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