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Oh, my aching knee! Best treatments for knee osteoarthritis

Do you have knee pain?

Osteoarthritis (OA) is the most common joint disease worldwide with significant health and lifestyle costs.

 

Osteoarthritis (OA) is a progressive joint disease identified by joint inflammation. Knee arthritis is one of the most disabling conditions that affects more than a third of adults over 65. An estimated 30 million Americans are currently affected by this disease. 

The financial costs nationally for the care of adults with OA are estimated to be north of $30 billion each year. Some researchers predict that the total cost will rise and exceed $89 billion soon.  

As people are living longer, so increases the prevalence of knee pain and the need for cost-effective treatment and care options. Treatment choices should also factor in different age ranges and population needs. Currently, 80% of adults affected by OA report struggling with limited movement, and 20% report being unable to perform essential activities of daily living.

KNEE OA2

What is Osteoarthritis of the knee?

Within the knee is a smooth fibrous connective tissue known as cartilage. This cartilage cushions the bone where it comes into contact with other bones. In a typical joint, the cartilage is a shock absorber that allows for even joint movement without pain. When cartilage breaks down or is damaged, it may tear or become thin and can even disappear altogether. A lack of cushion leads to joint pain and degenerative conditions such as knee OA. These defining precursors result in a narrowing of the knee joint space, causing pain, immobility, and disability.  

The symptoms of Osteoarthritis, such as knee pain, stiffness of the joints, and muscle weakness, are risk factors for loss of mobility and lead to obstacles to the quality of life for patients.  

Signs of Knee O/A include:  

  • Pain with movement
  • Stiffness- especially early morning stiffness
  • Loss of range of movement
  • Pain after sitting or lying for any period
  • Joint enlargement and swelling

Despite numerous studies, specific causes for OA and knee pain remain unknown.

Scientists believe that a combination of factors such as obesity, aging, and any knee injuries, coupled with possible genetic predisposition, may predispose adults to earlier disease onset and knee pain.

Researchers do know that repeatedly managing more weight than is healthy, age, and inactivity play important roles in the development of knee pain and OA.  

As there is no specific cure for OA, current treatment aims to control pain and improve function and health-related quality of life. 

Symptoms of Osteoarthritis of the knee can vary. Some people may be incapacitated by dysfunction and pain, while other adults- despite the severity based on scans- can do everyday activities with little or no knee pain. Prior injury is often a significant indication of the future development of the disease. Another major cause of knee OA is often associated with carrying excess weight, leading to premature wear and knee injury.  

Occasionally, knee pain, limping, and joint function do not respond to medications, and further intervention is required to treat the problem, starting with physical therapy, then perhaps injections or a total knee replacement though many patients are not candidates for joint replacements.

The severity of the disease and pain level varies from person to person. Hence, each treatment plan will be based on the severity of disease, age, gender, weight, lifestyle, and the patient’s capabilities. The goal of any treatment should be to decrease pain, increase the range of motion, increase strength, educate, and improve fitness levels and mobility.  


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There are several things that patients can do to lessen the risk of developing knee osteoarthritis:

Weight management is one of the first recommendations to reduce knee Osteoarthritis if a patient carries excess weight. Studies of OA consistently show that overweight people have higher rates of knee OA than patients with lower body mass. Since force on the knees is three to six times our body weight, people with more mass have much higher pressures on their knees, leading to knee OA. 

Overweight adults can have circulation deficiency and may develop a cartilage or bone problem, causing cartilage breakdown and irritating the bone underneath the cartilage.  

Weight loss is, therefore, a critical step to relieving knee pain and slowing the progression of degenerative arthritis. A body weight reduction of just 10% is associated with higher function and reduced pain in knee OA patients.

Pre hab

Physical Therapy & Rehabilitation are the most widely- and successfully- used remedies for knee Osteoarthritis. Physical therapy has repeatedly proven helpful for patients suffering from pain and immobility. Appropriate levels of fitness walking, aerobic exercise, and strength training with an expert therapist have all resulted in functional improvement in patients with knee pain and OA.  

Physical therapy offers a non-interventional treatment for patients that also encourages safe movement, increased daily activity, long-term strengthening, and a better quality of life. PT helps adults live with less knee pain, joint stiffness, and improved physical function. About 75% of PT patients report improvements in pain and function and a return to feeling more ‘in control of their bodies at the conclusion of treatment, according to the National Institute of Health.

Knee pain or discomfort during physical activity does not necessarily mean you will injure yourself further.

