2nd Aug 2018
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How to manage knee osteoarthritis and postpone surgery
Author: Jason Lee
How to manage knee osteoarthritis

Glenn has a dodgy knee that has been giving him pain for some years, but he is reluctant to head off to a surgeon for a replacement just yet. He asks physiotherapist Jason Lee how he can best manage the condition.

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Q. Glenn
I’m 63 years old, and I’ve got a dodgy knee. Some days it’s fine, others not. I’m reluctant to head off to the doctor just yet as I’m fearful of what he might say. Is there anything I can do to ease the problem and at least put off the prospect of a replacement?

A. Degenerative joint disease (osteoarthritis) affects an increasingly large proportion of the population. Knee osteoarthritis (OA) is one of the most common chronic musculoskeletal conditions seen by physiotherapists. While severe cases of OA can be addressed with a knee replacement, current guidelines emphasise the importance of conservative management as an early intervention/trial, including exercise and pain-relieving medication.

Knee OA is diagnosed based on symptoms and thorough assessment. Symptoms commonly include the joint being stiff in the morning or after prolonged sitting, pain with prolonged weight bearing (through standing or walking), joint swelling, noise with movements of the knee, and/or altered joint shape or size.

Depending on the stage of knee OA, symptoms can vary and can be dependent on activity. In early cases of OA, symptoms and pain may occur only during activity. In some severe cases, symptoms can be constant regardless of activity.

Your health professional, such as your GP or physiotherapist, is well placed to thoroughly assess and diagnose the likelihood of knee OA. Imaging techniques such as X-ray and MRI can play a role in diagnosing OA. However, symptoms do not always match the severity of symptoms. For example, people can have significant knee pain without much change on an X-ray. Conversely, people can have significant changes on imaging yet experience minimal symptoms.

While physiotherapy can assist in managing symptoms, a long-term exercise program is crucial. Exercises for knee OA should never be painful. As each person is different, it is important to consult your health professional on the most specific and safest exercises for you.

Exercises can be performed at home, often without the need for any special equipment. Equally, if you regularly go to the gym, these exercises can be incorporated into your gym routine.

Exercise programs for knee OA should include cardiovascular, strengthening and flexibility exercises. Cardiovascular exercise is important to maintain general fitness and weight management. Depending on the stage of knee OA, long walks can be unpleasant given walking is weight bearing and there is impact through the joint.

Commonly, sufferers find cycling is good cardiovascular exercise as it is non-weight bearing. Cycling can also assist in maintaining flexibility of the joint. Swimming/hydrotherapy is another way to safely exercise with less force through the joint.

Importantly, strengthening the muscles surrounding the knee, such as the thigh, calves and gluts, has been shown to reduce knee OA symptoms. These exercises can include a mixture of functional exercises (bridges or squats) and isolated exercises to target these areas specifically (calf raises, hip exercises with resistance bands).

As with any exercise, it is important to perform them correctly and progress them to provide an ongoing challenge and to continue improvement.

Besides exercise, it is important to manage symptoms during ‘flare-ups’. Heat and ice can be used for symptomatic relief. If your knee is feeling warm or swollen, try using an ice-pack for 10 to 15 minutes to reduce pain. Alternatively, if you’re experiencing a dull ache in the knee, a heat pack can be useful.

In consultation with your GP, simple pain medication such as paracetamol can also be useful. Importantly, ensure that you pace yourself and avoid spikes in activity levels. Avoid excessive activity that causes flare-ups followed by periods of inactivity to recover. While it is easier said than done, it is important to aim to maintain regular sessions of physical activity where possible, regardless of symptoms.

Knee OA can be challenging. However, with the guidance of a trusted health professional, it is possible to manage and reduce symptoms regardless of the severity of OA.

Jason Lee is a physiotherapist. He is happy to answer any questions you may have. Simply send an email to newsletters@yourlifechoices.com.au.

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    Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner or health professional.





    COMMENTS

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    Scott
    2nd Aug 2018
    10:39am
    It's very odd that a physiotherapist does not mention food reduction as a well established (if unpopular) way of avoiding or postponing knee surgery for the overweight
    pedro the swift
    2nd Aug 2018
    10:50am
    Not allowed to mention "overweight". Not politically correct.
    Just like you can't mention the war in Berlin.
    Circum
    2nd Aug 2018
    2:28pm
    My GP sent me to a specialist in the public system.After waiting many days I saw the specialist.He asked me "what should I do".I replied,tell me to go away and lose 20kg.If my knee is still bad then come back.He said ok and I never saw him again.
    patti
    2nd Aug 2018
    11:17am
    I've had no choice about postponing my knee surgery, as in the public health system I have already had to wait 12 months. Also waiting for foot repair surgery, which, according to my surgeon, needs to be done first (makes sense). Finding it hard to walk quite often now, but must keep moving. Don't know how much longer I will manage
    Allenmack
    2nd Aug 2018
    12:50pm
    About seven years ago a very expensive doctor (specialist) told me i will need a complete knee joint replacement in about 4 years. So I did some research and eventually found Dr John Bergman online youtube and his exercise fixed my knee. Ok it's not perfect but its better than ever, no more clicking & swelling or aching in the middle of the night. It is demonstrated on this link, it is very simple and effective and it works.
    https://www.youtube.com/watch?v=wP1Vv5Bzw_Q&list=PLFQTQ56E1UApQStAD9Tx5t9eFQ8yATCfy
    ROB
    2nd Aug 2018
    12:54pm
    We have a simple answer; pain reduced in minutes and Cartilage rebuilding overnight - no drugs or supplements induced or ingested, no risky (and often painful) procedures, low in cost, easy to use, proving safe and effective for ALL ages and already accepted by TGA in Australia and the Medical authorities in the 100+ countries this technology is distributed and even used in hospitals in Europe and elsewhere about the world.
    johnp
    2nd Aug 2018
    1:16pm
    how to contact ??
    ROB
    2nd Aug 2018
    1:22pm
    Not sure johnp, we are not allowed to post contact details in here as that would apparently appear as we are trying to sell something? You can ask the Admin for our contact details and try that way? Else there is a group in Australia assisting people around the world with the technology, see Facebook Lifewave Team Learning.
    ROB
    2nd Aug 2018
    4:33pm
    We believe that anything safe you can do to ease pain is a bonus. The technology I mention is extremely fast for easing pain as shown in the link below. This technology also creates accelerated healing. In particular the technology is as easy to use as applying a band aide, so anyone can safely use this in their own home. https://www.dropbox.com/s/cxx4veo7s8ep7lo/Knee%20pain%20reduction%20August%202018%20Lifewave.jpg?dl=0
    Pamjean
    2nd Aug 2018
    1:36pm
    I have found fish oil a big help, no more pain with regular use.


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