If you have pain inside of your knee and have limited motion, this one is for you.
Osteoarthritis (OA) is a different condition than the previous 3 knee conditions we discussed. Although OA is a condition where the long-term symptoms can be managed by means of exercise and change in lifestyle, it is a mainly found under an older population of 50 years plus and very different compared with what we have seen with ITB, PFS and Patellar Tendonitis that we typically find under younger and active individuals.
What is Osteoarthritis / OA?
Osteoarthritis in the knee is the most common cause of musculoskeletal pain in the knee. It is often referred to as degenerative joint disease or ‘wear and tear’ arthritis as the natural cushioning / cartilage between the joints wither away.
There is strong clinical value to suggest that OA associates with:
- pain in the knee and stiffness the 1st 30 min in the morning when you wake up
- typical under a population from 45 years old and up.
- Limited range of movement and stiffness along with bone and crunching sounds we refer to as crepitation or synovial pops
- Feeling of tenderness when the knee is examined, touched and tested, we like to refer to this as palpations
- Bone enlargements due to bone deposits
- No real detectable signs of warmth
If you are suffering from these symptoms then corrective exercises and lifestyle changes can be implemented to remedy the situation. There are mainly 3 phases of the cartilage degeneration and although exercises and a healthier lifestyle is prescribed in the 1st and 2nd phases it is still widely regarded that X-Ray is still the gold standard for radiographic examination and is reliable. In the latter phase’s mobility, daily activities and quality of life is severely affected and this is usually where partial surgery or total bone replacements are done.
What causes Osteoarthritis?
I’d like you to look at the following perspective. Regardless if you are strong and fit or unhealthy and unconditioned you still need to move. You move by walking in and around your home, to the office and at the office. Occasionally you will run for health or recreational purposes or run after your dog or your toddler. Life has 3 dimensions and for you to get around you need to move for many decades. The wearing down of the joint can be contributed to decades of knee movement and weight bearing activities. You are going to use your knees in life and eventually they are going to struggle. Chances are that all of us will suffer from a degree of OA in our lifetime. There is no cure for OA, but the long-term symptoms can be managed through regular training and a healthy diet and lifestyle. If you are overweight, not paying specific attention to your health and not engage in regular health related activities then your loading excessive and more weight on your knees with every step that you take and run into problems sooner and may be stuck with it for decades.
The Synovial fluid lubricates the knee and along with cartilage allows your femur / thigh bone to glide effortlessly over your shin bone / tibia. As this cushioning wears away the bone surfaces will be left exposed and you end up with bone rubbing over bone. Little osteocytes / growths emerge as a natural response to this friction and loss of cartilage.
There are some awesome and weird approaches that have been applied in the attempt to increase quality of life with OA that haven’t held up against the clinical studies and research that are worth looking at if you have been struggling with OA and haven’t been able to regain your quality of life back yet.
What do the studies tell us?
A recently updated study by the Royal Australian College of General Practitioners have taken a multitude of studies and are comparing costs, effectiveness and clinical comparisons between the different approaches on Osteoarthritis in the knee and have debunked a few approaches and myths. These guidelines are based on self-management and non-surgical treatments to improve the health of people.
It’s an 82-page report and I’m happy to share it, here is a summary: If you have had experience in any of these approaches, I’d love to hear your feedback. The report has been met with some controversy as some methods that have been used for years are proven to be ineffective, but the findings hold very well.
1) Glucosamine injections are not holding up against long term effects of OA. Although a short course of non-steroid anti-inflammatory oral medications have proven to relieve pain. Of all the topical analgesics ( medication applied to the skin and not injected or taken orally) -duloxetine is the one that is well supported for use, if you prefer creams and rubs above medication then keep an eye out for duloxetine.
2) Water rehabilitation exercises vs. land-based exercises are still valid but not enough. There is low recommendations for aquatic resistance training. This mainly depends upon personal preference and the availability of local facilities. In my experience water training does work but for the 1st phase where slow, controlled and light resistance is essential but sound and progressive increase in load and range of motion needs to be applied and this is where land based training comes in very handy and rounds off the training well.
