A Pain in the…Knees
Osteoarthritis (OA) is the most common form of over 100 types of arthritis which affects approximately 302 million people worldwide. The CDC estimates that 54.4 million (1 in 4) adults in the US have some form of arthritis, with that number expected to rise to 78 million by 20401. OA can affect any joint in the body but is commonly seen in the hips, knees, spine and hands2.
Previously, OA was thought to be a “degenerative” or “wear and tear” disease. However, current research has expanded this understanding to include the whole joint with alterations to the bony structures (femur, tibia and patella), cartilage (meniscus and articular cartilage), ligamentous structures and synovium (which produces synovial fluid to lubricate the joint). These pathological changes can lead to pain, stiffness (in the morning or after prolonged sitting), swelling, loss of normal function3, grinding or popping and/or buckling, affecting one’s ability to walk, navigate stairs or perform everyday activities such as household chores4.
Risk factors for developing OA are divided into two categories: nonmodifiable and modifiable. Nonmodifiable risk factors include hereditary (genetic predisposition) and congenital (abnormalities in the bones of the knee). Modifiable risk factors, one’s you can change, can be addressed through treatment (e.g. physical therapy). The most modifiable factor in the United States is excessive weight. Every pound of excess weight places 2-4 lbs of extra force on the knee joint4. This excess weight increases compressive forces in the knee and can exacerbate the symptoms and/or progression of OA.
Patients with OA have several options regarding treatment. Your doctor may suggest pharmacological treatment including NSAIDs, hyaluronic injections, corticosteroid injections, or platelet-rich plasma (PRP) injections4. Surgical interventions include partial or full joint replacement. However, current practice has evolved due to non-pharmacological, multidisciplinary care. Treatment often requires a change in lifestyle, with an emphasis on reducing sedentary lifestyle and weigh gain. Without regular physical activity, muscle strength and function decreases. To assist in stabilizing the knee and slowing the progression of OA, it is vital to strengthen the quadriceps (thigh muscles) and surrounding musculature5 of the hip and knee.
The American Physical Therapy Association (APTA), The Arthritis Foundation and the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) recommend exercise to improve the symptoms associated with knee OA6,7,8. After taking you through a full physical examination, your Doctor of Physical Therapy will prescribe an individualized plan including manual therapy, stretching, range of motion and strengthening exercises for the muscles of your knees, hips, glutes and core with the goal of decreasing stress to the knee joint and improving your function. Your physical therapist will also prescribe a home exercise program to supplement work done in the clinic.
Many people return to the activities they love including golf, hiking, swimming, biking and yoga. Please do not suffer in silence. OA is manageable and adding physical therapy into your plan of care will not only decrease pain but increase your function.
For more information, please contact your local orthopedic physical therapist to begin the journey back to performing your favorite activities with less pain. Physical Therapists improve the way you move!
Ryan Hastie, PT, DPT, CSCS
Doctor of Physical Therapy
Certified Strength and Conditioning Specialist
Titleist Performance Institute Medical 2 Certified
References
- https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm
- https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology. 2020;72(2):220-233. Doi: 10.1002/art.41142
- Lespasio M. Knee Osteoarthritis: A Primer. The Permanente Journal. 2017. Doi: 10.7812/tpp/16-183
- Zacharias A, Green RA, Semciw AI, et al. Efficacy of Rehabilitation Programs for Improving Muscle Strength in People with Hip or Knee Osteoarthritis: A Systematic Review with Meta-Analysis. Osteoarthritis Cartilage 2014;22:1752-1773
- https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-osteoarthritis
- https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/benefits-of-exercise-for-osteoarthritis
- https://www.jospt.org/doi/pdf/10.2519/jospt.2018.0507
