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Osteoarthritis of the knee

What is it?  

Osteoarthritis is a wear and repair process and a commonly affected joint is the knee. It can lead to joint pain with limitation of movement, which can affect daily activities.  Osteoarthritis is the most common type of arthritis, affecting approximately 9 million people in the UK.

Versus Arthritis have produced a summary of ‘What is Osteoarthritis?’ which you can watch in the video below.

In osteoarthritis we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely. Changes to the cartilage can lead to pain, stiffness, and loss of movement. This can in time lead to weakness around the muscles of the joint.

It most commonly affects people older than 45 and is more common if you are overweight, have a family history of it, or have previously injured the joint in question. Osteoarthritis has varying degrees on functional limitation and effect on quality of life. Contrary to popular belief it does not affect everyone as you get older and does not necessarily get worse with age.

What are the common symptoms of Osteoarthritis of the knee?

With osteoarthritis of the knee you may feel pain on either side of the knee, the front or sometimes around the back of the knee.  Morning stiffness lasting less than 30 minutes is also very common. You may hear noises coming from the knee (crepitus). You may see or feel some swelling around the knee. You may have difficulty fully bending the knee or straightening the leg. Pain may be present if you have been on your feet for a long period. You may have pain when walking or performing the stairs.

How to manage it?

If you think you have, or have been diagnosed with osteoarthritis of the knee by a healthcare professional there are several things you can do to help manage your symptoms and stop it from worsening

Exercise

Exercise has been shown to be beneficial in osteoarthritis. Try to increase your activity levels and consider taking up exercise.  Walking, swimming and cycling are often well tolerated but choose something you enjoy. It is important when starting exercise to start easy and build up slowly. A small increase in your pain when you start is okay.

Strengthening 

Osteoarthritis can lead to weakness.  Strengthening the muscles around your knee will allow you to do things more easily such as standing up, walking and climbing stairs.  You need to focus on getting your thigh muscles (quadriceps) strong.  Again some pain when starting exercise is okay provided it is tolerable.  Start with simple exercises and build up.

Try the simple exercises below. If you are having difficulty with them please speak to a physiotherapist for advice.

Exercises

Quadriceps exercise – straight leg raise in sitting

Sitting on a chair, slowly straighten your knee as high as it can go and slowly lower it down again. 

Repeat 5 times on each side; increase the amount of repetitions as you feel able.

Knee bends

Lying on your back, lift your knee towards you, sliding your heel on the floor/bed, then let it come back down. 

Repeat 10 times on each side; increase the amount of repetitions as you feel able.

Static quadriceps contraction

Lying on your back, squeeze your knee in to the bed. 

Hold up to 5 seconds and relax.

Repeat 10 times on each side; increase the amount of repetitions as you feel able.

Quadriceps exercise – straight leg raise in lying

Lying on your back, lift your leg up straight approximately 30 cm off the floor / bed. 

Hold up to 10 seconds and slowly lower it down.

 Repeat 5 times on each side; increase the amount of repetitions as you feel able. 

Sit to stand exercise

Sitting in a chair, stand up and sit down slowly. 

Try not to use your hands if possible. 

Make this harder by: 

a) moving the foot of your affected knee closer to you and then progress to 

b) standing from a lower height.

Step ups

Step onto the bottom step of stairs. Hold on to the bannister if necessary.

Step up and step down on the first step.

Repeat this with each leg. Do as many as you feel comfortable with.

Rest for 1 minute and then repeat this twice.

To progress you can use a higher step.

Weight control

If you are overweight, try to lose some weight. Even a modest weight loss can make quite a difference to your symptoms.

Using a walking aid such as a stick or walking pole in the opposite hand to the affected knee can also help to take pressure off the painful joint.

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice or heat therapy 

Heat may be helpful in the form of a hot water bottle, wheat pack or hot shower. This can help to relax the muscles around your knee and may allow exercises to be more effective.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

 

Your GP or physiotherapist may refer you to an ESCAPE Pain class.

This is an evidence based programme of 12x one hour sessions over the course of 6 weeks which comprise a 15-20 minute education/discussion element and a 30-45 minute exercise programme.

The aims of the course are to help you better manage your symptoms; carry out normal activities, become more active and to continue to exercise.

The classes are being run in a number of physiotherapy departments. There is also an online programme to follow and escape pain app available to download. Please click here for more information.

Important information to know:

Being overprotective and doing less can mean that you will get weaker and stiffer and eventually have more symptoms.

The stronger the muscles are that surround the knee, the less the arthritic changes will have an impact on your life

It is safe to exercise, and exercise does not speed up the osteoarthritic process.

Many people have signs of osteoarthritis on x–rays but no symptoms. We often find that the changes seen on x-rays do not always correlate to the level of pain a person will report. These changes are best thought of as normal age related changes. The pain is believed to be as a result of a flare up of your osteoarthritis. This often settles as the body repairs itself. This is the wear and repair cycle.

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