3) Regular exercise is important for relieving pain and improving function in people with knee OA. Land-based exercise such as muscle strengthening exercises, walking and Tai Chi are strongly recommended. Thai Chi is ideal as the application is slow, controlled and focuses on the isometric strength improvements of the knee. For those who are overweight (BMI ≥25kg/m2) or obese (BMI ≥30 kg/m2), a minimum weight loss target of 5–7.5% of body weight is recommended though training and changes in eating patterns.
4) Heat pack applications are recommended higher than cold pack application due to the soothing effects reported from the clients.
5) There are recommendations against therapeutic ultrasound, shockwave therapy, laser therapy, interferential therapy, footwear marketed for knee OA , valgus braces and lateral wedge insoles for medial knee OA, arch supports , patellofemoral braces and kinesio taping. Placebo effect was a main contributor to many of these applications, but if placebo works and relives pain, I’m definitely a fan.
7) Massage and manual therapy, stretching, soft tissue and joint mobilization prove to hold up against research findings. This should be considered only as an adjunctive treatment to enable engagement with active management strategies like strength training and movement of the joint.
Exercises for Osteoarthritis to aid in long term suffering
Before we look at the exercises, lets discuss safety first. Stiffness and pain are a major issue with OA, so we need to engage in safe, effective and gentle exercises first. Individuals who do suffer from OA have a restricted range of motion in their knees so their balance will also be affected.
Daily mobility and movement
Mackenzie concept – This is a jewel of an exercise. I’d recommend applying this simple movement to your daily routine. Even the slightest improvement in mobility from applying this easy method a few times a week for just a few days have proven to ease the pain. The more mobility you gain, the less pain. Be sure not to push down on the knee but support the knee above and below by using your hands and gently pushing down x 10 times. You can repeat this a few times a day.
Daily strengthening exercises to support the knee
- Seated leg raises – This is a simple yet excellent exercise. It requires you to contract the quads as best you can for a set time of 10 seconds per repetition. The knee remains in the same position and only the quads are activated, making this an ideal exercise to gently strengthen the quads without running the risk associated with excessive flexion and extension. Complete 10 reps and hold each rep for 10 seconds.
2. Quad contractions – another quad strengthening exercise that is safe and effective. Support the knee with a rolled-up towel in order to allow slight movement when the knee is relaxed. Squeeze the quad and hold for a few seconds. Complete 10 reps and hold each rep for 3 seconds.
3. 90/90 breathing – Place your feet onto a chair. Be sure to dig your heels into the chair, this will activate the calve and hamstring muscles that attach into the knee. Activate the gluteus by lifting your hips off the floor. Hold this position for 30 seconds. You should aim to do multiple sets of 2 min hold as you progress.
4. Modified toe-wiggle squats – Be sure that you are well supported here by placing your hand onto a railing or a structure. Be sure to squat only as deep as your body allows you. Focus on placing all the weight onto your heels and move your hips first as to load the eccentric muscles. Notice how I van wiggle my toes on the video, this will not be possible if my weight was on my toes. Complete 2 sets of 10 reps.
5. Glute bridges – Be sure to get the hips up as high as possible. You will notice that I’m showing 3 possible positions here – the feet 30 cm from your hips is a good and neutral position. If you feel some tension or pain on the knee be sure to move your legs forward / away from you, this will load the hamstrings and gluteus more and ease pressure on the knees. The 3rd position is not ideal, I wouldn’t recommend this to anyone that has OA, but your goals is to one day be able to gain your range of movement back so that you are indeed able to place your knees closer to your hips. Complete 10 reps x 2 sets.
6. Heel slides – Start off in a glute bridge position. Slide a towel slowly and controlled by straightening the leg. The active leg may have difficulty bending and straightening so be gentle. The focus is on the supporting leg that is working to support the weight. Be sure to use your hands to support the working leg. Complete 10 reps x 2 sets per leg.
7. Knee squeezes – Use a ball or pillow to gently squeeze the knees together. Complete 10 reps x 2 sets.
In the final part of our knee series we will compare the 4 different knee conditions we have been examining. As you may have noticed there are close similarities and yet they are treated differently. I will summarize the different approaches and exercises in am easy to use guide so that we can assist and increase your quality of life.
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