Condition guide
A common knee problem, especially after the age of 45, that makes itself felt on stairs, when squatting and on long walks. Osteoarthritis does not mean "that's it, nothing can be done": with the right exercise and weight control, pain can ease considerably.
Osteoarthritis is a process that begins with thinning of the cartilage covering the joint surfaces, but it affects more than just the cartilage: the bone, the joint lining, the ligaments and the surrounding muscles are involved too. Bony outgrowths can form at the edges of the joint, and the joint may swell from time to time.
If you are over 45, with knee pain that gets worse with activity and morning stiffness that lasts less than 30 minutes, the diagnosis can usually be made from an examination; guidelines do not recommend routine imaging.
High body weight is responsible for about 20% of the disability caused by osteoarthritis.
Being told "your X-ray looks really bad" often causes needless fear. In a review that pooled the research, only 15–76% of people with knee pain had osteoarthritis on their X-ray, while 15–81% of people with osteoarthritis on their X-ray had pain.
In other words, what your X-ray shows does not decide how bad your pain is or what you can do. What really matters is muscle strength, mobility, weight and daily activity. All of these can be changed.
Guidelines put three things at the centre of treatment: exercise, weight control and understanding the condition properly.
Not recommended in the guidelines: glucosamine supplements, hyaluronic acid injections into the joint, and arthroscopic "washing out" or "cleaning" of the knee (except in special cases such as a locking knee).
Exercises at home
You may feel some mild pain during exercise; if the pain is no worse the next day, it is safe to carry on. If there is a clear increase in pain, or swelling, the next day, cut down the number of reps. The first three are done lying down or sitting, so they are also suitable during painful spells.
Sit up straight on a chair. Slowly straighten one knee and lift your leg until it is parallel to the floor, tightening the muscle at the front of your thigh. Hold for 5 seconds, then lower slowly.
10 reps on each leg, twice a dayLie on your back or sit with your leg stretched out, and place a rolled-up towel under your knee. Press the back of your knee down into the towel; the muscle at the front of your thigh will tighten and your heel will lift slightly. Hold for 5 seconds.
10 reps, 2–3 times a dayLie on your back and bend one knee. Keeping the other knee straight and tightening your thigh, lift that leg up to the level of your bent knee. Lower it slowly.
10 reps on each legCross your arms over your chest. Lean slightly forward and stand up from the chair, then sit back down with control. If it is hard, push up with your hands or use a higher chair.
10 reps, 1–2 times a dayLie on your side with the bottom knee slightly bent. Lift the top leg with the knee straight and toes pointing forwards. Your hip muscles help keep the knee stable.
10–15 reps on each sideLean your back against a wall with your feet half a step out from it. Let your back slide down the wall as you bend your knees slightly, going only as low as you can without pain, then straighten up. Do not let your knees go past your toes.
10 repsProtecting your knee does not mean keeping it still; it means spreading the load wisely.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
A programme of strengthening and mobility exercises for a knee with osteoarthritis.
Approaches worth trying before surgery, and tips for everyday life.
Long periods of rest are not recommended. Joint cartilage is nourished by movement; regular walking and strengthening exercises reduce pain and protect the knee. On days when the pain is much worse, ease off, but do not stop completely.
Hold on to the handrail. Going up, step up first with your good leg; coming down, step down first with your painful leg. If you use a walking stick, move it together with your painful leg.
In the hand on the opposite side to your painful knee. The stick touches the ground at the same time as your painful leg and reduces the load the knee has to carry.
The UK guideline on osteoarthritis (NICE) does not recommend glucosamine supplements or hyaluronic acid injections into the joint. A cortisone injection into the joint, on the other hand, may be considered for short-term relief lasting 2–10 weeks when other treatments are not enough.
If pain and restricted movement seriously disrupt your daily life despite exercise, weight control and medication, you need an orthopaedic assessment. The decision is based on your quality of life, not on how your X-ray looks. Exercises done before and after surgery speed up recovery.
The following may point to a problem other than osteoarthritis. See a doctor without delay:
Sources
İhsan Eren