Osteoarthritis of the Knee
Osteoarthritis of the Knee, What is it?
What are the symptoms, what can cause it, what are the treatment options and what should I expect? Basic knee anatomy: The knee joint is comprised of the connection of the femur AKA thigh bone, tibia or shin bone, fibula,( smaller, next to tibia, and the patella ( knee cap). The three long bones are connected by supportive ligaments. The ligaments of the knee include the cartilaginous medial and lateral meniscus, the cruciate ligaments which provide anterior/posterior stability and the medial and lateral co-laterals, which offer side stability.
Multiple muscles control motion at the knee joint. Knee motion includes, extension: the motion from bent to straight, by contraction of the thigh or quadriceps-femoris group . The four quadriceps tendons combine to form the patella tendon. Flexion or bending of the knee is performed by the hamstring muscle group.
Pain at the knee is due to inflammation which is the body’s natural response, most often due to injury, overuse, or conditions such as osteoarthritis of the knee (OA).
So What is Osteoarthritis of the Knee?
The etymology of the word means innflammatory bone and joint disease. Hereditary factors, wear and tear over time, and obesity are some of the major causes of OA. The degenerative type is most common. Other types include rheumatoid (autoimmune), septic (infection) and gout (a metabolic disorder). The most common OA is characterized by progressive degenerative changes in the knee cartilage meniscus. Over a period of time there is thickening and overgrowth of adjacent articulation surfaces of the bone. These joint changes can be visualized on x-ray, Cat Scan, or MRI studies.
The symptoms of knee joint OA include pain, include swelling, redness, crackling sounds which may be accompanied with loss of motion.
Treatment: Lifestyle modification include weight loss, cessation of smoking which is linked to OA, and moderate exercise program which helps strengthen muscles and improve knee joint motion. Tai-chi is recommended light force exercise. See abstract below.
Treatment for acute (fresh) vs. Chronic or long standing, greater than 90 days):
Acute treatment: Remember RICE: R-est, I-ce, C-ompression, and E-levation.
Over the counter pain medication, or analgesic salves eg. Ben-gay or Tiger Balm. Moist heat may increased blood flow and promotes healing.
Conservative care as done by a licensed chiropractor, patient education, includes joint mobilization, massage, muscle balancing, therapeutic and rehabilitative exercises. Physical medicine modalities include ultrasound for calcific tendinitis; TENS – transcutaneous electro-muscle stimulator; or laser light- to reduce inflammation.
Other approaches include unloading the knee with supportive braces, or shoe insoles. Extracorporeal shock wave therapy is another nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients’ function. Sports medicine chiropractic providers also employ kinesiology taping methods which have been shown to be effective.
Conditions which last longer than 90 days or become recurrent. Over time or due to repeated injuries, some patients develop knee joint osteoarthritis.Conservative treatment options may include strengthening exercises, e.g. stationary bicycle, or weight training. For some pain injections may become an option.
As a last resort surgery ranging from arthrosocpy to total knee replacement, may become necessary, for more serious knee joint problems, in the properly selected patient.
- Ann Intern Med. 2016 Jul 19;165(2):77-86. doi: 10.7326/M15-2143. Epub 2016 May 17.
Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial. Wang C, et. Al.
CONCLUSION: Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis
2) J Phys Ther Sci. 2016 Jan;
The effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion. By Lee K et al
3) Phys Ther Sci. 2017 Mar; 29(3): 536–538.
The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. by Ji-Hyuen Lee et al