Knee Osteoarthritis

1. Introduction

Osteoarthritis is the most common form of arthritis and one of the leading causes of pain and disability worldwide. It can affect people at any age, but it is most common in people over 50 years of age ⁽¹⁾. Almost any joint can be affected by osteoarthritis but most commonly it affects the knees, followed by the hips and the small joints of the hands ⁽⁸⁾. Patients often report pain accompanied by varying degrees of functional limitations and reduced quality of life. It can be diagnosed using the patient’s age, symptoms and a physical examination, with or without an X-ray. Exercise, education and weight loss improve symptoms and function in most patients with knee osteoarthritis and should be trialled initially.

Knee osteoarthritis is often described as ‘wear and tear’, implying that the joint has ‘worn out’. Symptoms and physical function are frequently assumed to be directly related to these ‘wear and tear’ changes, which might make you think that symptoms would worsen with further use. This is a common misconception as appropriately loading (exercising) the knee stimulates healing and is essential for joint health. Furthermore, ‘wear and tear’ changes do not always correspond with symptoms as people can have changes identified with imaging (X-ray and magnetic resonance imaging) but be pain-free ⁽⁹⁾.

4. Risk Factors

This is not an exhaustive list. These factors could increase the likelihood of someone developing knee osteoarthritis. It does not mean everyone with these risk factors will develop symptoms.

• Previous knee injury – might contribute to changes in joint structure and shape which can further exacerbate osteoarthritis changes.
• Age – increasing age is the strongest risk factor for developing osteoarthritis ⁽⁷⁾.
• Family history – there is evidence of a genetic influence of osteoarthritis.
• Obesity – increases the load on weight-bearing joints, increases the risk of developing knee osteoarthritis more than threefold and accelerates disease progression ⁽⁷⁾.
• Joint laxity and reduced muscle strength – may cause abnormal wear and joint loading ⁽¹⁰⁾.
• Being female – osteoarthritis is more common in women ⁽⁷⁾.
• Other conditions – this can happen when a joint is damaged from pre-existing complaints such as rheumatoid arthritis or gout.

8. Rehabilitation

It is not possible to prevent osteoarthritis changes altogether, but measures can be put in place to improve outcomes ⁽³⁾. Rehabilitation programmes should be performed 2-3 times per week for at least 12 weeks, but ideally maintained long term.

Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing knee osteoarthritis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression. If weight-bearing exercises are not tolerated, lower weight-bearing alternatives could be trialled (e.g. aquatic exercise or bike).

10. Return to Sports/Normal Life

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a multi-modal treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment.

Book an Appointment

Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

We have Pure Physiotherapy clinics across the country including Norwich, Dereham, Bolton, Manchester, Rochdale, Sheffield and Barnsley. Please view our clinics to find the closest physiotherapy clinic for you.