Knee pain in older adults is a common presentation at our clinic. Often we find the cause to be multi factoral, with some component related to osteoarthritis (OA) of the knee joint.
So what is knee OA?
Knee OA is a chronic condition that can result in pain, stiffness, muscle weakness, swelling, and joint instability (Page, Hinman, & Bennell, 2011). Specifically, knee OA leads to damage of the articular cartilage chondrocytes, extracellular matrix and the subchondral bone (Takeda, Nakagawa, Nakamura, & Engebretsen, 2011). These impairments can lead to a decrease in optimal physical functioning and a reduction in our quality of life.
Currently there is no cure for knee OA, however there is hope. There is strong body of evidence that suggests exercise and physiotherapy can help improve physical functionality and quality of life (Bennell, Kyriakides, Hodges, & Hinman, 2014).
Am I at risk of knee OA?
· Ageing (>45years)- “wear and tear”
· A family history
· Being overweight or obese (even > 1kg over your ideal weight increases your risk)
· Muscle weakness of the lower limb
· A previous knee injury (such as an ACL rupture or meniscus injury)
How is it diagnosed?
Diagnosis can be established through a clinical functional examination and confirmed by an X-ray (Takeda, et al., 2011).
Treatment and management
Early identification of biomechanical abnormalities are imperative as they can help decrease the progression of knee OA (Brukner & Kahn, 2012). There is some evidence to suggest that a combination of management strategies (i.e. physiotherapy and weight loss) can provide significant outcomes when compared any one treatment intervention alone (Page, et al., 2011).
The aim of strengthening exercises around the knee is to improve motor control around the hip and knee, and increase stability of the knee joint during activity (Rahmann, 2010).There is some evidence to suggest that an exercise program is beneficial in improving muscle strength and joint mobility in older adults (Brukner & Kahn, 2012).
Exercise in the form of both strengthening and aerobic training has been found to have similar effects to analgesic (e.g. panadol) and non-steroidal anti-inflammatory drugs (Page, et al., 2011). Additionally, aquatic based exercise has yielded positive reductions in pain and improved physical function. Aquatic exercise is ideal as an introduction to exercise, especially in more advanced cases of the condition as the warm water temperature and decreased loading of the knee joint assists with pain relief (Rahmann, 2010).
Taping of the knee, especially the patella (knee cap) and soft tissue structures has been shown to be beneficial in the realigning of the patella so as toreduce the amount of stress placed on the patella-femoral joint (Page, et al., 2011). Research has suggested that taping of the knee can have immediate and short-term reductions in pain (Page, et al., 2011).
Often the muscles around the knee joint (e.g. quadriceps, hamstrings, and calves) can become restricted thus cause pain and impairment of the knee. Physiotherapy manual therapies such as joint mobilisation and movement, stretching, and soft tissue massage are often effective to unload the joint, improve range of motion and improve function. Research evidence has suggested that these manual physiotherapies can provide significant and sustained improvements in symptoms of individuals with knee OA (Hinman, 2014).
Take home message
With correct activity modification, strengthening exercises and symptom management, provided by a physiotherapist, a healthy and activity filled life can be enjoyed by people with knee OA.
When it comes to getting your knees, come in to see one of our highly skilled physiotherapists. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advise on the best course of action for your condition to get you feeling better than you could’ve imagined. We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment.
Bennell, K. L., Kyriakides, M., Hodges, P. W., & Hinman, R. S. (2014). Effects of two physiotherapy booster sessions on outcomes with home exercise in people with knee osteoarthritis: A randomized controlled trial. Arthritis Care & Research, 66(11), 1680-1687. doi: 10.1002/acr.22350
Brukner, P., & Kahn, K. (2012). Clinical Sports Medicine (4th ed. ed.). North Ryde, N.S.W.: North Ryde, N.S.W. : McGraw-Hill Australia.
Hinman, R. (2014). Manual physiotherapy or exercise leads to sustained reductions in pain and physical disability in people with hip and knee osteoarthritis. Journal of Physiotherapy, 60(1), 56-56. doi: 10.1016/j.jphys.2013.12.005
Page, C. J., Hinman, R. S., & Bennell, K. L. (2011). Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, 14(2), 145. doi: 10.1111/j.1756-185X.2011.01612.x
Rahmann, A. E. (2010). Exercise for people with hip or knee osteoarthritis: a comparison of land-based and aquatic interventions. Journal of Sports Medicine, 1, 123.
Ryu, J. H., Lee, A., Huh, M. S., Chu, J., Kim, K., Kim, B.-S., . . . Youn, I. (2012). Measurement of MMP activity in synovial fluid in cases of osteoarthritis and acute inflammatory conditions of the knee joints using a fluorogenic peptide probe-immobilized diagnostic kit. Theranostics, 2(2), 198-206. doi: 10.7150/thno.3477
Takeda, H., Nakagawa, T., Nakamura, K., & Engebretsen, L. (2011). Prevention and management of knee osteoarthritis and knee cartilage injury in sports. British Journal of Sports Medicine, 45(4), 304. doi: 10.1136/bjsm.2010.082321