Knee Osteoarthritis

By Physiotherapist: Loulou Negoescu

Osteoarthritis (OA) is the most common form of arthritis, involving inflammation and structural changes of the joint, causing pain and limiting function (1). Pain and stiffness are the most common symptoms. As with lots of medical imaging there is a poor relationship between what the patient feels and what the image shows. This means they don’t always match. For example, someone’s x-ray might show moderate to severe degeneration, but not feeling any symptoms of pain and the opposite is also true (1).

OA as a condition is which is surrounded by non-truths.  Phrases like ‘bone on bone’, and the many stories of friends and family with OA give the impression that loading degenerative joints is harmful, and unnecessarily painful (2). Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, have avoided activity for fear of causing harm which can lead to further reduced function (2).  

So, what should someone with Knee OA do?

Articular cartilage breakdown is the hallmark of OA and is caused by a reduction in function to the proteins that are integral to a healthy joint leading to tissue degeneration (3). Whilst the exact cause of knee OA remains unknown, many factors such as age, body mass index (BMI), knee injury, inflammation, sex and family history contribute to its development and progression (3,4). In fact, every second major knee injury from sports results in OA 10–15 years later (3).

Does exercise wear out my knees?

There is a common idea that running, or squatting will eventually “wear down the knees”. Ask most people – there is an intuitive and common idea that the knee joints “wear out” from too much exercise. This, however, is a myth. A recent review said knee joint loading exercise lead to increased cartilage volume and had a positive effect on cartilage defects (3). Moderate doses of physical activity could even slow down cartilage degeneration in middle-aged individuals at early OA stages (3). The review concluded by saying knee joint loading exercises seem not to harm articular cartilage in participants at increased risk of, or with, knee OA (3).

What is really going on inside a knee with OA?

Articular cartilage in the knee seems to follow a U-shaped curve in relation to level of activity/loading and risk of damage/degeneration. High impact activities like jumping and sports have been associated with cartilage deformation and increased risk of knee OA development. Whereas those with sedentary behaviours who do not load the knee joint much have also been shown to have detrimental effects on knee cartilage health. Thus, somewhere in the middle seems to be just right.

Running and Knee OA

Looking at a 10-year cross-sectional study of almost 2700 people that self-selected runners showed no increased risk of symptomatic knee OA compared with nonrunners (5). Another study of 45 long distance runners from 1984 to 2002 showed that runners did not have more prevalent OA, nor more cases of severe OA than the control group who did not run (6).

Tailored exercise is the best medicine

From what we know so far – Exercise is a first line treatment of Osteoarthritis. Group exercise for OA has particularly been shown to be helpful, with improvements seen in patient’s pain, physical function, physical activity and quality of life and reduce the number of patients taking painkillers and being on sick leave (7). Every person is different and their symptoms/history unique – as such the exercise for someone with knee should be prescribed by a qualified Physiotherapist to suit their individual context and requirements.

We offer tailored exercises classes including resistance training for over 55’s called Silver Strength on a Monday, Wednesday and Thursday at 8-9am.

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References:

1. Cross, Marita, Emma Smith, Damian Hoy, Sandra Nolte, Ilana Ackerman, Marlene Fransen, Lisa Bridgett et al. “The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.” Annals of the rheumatic diseases73, no. 7 (2014): 1323-1330.
2. Hurley, Michael, Kelly Dickson, Rachel Hallett, Robert Grant, Hanan Hauari, Nicola Walsh, Claire Stansfield, and Sandy Oliver. “Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review.” Cochrane database of systematic reviews4 (2018).
3. Bricca, Alessio, Carsten B. Juhl, Martijn Steultjens, Wolfgang Wirth, and Ewa M. Roos. “Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials.” British journal of sports medicine53, no. 15 (2019): 940-947.
4. Timmins, Kate A., Richard D. Leech, Mark E. Batt, and Kimberley L. Edwards. “Running and knee osteoarthritis: a systematic review and meta-analysis.” The American journal of sports medicine45, no. 6 (2017): 1447-1457.
5. Lo, Grace H., Jeffrey B. Driban, Andrea M. Kriska, Timothy E. McAlindon, Richard B. Souza, Nancy J. Petersen, Kristi L. Storti et al. “Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross‐Sectional Study From the Osteoarthritis Initiative.” Arthritis care & research69, no. 2 (2017): 183-191
6. Chakravarty, Eliza F., Helen B. Hubert, Vijaya B. Lingala, Ernesto Zatarain, and James F. Fries. “Long distance running and knee osteoarthritis: a prospective study.” American journal of preventive medicine35, no. 2 (2008): 133-138
7. Skou, Søren T., and Ewa M. Roos. “Good Life with osteoarthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide.” BMC musculoskeletal disorders18, no. 1 (2017): 72