Knee Osteoarthritis and what you can do
Is Knee Pain Stopping You?
Are you parking as close as possible to a store front just to avoid walking the extra steps?
Do you avoid having to climb the steps, even when you need something from upstairs?
Have you been limited with activities you love, like tennis, hiking, or walking you dog?
I recently had a patient tell me her knee pain prevented these things. She was only 52-years-old, and she feared that the only thing that would help her was surgery. Worse still, she feared needing to get her knee replaced at such a young age.
But with knee pain preventing her from climbing stairs normally and preventing her normal walks with her dog, she didn’t think there was an alternative.
She believed that her knee was “bone on bone” and most of the pain was caused by “wear and tear.”
The medical profession would term this “osteoarthritis” of the knee, and OUCH!, that conjures up a lot of hopelessness in people. Most people believe that using the knee could further damage it. Almost everyone believes that their pain will get worse over time.
Most of us would consider 52-years to be too young for arthritis.
Motion is Lotion for the Joints.
But what is arthritis?
Actually, it is the normal aging of the cartilage in a joint. And I hate to say it, but if you’re no longer growing cartilage, then it’s a maintenance game. Which means that if you are older than about 24-years, you are on the “keep things healthy” side of the equation. Younger than that, and you still have a shot at growing some new cartilage.
Oftentimes, the cartilage is thought of as “the shock absorber” of the joint. But that’s not its main job. In fact, it shouldn’t be high on the task list for the cartilage, if you can help it. The more shock the cartilage absorbs, the more likely it can be damaged.
However, your muscles should actually be the shock absorbers. By having stronger muscles, you can prevent a lot of the shock from overloading the cartilage…which should give you a longer time with healthy cartilage.
The cartilage is actually a bit more “squeezable” than bone to allow for some softening of the forces in a joint, but it is mainly for helping to provide friction-free movement through the joint. Additionally, friction takes a lot more effort to work through.
If you use the common analogy of your joints being “hinges,” then you can think of the arthritic joint as being a slightly sticky hinge. It still works, but it takes a bit more effort to move the door.
On the other hand, abnormal wear of the cartilage is more appropriately termed degradation of the cartilage. When the cartilage is degraded, it is aged much more than you would expect for someone’s chronological age or activity level. Think of this a hinge that grinds, squeaks, pops, and requires a lot of force to move as the door swings.
Furthering the Analogy of the Door Hinge
You might have noticed that the more you move a “sticky” door hinge, the smoother it works. Even for the popping, grinding, squeaking door hinge, swinging the door open and closed generally makes it easier to move. This might happen for several reasons, like getting some of the grease in the hinge to move again which makes things easier to glide, getting the grease into the “sticky” point, or by just getting the rust broken free, allowing the movement to take place again.
Similarly in your knees, when you start moving the arthritic joint, it might be more painful and stiffer at first. But persistence can really pay off, as most folks with knee arthritis realize easier movement with less pain just by keeping the knees moving. This is why you might experience more pain/stiffness early in the morning or after sitting for a while. Then after moving through the discomfort for several minutes, you find yourself moving better, walking more easily, and having less discomfort.
It turns out the old adage “Motion is Lotion” really is a good way of thinking about this. Just like in the door hinges, movement gets the “grease” (synovial fluid) of your joint moving and “squeezed” into and out of the cartilage, which keeps it healthier.
Both normal wear (arthritis) and abnormal wear (degradation) can occur gradually over a prolonged time, or suddenly after an injury.
As the cartilage thins on the end of the bones, swelling, stiffness, and pain can become limiting.
When the knee is involved, this can lead to difficulty with climbing (and especially descending) the stairs. Frequently, it makes people feel like they cannot walk far, let alone do exercises that involve the legs.
Unfortunately, we know that two risks of developing knee arthritis are age and family history.
Great, right? The two things that you have no control over!
But wait, don’t give up hope!
There are several other factors that are in your control.
1- Dropping a few pounds can greatly reduce knee loads. In fact, losing one-pound of body weight reduces force across the knee by 4-pounds when climbing the steps! Now that’s a powerful way to reduce stress on the knee. Even losing a few pounds can greatly reduce the stresses at your knees. No need to go on a crash diet, or to be disappointed that you aren’t dropping a lot of weight. A modest amount of weight loss can make a big difference. Dropping 5-pounds of weight will reduce loads at your knees by a whopping 20-pounds!
