in the cartilage repair process.

Osteoarthritis can be classified by its cause as being either Primary or Secondary. Primary means the osteoarthritis does not have a known cause; when the cause is known, it is considered Secondary. These causes are diseases known to affect the natural healing and repair process of articular cartilage and bone; for example, following trauma such as a meniscus or ACL injury, a congenital joint disorder such as hip dysplasia, a metabolic disease such as diabetes or gout, or a hormone conditions such as hypothyroidism.

Osteoarthritis primarily affects the cartilage in the joint, as well as the bones. Often there is degeneration of the articular cartilage, and excessive growth of the bone (also known as hyperplasia), which can lead to joint pain, stiffness, and potentially swelling if not addressed. Common symptoms reported by clients are that it is often worse in the morning but improves within 30 minutes of movement, worsens with prolonged activity (i.e., walking long distances), and improves with short-term rest and the use of ice, with the general trend across time being a worsening of the overall symptoms.

Why does it occur?

The process of osteoarthritis is a convoluted journey; put simply, it occurs due to a disruption of the normal repair process of cartilage in our joints and not as a result of “general wear and tear” from engaging in sports, work, or other activities around the home. Cartilage is responsible for providing shock absorption and comfort when completing our favourite activities, and when the integrity of this tissue is affected, the symptoms of osteoarthritis can start to occur.

Typically, throughout our days, weeks, and life, we are putting a certain amount of healthy mechanical stress through the cartilage which results in a normal amount of degradation. This is matched by an equal amount of repair (or synthesis), ultimately leading to a healthy loss and replacement of cartilage in our joints.

In patients with osteoarthritis, this healthy repair process is disrupted (potentially) by the aforementioned secondary causes, and the rate of degradation increases. As a result, the body attempts to overcompensate by increasing the speed of repair and creation of new cartilage. The outcome of this mismatch is that the new cartilage is poorly formed, has less elasticity and is more brittle and more prone to cracking, fissuring, or erosion. This ultimately leads to cartilage that offers subpar shock absorption, and an increase in the pain associated with our favourite activities.

Imaging does not always show the full picture!

Despite commonly finding radiological signs of osteoarthritis on imaging and scans, these findings do not correlate to the patient’s pain or function. Often, these findings are incidental, and a majority of the population will have them but will be free of pain with no impairment of knee function. So when assessing patients, it is important to treat the patient as a whole, rather than focusing on what the MRI or X-ray results may show.

What can I do about it?

Generally, there are two pathways when it comes to the management of knee osteoarthritis; these are either conservative or non-conservative management, with conservative management being the first-line recommendation to managing this disease.

Non-conservative management refers to the surgical options available to address the disease. These range from non-invasive procedures such as a knee arthroscopy to more invasive procedures such as a partial or total knee replacement. A knee arthroscopy is when the surgeon completes a small incision and assesses the integrity of the knee joint, likely removing excessive bony growth, torn menisci or any structures which may be contributing. A partial or total knee replacement is a major surgery where the surgeon removes the original joint and replaces it with an new, artificial joint.

Stay tuned for a blog further explaining the process of a total knee replacement, what you can expect from the post-op recovery, and how physiotherapy is vital to optimising your recovery throughout the entire journey.

Conservative management refers see using in Bunbury at Veen Physiotherapy. The non-invasive strategies help to maintain knee function, strength and range, whilst also managing pain, which is the primary role of a physiotherapist in the management of this condition.

The core aspects of conservative management include:

1. Strengthening exercise
As Physiotherapists in Bunbury we can engage you in structured and specific exercise which will allow you to build the strength and endurance of the muscles that cross the knee joint. As the strength in these muscles improve, there will be less pressure and stress applied to your knee joint throughout everyday activities. This will result in an improvement in your knee function, and a reduction in your pain.

2. Cardiovascular Exercise
Engaging in at least 30 minutes a day of moderate intensity cardio exercise has been shown to improve fitness and decrease the intensity of chronic pain. As our body becomes fitter, we are less likely to rely on unhelpful compensation strategies which can exacerbate our pain. Examples of these exercises include comfortable jogging, cycling, swimming, water aerobics, or utilising the row machine at the gym. As we are a physio near you we can help you choose the right exercise for you.

3. Group Pilates, Hydrotherapy, or Yoga
Any of these forms of exercise are low impact, fun, and engaging and have been shown to be a great way to start exercising when managing the symptoms of knee osteoarthritis.

4. Weight Loss
Engaging in exercise and proper nutrition can lead to healthy and gradual weight loss. As a result of this, our joints will be under less mechanical stress and pressure when performing the everyday activities that we love to do, which can lead to a reduction in pain and discomfort.

5. Drug Therapy
Talking to your family doctor to be provided with medical management such as pain medication can help when it comes to returning to exercise after a long period of inactivity. This is particularly important if your knee osteoarthritis symptoms flare up quickly and have been limiting your engagement in simple exercises. Utilising pain relief in order to get the most out of your exercises is a great way to get on top of your knee osteoarthritis!

Conclusion:

Knee Osteoarthritis is a unique disease process, resulting in the loss of and formation of poorer quality cartilage within the joint. Though closely correlated to age, knee osteoarthritis is not caused by age, but rather by other secondary factors. The disease can be quite debilitating, and contributes to significant impairment when trying to complete general tasks in the community, however there are plenty of management options available. Pursuing conservative treatment via exercise and weight loss is always the best option when it comes to the management of this disease. Not only can it lead to an improvement in pain and function, and reduce the likelihood of requiring surgery, but it is also incredibly useful to prepare your body for surgery, if non-conservative management is required later in life.

When visiting a physiotherapist at Veen Physiotherapy, we will complete a comprehensive assessment of your condition and create a patient-specific management plan to help you achieve your goals.

So don’t hesitate to book in with Veen Physiotherapy, Bunbury WA to get on top of your pain and return to the activities you love!

References:
Hsu, H., & Siwiec R. M. Knee Osteoarthritis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507884/?report=classic

Mo, L., Jiang, B., Mei, & T., Zhou, D. (2023). Exercise Therapy for Knee Osteoarthritis. The Orthopaedic Journal of Sports Medicine, 11(5). 1-15. DOI: 10.1177/23259671231172773

Felson, D. T. (2009). Arthroscopy as a Treatment for Knee Osteoarthritis. Best Practice & Research Clinical Rheumatology, 24(1). 1-4. Doi:10.1016/j.berh.2009.08.002

Kats, J. N., Arant, K. R., & Loeser R, F. (2021). Diagnosis and treatment of hip and knee osteoarthritis: A review. JAMA, 325(6). 568-578. Doi:10.1001/jama.2020.22171.

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