Osteoarthritis: Knee Exercises, Causes, Symptoms

Osteoarthritis (OA) is one of the most common topics a lot of our patients frequently ask us about. Below we will discuss the common causes and symptoms of osteoarthritis, and what you can do to help prevent or treat this condition. In particular, later in this article we will go over some useful exercises for osteoarthritis of the knee.

1. OSTEOARTHRITIS CAUSES

Osteoarthritis is the most common form of arthritis and describes when protective cartilage layers at the ends of bones wear down over time. Cartilage is made up from special types of collagen fibres, and is a firm and slippery tissue which enables minimal friction during joint motion. While osteoarthritis can start to occur in younger people, especially in those frequently performing high impact activities; generally this form of arthritis occurs more commonly in people middle-aged and above.

Often times people going to their GP may hear osteoarthritis being called an “old-age” disease, and that there isn’t much they can do about it. Frequently these patients are given medications for their pain and sent away to deal with this life-long condition. You will see below that there is much more to consider regarding osteoarthritis, and some helpful measures you can take to address this condition.

Some common factors that may increase your risk of osteoarthritis include:

• Age – The longer you have been around, the more time you have had for stress impact to accumulate. Also your body’s natural repair mechanisms start to slow down as you age.
• Repeated stress on a joint – Your daily work or lifestyle habits may have you performing the same movements over and over, which can increase your chance of developing osteoarthritis over time.
• Improper biomechanics – Often overlooked as a primary cause of increased stress and eventual wear and tear on our joints. Small “misalignments” or inefficiencies in your movements may increase your risk of developing osteoarthritis. At Elite Spine we are experts at detecting these subtle problems often years before signs of OA become apparent on X-rays.
• Joint injuries – Injuries or trauma to a joint, especially if not rehabilitated properly, can increase your chance of developing osteoarthritis. Sometimes this may occur even in joints which you thought had healed and were not causing you any pain.
• Obesity – This is a double-edged sword since it adds extra stress to weight bearing joints like your knees, hips or your spine. In addition, fatty (adipose) tissue produces proteins which may add to unwanted inflammation in and around your joints.
• Sex – Women appear more likely to develop osteoarthritis on average, although the exact reasons for this are yet unknown.
• Genetics – Still not completely understood, there do seem to be genetic correlations for increased risk of developing osteoarthritis.
• Metabolic diseases – Diabetes, hemochromatosis (too much iron in the blood), and some others may increase the risk of developing OA.

The above are risk factors which increase your chances of developing osteoarthritis vs. rheumatoid arthritis (autoimmune) or gout (metabolic disease), which have different causes and presentation.

2. OSTEOARTHRITIS SYMPTOMS

Symptoms of osteoarthritis will usually develop with a slow onset and may gradually get worse over time. Some of the most common OA signs and symptoms include:

• Pain – Joints with osteoarthritis may feel aching or painful with certain movements or positions.
• Stiffness – Affected joints and surrounding tissues will often become stiff with lack of movement over a period of time. This may be most noticeable upon waking up in the morning.
• Loss of flexibility – Osteoarthritis may prevent you from moving your joint through its full range of motion.
• Tender to the touch – You may feel sore or tender when applying light to medium pressure at or near the joint.
• Bone spurs – Often visible on an X-ray, and sometimes palpable to the touch. You may feel hard lumps at or around a joint with osteoarthritis.
• Swelling – Often caused by chronic, low-level soft tissue inflammation around the joint.

If you have noticed one or more of these signs or symptoms of osteoarthritis in your knee, hips, hands, spine or elsewhere, it may be time to give us a call before the condition gets worse.

3. DIAGNOSIS AND TREATMENT OF OSTEOARTHRITIS

Diagnosis

At Elite Spine, our doctors are experts in the art and skill of palpation. Palpation is the process of using one’s hands to check the body, especially while perceiving/diagnosing a disease or illness. If we suspect that you may have osteoarthritis, our doctor will carefully check your affected joint(s) for signs of bone spur formation, swelling, redness, tenderness and flexibility. Of course, a proper health history is always a part of the consultation process as well to help rule in or out certain conditions.

In some cases, follow up X-rays may be recommended to confirm suspected osteoarthritis. Although cartilage does not show up on an X-ray, it will show a narrowing of affected joint spaces. Sometimes bone spurs around the affected joint may also be present. Typically an MRI is not needed to diagnose osteoarthritis; however, it can help to provide more information for complex cases.

Additionally, laboratory tests may be ordered to cross-check and rule in or out other potential causes of your joint problems. Blood tests may be ordered to check for potential autoimmune conditions such as rheumatoid arthritis. Or joint fluid analysis may be performed to test for inflammatory markers and whether your condition may be from gout or an infection rather than osteoarthritis.

Treatment

Osteoarthritis which has already accumulated is generally considered irreversible, although there are treatments available to reduce pain and symptoms associated with OA. Also, we like to remind our patients that prevention is always easier than a cure. We often help make corrections and give advice to patients early on, which can help them avoid development of osteoarthritis down the road.

Several kinds of medications, which may be over the counter or prescription, are often a first-line strategy of most medical doctors when treating a patient with osteoarthritis. These are typically designed to reduce pain and/or inflammation. However, long-term use of many medications is coming under increasing scrutiny since the negative side effects may be harmful to the body in other ways such as causing gastric bleeding, ulcers, cardiovascular problems and liver or kidney damage. Injections of cortisone for pain and inflammation relief may be useful to some, but you should be cautious as overuse of these steroid injections has also been shown to increase risks of bone and joint damage as well.

