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Saturday, 20 July 2019 19:49

The Worn Out Knee

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A large population of people over the age of 45 have a condition in the knee called knee osteoarthritis or also known as knee OA, where the cartilage in the knees are worn away causing bone on bone contact between the thigh bone and shin bones. Complaints include joint swelling, joint stiffness and most common one, pain.

The word Osteoarthritis describes a condition that causes wear and tear of your joints, and in the case of the knee, it’s the wear and tear of the cartilage that separates and helps cushion our knees. In knee OA, not only does the cushion/cartilage gets worn but the soft tissue that surrounds our bone and the ligaments around it, which ultimately can lead to pain and loss of function.

Early on in the 2000’s it was once thought that Knee OA was a condition that was inevitable resulting from a long and active life but research has shown that knee OA is a complex process with many causes, and some experts say that it is not an inevitable part of aging. By looking at the contributing factors we can mediate the risk and drastically reduce the chances of and delaying the onset of knee OA.

  1. Maintain a healthy weight
    • Excessive weight is one of the biggest predictor of knee OA, this is due to the fact that extra kilo’s put extra stress on the knees and hips. Each kilo you gain puts an extra 4 kg of force through your knees, and over time this added force can really wear out your knees.
    • Mechanical stress is not the only reason why our cartilage decides to kick the bucket early. Systemic inflammation can trigger the early break down of cartilage tissues. Fat cells produce these inflammatory cells which will speed up the degenerative process. So by reducing your weight not only do you reduce the overall mechanical load through the legs but also reduce the systemic inflammation.
  2. Control blood sugar
    • High levels of blood sugars within the body may be a huge contributing risk factor for knee OA. The high levels of blood sugar causes an influx of insulin to circulate through the body triggering systemic inflammation leading to early cartilage loss. Looking at population consensus data, Overseas research shows that more than half of diabetics have some form of OA.
  3. Get physical
    • The gold standard for treatment and prevention of knee OA is getting fit. It is also one of the best ways to keep joints healthy. Contrary to popular belief cartilage cells thrive under pressure, meaning they need to be stimulated or else they will just wither away. Getting fit also fixes the previous 2 factors in delaying knee OA. You do not need to join a gym however just start by taking a little walk, although, if you do feel some sort of pain, listen to your body and take frequent breaks.
  4. Play it safe
    • Once a joint is injured in some way it is nearly 7 times more likely to develop OA compared to a joint that has never been injured, this number jumps up dramatically if the joint needs to be operated on. It is nearly unavoidable to prevent injuries we can do things to mitigate the risk. Use protection when possible and have adequate training for it. Playing your sports once or twice a week is not adequate training.

Looking at Australia we have an ever growing aging population, with increasing rates of obesity, it is paramount to start thinking about how we can prevent knee OA. According to professor David Hunter from the university of Sydney, who is a world leading OA expert, “GP’s in the past have recommended glucosamine or anti-inflammatories to manage or prevent knee OA, but now evidence shows that the safest and most effective way of treatment is exercise, with many cases of OA can be assisted with diet and lifestyle changes. The new guidelines outline the importance of long-term management of the condition, with a focus on non-surgical interventions, and recommend that medication and surgery should be used as a last resort. Studies have shown that surgeries provide little gain for the patient, with risks and high costs, and opiods can be ineffective for pain management but have severe side effects such as risk of dependency.”.

“People living with osteoarthritis are encouraged to have informed conversations with their GP about preventive care like physical exercise and weight loss,” added Professor Hunter, who is University of Sydney's Florance and Cope chair of Rheumatology.

So what is the current guidelines in treating people with knee OA?

Currently there 100’s of “cures” or treatment for knee OA ranging from using glucosamine tablets to ingesting shark cartilages. However these treatments have shown little effect in and does not address the overall holistic nature of knee OA. The only one tried and true method of preventing and managing knee OA is structured exercise, with medication as adjunct treatment in the management of pain relating to knee OA.

The main role of exercise is improve physical function and reduce pain.  By increasing our muscle strength around our knees we reduce the actual load that goes through the knees. You can think of your muscles as shock absorbers, with more muscle strength and better motor control you can absorb more forces with your muscles, instead of them going through the knees. Every person is different so in order to get the right exercises you need to be assessed by a qualified health professional such as a physiotherapist to prescribe the right exercise and dose.

If you are unable to get to a health professional or if you are hesitant to do land base exercises, its best to try and start walking around or doing some gentle exercises in the pool. This way it puts less strain through the joints and it is more comfortable.

The take home message for knee OA would be that its never too late to change! Exercise, whether it be as simple as walking in the pool to hitting it hard and safe at the gym will be of GREAT benefit. Even more effective is exercise done with perfect technique! If your interested in one of the many classes run at BPS by experience Physiotherapist and experts in biomechanics ... ie perfect technique ... please give us a call on 8544 1757 or drop us an email at we would be happy to guide you in the right direction for your specific  situation! 

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