Knee Osteoarthritis: Understanding the Symptoms, Causes and Treatment

Knee osteoarthritis (OA) is extremely common, but it does not mean you have to give up the activities you enjoy. With the right combination of exercise, education and lifestyle changes, many people can significantly improve their pain, strength and mobility.

At Pipers Physiotherapy, we help people with knee osteoarthritis understand what is happening in their knee and, most importantly, what they can do about it.

What is osteoarthritis of the knee?

Osteoarthritis (OA) is a condition that affects the joints and is particularly common in the weight-bearing joints of the lower limb, including the knee. Pain, stiffness and swelling are some of the most common symptoms of knee OA, which can gradually affect walking, exercise and everyday activities.

Knee OA involves changes to several structures within the joint, including the cartilage, underlying bone and synovial membrane (the thin layer of tissue that lines the joint). As the condition develops, the cartilage can become thinner and less able to provide its normal shock-absorbing function. Changes to the underlying bone can also occur, including the formation of osteophytes (extra bone growth around the edges of the joint).

The synovial membrane can become irritated and inflamed, a process known as synovitis, which can contribute to swelling (an effusion) and pain. Together, these changes can lead to increased pain, stiffness, swelling and reduced movement, which may gradually make activities such as walking, using stairs, exercising or kneeling more difficult.

It is important to remember that osteoarthritis is not simply a case of "wear and tear" or bones rubbing together. The symptoms of knee OA can vary considerably between people, and the amount of change seen on an X-ray does not always correspond to the amount of pain someone experiences. Some people may have significant changes on an X-ray but relatively few symptoms, while others may experience considerable pain despite relatively modest changes on imaging.

What are the stages of knee osteoarthritis?

You may have heard knee osteoarthritis described as being mild, moderate or severe, or divided into four stages.

These descriptions are usually based on the appearance of the joint on an X-ray, often using grading systems such as the Kellgren-Lawrence classification.A simplified description is:

Stage 1 – Minimal changes

There may be very early changes within the joint, with little or no narrowing of the joint space. Many people at this stage have few, if any, symptoms.

Stage 2 – Mild changes

There may be early narrowing of the joint space and the development of small osteophytes.

Some people begin to experience pain or stiffness, particularly during or after activities that place more demand on the knee.

Stage 3 – Moderate changes

There is usually more obvious joint-space narrowing and bony change.

Pain and stiffness may become more frequent, and activities such as walking, using stairs, squatting or exercising may become more difficult.

Stage 4 – Severe changes

There may be substantial narrowing of the joint space, significant bony changes and alterations to the shape of the joint.Symptoms can be more persistent and may significantly affect walking, sleep and everyday activities.

What causes knee osteoarthritis?

We don’t know exactly why some people develop osteoarthritis in their knees. But there are some things that can increase your risk which include:

• Age: The likelihood of developing osteoarthritis increases as we get older. However, OA is not an inevitable part of ageing, and many older adults remain active without significant knee symptoms.

• Weight: Carrying excess body weight can increase the mechanical load placed through the knee.There are also biological effects associated with excess body fat that may contribute to inflammation. If you are living with overweight or obesity, weight management can form an important part of managing knee OA.

• Previous Knee Injuries: Previous injuries, including significant ligament or meniscal injuries, can increase the likelihood of developing osteoarthritis in the affected knee.

  This is one reason why appropriate rehabilitation after a knee injury is important.

• Excessive stress: too much stress on your knee from your job, doing too much high impact exercise like high-mileage running or playing high impact sports could increase the risk of OA.

• Genetics:Your genetics can influence your likelihood of developing osteoarthritis. Having a family history of OA may increase your risk.

• Bone deformities: The way forces are distributed through your knee can influence the loads placed on different parts of the joint. Previous injuries, changes in alignment and other structural factors can therefore play a role.

What are the symptoms of knee osteoarthritis?

Symptoms can vary considerably between people and can fluctuate over time.

Common symptoms include:

• Pain: Both movement and inactivity can cause pain. Regular, gentle movement may alleviate some of this pain. It can often be worse at night

• Stiffness: The knee may feel stiff after sitting for a long time or when you first get moving.Morning stiffness can occur, although stiffness lasting more than around 30 minutes may suggest another condition and should be assessed.

• Swelling:Some people develop swelling within or around the knee. This can fluctuate depending on activity and symptom levels.

• Reduced movement:You may find that you cannot fully bend or straighten your knee.

• Crepitus: You may hear crackling, clicking noises, or feel a grating sensation when you move your knee.

• Weakness: Pain and reduced activity can lead to weakness of the muscles around the knee and hip, particularly the quadriceps. This can make everyday activities more difficult.

• Giving way:Some people describe the knee as feeling unstable or as though it may "give way". This should be assessed, particularly if it is frequent or associated with significant pain or previous injury.

How is knee osteoarthritis diagnosed?

Getting an accurate diagnosis is essential; it allows the clinician to select the most effective treatment plan for you.

Your Physiotherapist at Pipers will firstly ask specific questions about the onset of your problem, symptoms, past health, and exercise regime. How the problem started and a description of symptoms often gives the clinician a clear hypothesis for your potential diagnosis.

After the history taking, your physio will complete a series of clinical tests to help confirm a diagnosis. Depending on the severity of your symptoms, these may include:

• Measuring the range of movement of your knee.

• Looking for joint swelling, warmth, or redness.

• Feeling for crepitus (a grating sensation inside the joint) with movement.

• Assessing muscle strength, in particular the quadriceps at the front of your thigh and also the muscles around your lower leg and hips.

• Assessing muscle length and flexibility of quadriceps, hamstrings and calves.

• Watching you move your knee and how you perform activities such as walking, squatting, jumping, running.

• Gently, but skilfully, feeling around your knee joint to find exactly where it is most painful.

• Functional tests – If your pain is present during a specific activity or task, you may be asked to perform these, so the physiotherapist can assess exactly what is aggravating your pain.

• Assessing signs of injury to the muscles, meniscus, tendons, and ligaments surrounding the knee.

X-Ray for Knee Osteoarthritis

Whilst a clinical diagnosis of OA can usually be made following the assessment. A formal and definitive diagnosis of osteoarthritis of the knee requires an x-ray.

An x-ray can assess the severity of degenerative change and can be requested quickly and easily by your GP.

How is knee osteoarthritis treated?

Although there is currently no treatment that can reverse the structural changes of established osteoarthritis, there is a lot that can be done to manage symptoms, improve strength and function, and help you stay active.

At Pipers Physiotherapy, we can provide a range of treatments and rehabilitation strategies to help reduce your pain, improve your strength and mobility, and get you back to the activities you enjoy. Your experienced physiotherapist will take you through a specific, tailored, rehabilitation programme, which may include:

• Exercise:Exercise is one of the most effective treatments for knee osteoarthritis.

• Education and self-management: it’s important to understand your condition and to take an active role in your recovery. You will be given a clear explanation of the diagnosis and the causes of your symptoms, and we will discuss how you can manage your symptoms, and what’s required to ensure you reach your goals.

• Manual therapy: Your physiotherapist may use manual therapy such as joint mobilisations, massage or soft tissue release techniques to the surrounding muscles. This will help improve joint movement and reduce muscle stiffness or soreness.

  
  

Throughout your treatment at Pipers Physio, we will ensure that you feel well supported and involved in your rehab. As part of the rehabilitation program, we also conduct regular clinical testing to ensure that you are on track with your recovery to achieve your goals.