Diagnosis: Knee Osteoarthritis

 In Lower Limb

How Knee Osteoarthritis Presents

  • Do you get knee pain when moving?
  • Do you have constant knee pain?
  • Does your knees feel stiff when you wake up in the morning?
  • Do you feel weak and unstable at the knees?
  • Can you sometimes hear clicking and grating sounds coming from your knees?

If you’re experiencing these symptoms, you may have knee osteoarthritis – a disease which can limit your ability to move with ease and affect your balance.

Knee osteoarthritis - a disease which can limit your ability to move with ease and affect your balance.… Click To Tweet

How Knee Osteoarthritis Diagnosed:

Osteoarthritis (OA) is relatively uncommon below the age of 45, but above this age, up to 13% of men and 19% of women are affected by it.

Knee Osteoarthritis (author: Bruce Blaus source: WikiMedia Commons)

Knee osteoarthritis can be clinically diagnosed if you have knee pain, plus 3 of the following signs:

  • Age above 50 years
  • A short period of stiffness in the morning or after a period of inactivity, lasting less than 30 minutes
  • Clicking or grating sounds during knee movement
  • Bony tenderness
  • Bony enlargement
  • No palpable warmth

Plain X-Rays can be useful in assessing the severity of the disease as they can reveal the presence of bony spurs, joint space narrowing and subchondral (below cartilage) deficits.

Causes of Knee Osteoarthritis:

Osteoarthritis is caused the wearing down of cartilage in joints. Cartilage at the end of bones provide the smooth gliding surfaces in all moving joints of the body. They also provide cushioning from impacts for the softer ends of bone (which contain red bone marrow).

The breakdown of cartilage occurs due to mechanical stress. Cartilage does not have a blood supply, so it can’t heal or regenerate itself quickly, and so the continued wear and tear on it leads to a swollen, inflamed joint that is painful and stiff. If not carefully managed over time, the body’s natural response is to generate scar tissue and form bony spurs around the joint, creating even more pain and stiffness. It can become quite disabling, because the joints that bare most of the body’s weight and produce gross movement (the hips, knees and lower back) are the most severely affected.

Some of the main risk factors for developing are age above 50, ethnicity & genetic predisposition, muscle weakness and being overweight. High load activities such as certain sports and labour intensive occupations also increase your susceptibility. Previous injuries (such as joint dislocations) can also increase risk because they may cause damage to cartilage.

Treatment of Knee Osteoarthritis:

There is currently no cure for osteoarthritis. Physiotherapy aims to reduce pain and improve joint mobility to increase patient independence and participation in daily life.

The most important principles in the management of osteoarthritis are:

  • Most people with OA are either overweight or obese. There is good evidence that weight management leads to good outcomes for people with OA.
  • Aside from helping in losing weight, aerobic exercises, flexibility and strengthening of the muscles around the knee (quadriceps, hamstrings, etc.) has been shown to be effective in reducing knee pain and improve its biomechanics and function.
  • A healthy diet can also greatly assist in weight loss, but there is promising research showing that a diet high in vitamin C and D are protective against OA.

Your physiotherapist can provide you advice and guidelines on how to manage your knee pain based on the above principles. He or she may also recommend a knee brace. Your physiotherapist can also perform some manual therapy techniques such as traction or mobilisations to help in reducing pain and stiffness and restoring mobility.

Wayne Wu
Student Physiotherapist

References:

Juhl, C., Christensen, R., Roos, E. M., Zhang, W., & Lund, H. (2014). Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol, 66(3), 622-636. doi: 10.1002/art.38290

Osmosis (Producer). (2016, December 05, 2016). Osteoarthritis – causes, symptoms, diagnosis, treatment & pathology. [Video] Retrieved from https://www.youtube.com/watch?v=sUOlmI-naFs

Smolders, M., Van Der Perren, L., Sascha, H., Ritchie, L., Davis, J., & Selderslaghs, F. (n.d.). Knee Osteoarthritis  Retrieved December 05, 2016, from http://www.physio-pedia.com/Knee_Osteoarthritis

Wikipedia contributors. (2016, November 07, 2016). Osteoarthritis  Retrieved December 05, 2016, from https://en.wikipedia.org/w/index.php?title=Osteoarthritis&oldid=748296396

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