Depending on which joints are affected and their level of severity, in some cases, surgery may be recommended to “shave off” or add in bone fragments which help to realign and reduce stress on certain joints. Or in some cases, replacing an entire joint may be indicated if the wear and tear is too significant. Of course, surgery comes with its own risks and may not be the right choice for many with early to moderate stage osteoarthritis.

Conservative Management of Osteoarthritis

Many patients with osteoarthritis are increasingly looking for conservative management strategies that can help them reduce pain and inflammation, as well as regain strength, flexibility and stability of their joints for the long term. Some of the more common methods are:

• Exercises for osteoarthritis – In the next section we will cover some helpful exercises for osteoarthritis of the knee. If you suspect you may be having OA of other joints, don’t hesitate to get in touch with us.
• Joint mobilisation – Whether you are having osteoarthritis of the spine, knee, hips, or elsewhere…most people with mild to moderate cases of OA will benefit from gentle and specific mobilisation of the affected joints. This can be accomplished by hand or with special instruments.
• Low-level laser therapy (LLLT) – Also sometimes called “cold laser”, this treatment is totally non-invasive and can be used on almost any case of osteoarthritis. This is a very popular therapy used to help our patients reduce pain, swelling and inflammation with OA.
• Radial shockwave therapy (RSWT) – Or simply “shockwave”, this therapy has been useful for many of our patients with osteoarthritis as well. It has been shown to be able to help reduce bone spur formation in some areas, decrease pain, and stimulate the body’s natural healing process.
• Nutritional supplements – There is some debate on this subject, but many with OA have seen benefits from taking supplements or modifying their diet to increase glucosamine and chondroitin, omega-3 fatty acids, and oligomeric proanthocyanidins (OPCs – high in red wine, grapes, and other sources).

4. EXERCISES FOR OSTEOARTHRITIS OF THE KNEE

Your knee is a weight-bearing joint, and one of the most common joints to suffer from osteoarthritis. Typically the surrounding tissues and muscles which attach to the knees will experience various degrees of pain, stiffness or weakness. A proper evaluation is needed to determine which particular exercises or other therapies may best benefit you. However, below we have listed a few of the most common exercises for osteoarthritis of the knee which will help to reduce pain and improve mobility and stability.

For all of the below exercises, remember to breathe fully and deeply and to listen to your body. If you start to feel pain or sharp sensations, stop and ask your doctor or physical therapist if this exercise is appropriate for you.

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• • Sit and Reach Hamstring Stretch – Sit on the floor with one leg stretched out in front of you, or on a bed/bench with one leg straight and one touching the floor. Slowly bend forward and reach with your arms outstretched until you feel a pull in the hamstrings or the back of the knee. If you start to feel a pain, or the knee of your outstretched leg starts to bend, you have gone too far. Back off a little bit and hold that position. Hold the stretch 30-60 seconds per leg and repeat 2-3 sets on each side, time permitting.

• • Bent-Knee Calf Stretch – Stand approximately at arms length away from the wall with feet shoulder-with apart. Step forward with one leg, while keeping the back leg straight and foot flat on the floor. Lean in towards the wall to support yourself with your palms and bend the front knee. Lean and bend until you feel a pull at the calf muscles and/or back of the knee on the straightened leg. Hold the stretch 30-60 seconds per leg and repeat 2-3 sets on each side, time permitting.

• • Pillow Squeeze – You can perform this exercise laying on your back with your knees bent or sitting in a chair. It is designed to strengthen the inner part of your thighs, which are often weaker than the outer thigh muscles, causing an imbalance in the knees and legs. Hold each squeeze for 8 to 10 seconds and repeat 8-12 repetitions.

• • Seated Leg Raise – Sit in a chair at a height that ideally is tall enough to keep your foot from touching the floor. You may also add a folded towel under your thighs near the front edge of the seat (as pictured). Slowly extend one leg and try to hold in the extended position for 8-10 seconds before slowly lowering it to the starting position. Try to achieve 10-15 repetitions with each leg. If you find this becomes too easy, try progressively adding ankle weights to increase difficulty and muscle strengthening effects.

• • Single Leg Balancing – Stand close enough behind your counter top or the back of a chair to grab ahold should you need to. Slowly lift one foot off the floor and try to keep your balance on the other leg for at least 20 seconds. Over time you can work up to 1 minute on each leg. If that becomes too easy, try to do it with your eyes closed. This exercise will help activate stabilising muscles around your knee and improve neurological coordination and balance.

• Walking – Last, but not least, on our simple list is good old-fashioned walking! Simply getting movement into your joints may help reduce pain for many people and actually help to slow down further degeneration by maintaining proper blood flow and nutrients into and out of the tissues. Just make sure you’re wearing proper supportive shoes, and not pushing it past your limits to start out. Over time, your strength, flexibility and endurance will improve.

This is but a short list of exercises for osteoarthritis of the knee. For a more customised programme of treatment and exercise, feel free to reach out to us!

SEEING THE BIGGER PICTURE

Hopefully now you have a better understanding of the many factors which can cause osteoarthritis, and some of the useful therapies and exercises which can help those suffering from OA. While we certainly understand that most people come to our clinic with particular areas of concern, it is important that they begin to understand the basics of how the body is connected and the many ways one area may influence the other.

Aches, pains and even degeneration of one area of the body may in some cases actually develop due to abnormal function or alignment in other regions of the body. Then those problem areas may in turn begin to cause dysfunction in an additional part of the body. Appreciating how this “kinetic chain” of the body works can not only help us solve our patients’ concerns, but truly help them unlock their health potential and optimise their function and quality of life for years to come!

Author: Dr. Michael Bryant