YOGA

Movement or physical activity is often the best medicine for people suffering from knee pain and Osteoarthritis. Staying physically active should not only improve your joint mobility but also improve your overall quality of life and can help reduce depression. Adults with knee OA commonly focus on strengthening their ‘knee muscles,’ neglecting the essential hip muscle strengthening. Many patients with knee OA present with hip muscle weakness and are more prone to increased pressure on the knee joint. It is crucial to strengthen the hip as hip-strengthening activities improve the mechanics of your lower limb and reduce stress on the knee.

Movement in a non-painful Range of Motion

  • Reduces knee pain and inflammation
  • Balances knee joint range of motion
  • Strengthens lower muscles
  • Reduces risk of cardiovascular problems
  • Improves the connection between the mind and body 
  • Improves agility and balance

Aquatic exercise, cycling, and walking are usually safe and practical activities that don’t cause undue stress on the knee joint. Resistance training, yoga, and Tai Chi are excellent examples of exercises that improve balance and peace of mind at the same time.  *It is recommended that you consult with a licensed physical therapist or medical doctor before starting new exercises.


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A physical therapist will create an individualized treatment program for knee pain, considering the patient’s goals and lifestyle to ensure long-term success.

Thermal Treatment can help relieve pain quickly. Adults with knee pain and Osteoarthritis usually have established habits and preferences regarding heat vs. cold therapy to improve pain and function. 

  • Heat can come in differing forms, such as heat packs that help relax muscles or ultrasound machines that can warm further into the body.  
  • Icing and cryotherapy are shown to improve gait and movement and manage the inflammatory process, thus lessening pain.

Compression & Taping for knee pain and Osteoarthritis can help manage daily activities and sports. There are many different types of braces and taping options to relieve pain in the knee compartment. A physical therapist can help determine which will be the most effective for your condition.

Adjusting Your Footwear is an easy way to self-manage joint issues and knee pain, given that the position, support of the feet and ankles, and their motions definitely influence the pressure and wear on different knee areas. Biomechanical research shows that wearing appropriate shoes for your condition significantly improves knee alignment, especially with barefoot walking. Studies also prove that some types of footwear increase knee loads more than others. Working with an expert physical therapist will determine what will work best for specific needs.

Anti-inflammatories (Consult a licensed physician before changing or starting any pharmaceuticals.) Taking anti-inflammatories alongside physical therapy is often an important first-line treatment for knee pain and OA patients. Various NSAIDs are available, and a physician can determine which are appropriate for you. However, caution should be used when considering NSAIDs due to their side effects.  

Anti-inflammatory diet  Our diets influence the body across the board, it can be enormously helpful for adults with knee pain and Osteoarthritis to consider their diet and nutrition. Observational studies suggest that vitamin and mineral deficiencies play a role in the progression of joint diseases and inflammatory conditions. Hence, it pays to make healthy adjustments, which will often benefit weight management as well.

Therapeutic Injections & Surgery are typically a last resort for managing knee pain and Osteoarthritis treatment. Options available include Hyaluronic Acid injections that lubricate and cushion the knee joint, arthroscopic surgery, and partial or total knee replacement surgery. Surgery may increase the chances of subsequent knee replacement surgery as it usually removes tissue from in and around the joint.  

There are multiple risks associated with surgical procedures, including venous thrombosis, infection, pulmonary embolism, and in some cases, death. One in five patients who end up undergoing a total knee replacement is unsatisfied with the outcome.

Education plays a vital role when considering options for managing and treating knee pain and Osteoarthritis. Most current protocols- particularly exercise programs- are noticeably undervalued and underused by adults with knee OA, usually due to patient beliefs. Socioeconomic barriers, fear of movement & lowered confidence, lack of time to exercise in a busy daily life, and even having previously experienced pain at earlier appointments can cause issues.

Patient education is critical for decision-making, self-management, and medication adherence for adults with knee pain.

The negative impact of knee pain and Osteoarthritis on peoples’ self-confidence may be high, and often their pain becomes a central focus of their lives. Misleading advice and the belief that OA is an incurable disease can lead patients to reduce or stop physical activities. Patients tend to adapt to a lifestyle with less spontaneity, resulting in feelings of isolation and loss that negatively affects social relationships.

Knee pain and Osteoarthritis is best managed initially by conservative management. 

Treatment with a qualified physical therapist can help avoid more invasive and risky procedures. When your PT determines that it’s appropriate, they will guide and help determine the best course of action for you, your unique lifestyle, and your specific condition to reduce pain in the long term and improve your quality of life.  

For more information, reach out to the expert physical therapists at Healthy Consumer Physical Therapy.  We successfully treat patients with knee pain and Osteoarthritis every day.  


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Chris S
AUTHOR

Dr. Chris Sovey

Healthy Consumer PT

"We Help Adults 40+ Living With Pain, Stiffness, Or Loose Joints Get Healthy, Age Stronger, And Get Back To The Activities They Love, Even If Past Treatments Have Failed"

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