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Knee Deep in Osteoarthritis

    There it is.  The dreaded word that every person over the age of 40 hates to hear: arthritis.  Part of me feels bad for the condition.  He(or she) spends most of his(or her) existence becoming the focal point for every ailment suffered.  Back ache?  Arthritis.  Hands hurt?  Arthritis.  And the most common:


    Knee pain?  Probably arthritis.


    Take a look at this Google Image after searching Osteoarthritis (OA):

    knee pain, osteoarthritis, arthritis, walking, pain
    Photo courtesy of Google

    I can’t make this stuff up.  This guy is visibly in pain. “Eroded cartilage!” “Bone Spurs!” Talk about terrifying!


    The sad truth of it is, the arthritis present in this gentleman’s knee is most likely not contributing to his pain.  Pain does not always correlate with structural damage.  A large majority of patients with knee osteoarthritis have no symptoms at all (Heidari, 2011).  Just because we see it and have pain, doesn’t mean these two are correlated.  We wouldn’t assume that the wrinkles on an older individual is the cause of their migraines; it’d be silly to assume the same for knee pain and OA.


    “So what’s the big deal? It’s just a photo, right?”  Unfortunately not.  The way we, as a society, illustrate pain is psychologically damaging to our well-being.  Gunn and colleagues found that people who had pain correlated with their OA had a high fear of movement.  As physical therapists, the Rehab Renegade guys know that people who fear movement, don’t move.  People who don’t move have weaker hearts, weaker joints, weaker muscles, and reduced quality of life.  If I had to count with fingers how many people I’ve seen reduce their physical activity after an osteoarthritis diagnosis, I’d run out of fingers. Quickly.


    When individuals correlate their pain with structural damage, they try to fix the structure.  Our bodies, however, are much more complex.  We can’t just fix the damage surface from arthritis and be good to go.  Research supports this.  Procedures designed to resurface the damage parts of the knee (arthroscopic debridement) have no benefit to patients suffering from knee pain that was correlated to osteoarthritis (Laupattarakasem et al, 2008).

    American Academy of Orthopedic Surgeons and knee Osteoarthritis (OA)

    What’s worse is that current evidence on typical procedures to treat knee OA, designed to improve physical structure, aren’t always effective either.   The American Academy of Orthopedic surgeons published a summary of effective and ineffective interventions for the treatment of osteoarthritis.  Here are a few of their recommendations that are supported with strong evidence.


    Note: If you aren’t familiar with the compounds below, not to worry.  We type them only as a reference, just in case you or someone you know is currently relying on these strategies for relief:

    Several interventions they do not recommend:

    -Using glucosamine and chondroitin for patients with knee osteoarthritis is not recommended

    -Using hyaluronic acid for patients with symptomatic osteoarthritis of the knee is not recommended

    -Unable to recommend for or against intra-articular (IA) corticosteroids (e.g. knee injections) to patients with symptomatic osteoarthritis of the knee (although results remain inconclusive).


    One of the interventions they do recommend:

    -“We recommend that patients with symptomatic osteoarthritis of the knee participate in self-management programs, strengthening, low-impact aerobic exercise(such as walking, swimming, biking, etc.) and neuromuscular education; and engage in physical activity consistent with national guidelines”.


    Exercise and knee Osteoarthritis (OA)

    Let’s expand on this point.  The American Academy of Orthopedic Surgeons encourages those with knee osteoarthritis to continue strengthening regimens and exercise. The Rehab Renegade guys do as well, and for good reason.  Fransen and colleagues found that those who participated in land exercises can have a reduction of knee pain that can last 6 months after the exercise program is stopped.  Think about how long relief would last if we continue to exercise!


    I know what you’re thinking.  Summer is coming.  The last thing you want to do is spend time away from the ocean or pool.  No worries! That’s no reason to avoid strengthening regimens. There is moderate evidence to support that water-based exercise can improve pain, disability and quality of life in people with knee osteoarthritis as well. (Bartels et. al, 2016)


    The moral of the story is…

    Stay active, even in the presence of Osteoarthritis.

    Don’t let the picture above scare you into a life of immobility. Old age and arthritis is not a reason to stop exercising.  We can reduce painful knees with traditional exercise programs without physical structure.  For all those nay-sayers out there, I want you to take a look at the mobility of this 93 year-old woman.  I’d be willing to bet she has some arthritis, somewhere.



    Take back your body. Your knee is more than arthritis.


    Brendan Glackin, DPT, CSCS
    Glackin Physiotherapy, LLC


    References coming soon!