Knee arthritis a common cause of knee pain
Knee arthritis, or knee osteoarthritis (OA) is one of the most common conditions we see at Movement Centre in Randwick. It can affect one or both knees. OA often presents as knee pain and stiffness in the joint, especially around the inside / medial joint line. It can be a particularly frustrating condition to manage. Despite this, there is an awful lot you can do to manage the condition, improve function, and lessen pain.
What is osteoarthritis?
OA is a condition that affects a joint or joints in our body. It is characterised by several signs and symptoms:
- Joint line tenderness
- Crunching and clicking of the joint
- Joint pain and stiffness that may gradually improve with movement, but becomes more sore with too much loading.
Within the joint, knee osteoarthritis is characterised by:
- Bony spur formation
- Subchondral sclerosis – bony thickening; and thinning of the articular cartilage
- Joint stiffness
OA of the knee can be in the main weight-bearing joint of the knee – the tibio-femoral joint; or under the kneecap – the patello-femoral joint.
It is important to remember that OA is not a diagnosis of pain. The results we see on X-ray and imaging are also not a great indicator of the severity of the problem.
Who develops knee arthritis?
The prevalence of knee arthritis increases after the age of 50. Aside from age, sex and genetic factors, the main risk factors for development of OA include:
- Joint injury
- Joint overload
- Periods of physical inactivity
- Muscle weakness
Stiff and sore knees?
Often people presenting to us with knee OA
have a history of several years of joint stiffness, aches and knee pain. This may have been precipitated by an injury, or a marked increase in load. The early signs are often a joint that is stiff in the morning, and takes time to warm up with gentle movement. The pain often settles with gentle movement, but can worsen if pushed too hard or too far. The joint may become hot and sore if exercised too much – particularly with stairs. The knee pain is often initially located around the medial joint line. In cases of patello-femoral joint arthritis
the pain is often around the medial and lateral border of the patella.
The history of these conditions is often long, as patients push through the initial soreness, and have ups and downs in the severity of the symptoms.
To scan or not to scan?
By the time many patients present to us for physio, they often have seen a GP and had scans taken. Scans can be a confronting problem for many of our patients with knee pain. Scans – usually x-rays – are often a first step taken by GPs to identify the nature of the problem. The issue with scanning knees with pain is that the scan will often show up a whole host of things related to very normal processes in the joint. It is hard to delineate which of these normal processes is related to the clinical signs and symptoms the patient is experiencing. And more importantly, if this isn’t properly explained to a patient, the scan and the results can create fear, movement inhibition, and very genuine worry in patients.
Scans can be useful if we are unsure about what is happening in the knee. But often the scan doesn’t add information over and above the clinical signs and symptoms.
Best physio management of Knee arthritis
The RACGP guidelines for knee osteoarthritis management involves a tiered system for management. The first and best line of treatment recommended by the RACGP is for:
- Weight loss – where applicable
These three interventions present the most effective, affordable, and easy to implement strategies. Thankfully, these are all interventions we can help with at Movement Centre.
The second tier of management involves medication for pain and inflammation, heat, soft-tissue work, and walking aids. The third and final tier of intervention – for when conservative management hasn’t succeeded – is referral for x-ray, and orthopaedic specialist input.
Unfortunately we often see a complete inversion of these guidelines. Patients we see have often undertaken nearly every-step of the system before they undergo significant education or specific exercise therapy.
At Movement Centre, our physio Andrew is qualified with the GLA:D program, which is a program based on managing hip and knee arthritis with the best evidence.
What is the GLA:D program?
GLA:D stands for “Good living with Arthritis: Denmark”, and is a program developed by researchers in Denmark for the best management of hip and knee osteoarthritis. The program involves education and exercise classes that have been formulated to best improve symptoms and function of knee and hip arthritis. The program is suitable for knee or hip OA, and is appropriate across any age range, and most functional capacities. It is a prescribed exercise program, with exercises that are tailored in their difficulty for each individual. The program lasts for 12 exercise sessions, delivered over 6 weeks. Outcomes from the program show that ¾ people maintain meaningful improvement even 12 months after the program. Further, ¾ people who have previously desired surgery no longer wish to have surgery at the 12 month follow-up post-program.
At Movement Centre in Randwick, we will be commencing GLA:D classes for both individual and group exercises in the second half of 2022. Email us at firstname.lastname@example.org, or come and speak with us if you wish to have more information on the course.
For those not interested in the program, but still experiencing knee arthritis symptoms, we are happy to help with individualised care. Our approach involves addressing the functional and physiological limitations – primarily strength, range of motion and pain barriers. Our patients have access to our rehab gym
to utilise outside of their appointment times. This ensures that our patients have access to exercise equipment that they need to keep active.
Come and visit our team in Randwick at Movement Centre if you are experiencing knee pain
or stiffness. Knee osteoarthritis is a very manageable condition if treated with the best care. We pride ourselves on providing that best care, and helping our patients get back to the activities they love.