2- Strengthening the muscles around the knee can prevent too much force from getting to the cartilage, as well. The weaker your muscles are on the front of your thigh, the more often you will feel like your knee is unstable…like it is unable to hold you up, or might give way from underneath of you.
Being stronger almost always equates to being more functional.
What that means is this…the stronger you are, the more you are able to do.
I know. It seems like common sense, but even I am guilty of sometimes overlooking this little tidbit of wisdom.
Findings from different healthcare settings have identified that nonsurgical treatments for knee osteoarthritis are underutilized and knee replacement is overused. Research also suggests that people have little willingness to accept nonsurgical interventions for knee osteoarthritis.
Many people believe that physical therapy and exercise interventions will increase pain and can not replace lost knee cartilage. Because of this, many patients opt for experimental and surgical treatments which they believe will replace lost cartilage and cure their knee pain.
But categorizing normal arthritis as a disorder requiring medical treatment (like surgery) might create health concerns where none exist. Thus, it is really when the knee pain forces you to adapt what you are doing, or that you lose some ability to do things easily (like rising from a chair, or climbing the stairs) that you might want to consider getting more guidance on how to handle your knee pain.
A Simple Test for You
One simple test that you can perform to help you know how much your knee pain is hindering you is the chair-stand test.
In this test, you will stand up from a chair as many times as you can in 30-seconds, without using your hands. It is a great test for strength and endurance of your leg muscles…and really simple to perform at home. You can see how you rank for your age by clicking here.
Now, back to the 52-year-old who thought she would need to replace her knee…
She has been able to strengthen her thigh muscles without pushing through pain. First, she started by doing some isometric knee exercises, then progressed to movement based exercises in sitting, then to weight bearing exercises in standing.
A Starting Point
Now, that progression won’t work for everyone with knee arthritis, but can be a good place to start. The time that you might need to stay at any particular level of exercise is dependent on how your body is responding to the load of the exercise.
But perhaps the most important thing for this 52-year-old patient was that she was able to get back to walking her dog and climbing the stairs without pain. Best of all, she no longer feared needing a total knee replacement at her young age.
That doesn’t mean she won’t need that in the future, but let’s hope that it is much later in life and that she has many more active days between now and then. In the end, if she keeps her strength up, she will be going into any future surgery in a much better shape.
With some personal guidance, you can make the best decision about to approach your knee arthritis.
We, at Lifestrength PT, are always happy to speak with you.
Articles used for reference in this blog:
–J Orthop Sports Phys Ther 2020;50(1):1–4. doi:10.2519/jospt.2020.0601 https://www.jospt.org/doi/10.2519/jospt.2020.0601
–J Orthop Sports Phys Ther 2019;49(7):513–517. doi:10.2519/jospt.2019.8619
https://www.jospt.org/doi/10.2519/jospt.2019.8619
–J Orthop Sports Phys Ther 2020;50(6):309–318. Epub 6 Sep 2019. doi:10.2519/jospt.2019.9125
https://www.jospt.org/doi/10.2519/jospt.2019.9125
Osteoarthritis Myths https://oaaction.unc.edu/blog/myths-about-osteoarthritis/
Clin Orthop Relat Res. 2019 Sep;477(9):1975-1983.doi: 10.1097/CORR.0000000000000784.
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2 Responses
Hi, Scott !
Happy New Year !! Hope you and your colleagues are well.
As always, I learn from your articles. Love the phrase MOTION IS LOTION !! Simple, but motivating when there is pain.
It’s like you wrote this article for me today. Knees were not feeling their best and I was blaming that on the cold weather and the past activity. (5-6 years of iceskating and lots of jumping while in my 20s).
I did fairly well with the chair stand strength test, getting a score of 17—not too bad for a grandma I’m thinking. Guess I have to work on more regular exercising. Our one-mile walking loop around the neighborhood happens often only when I run out of excuses. Making a regular routine of it often alludes me.
When we do walk, I have noticed the achiness goes away after a while. That by itself should be motivating.
I had heard the one pound lost equals 4 in relief. So far, I’ve lost 20% towards my weight loss goal. That’s 32 pounds of pressure off my knees. Yikes !
As always, thanks for your articles. Stay well, best, Carol Simpson
Carol- Thanks for reading. Hopefully your excuse list gets shortened and the walks become more frequent, again. Great to hear from you!