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Non-Surgical Treatment of Knee Osteoarthritis

Osteoarthritis of the knee affects about 37% of people over the age of sixty in the United States. Joint pain at the knee can make basic everyday tasks harder, limiting physical function and increasing your risk for other problems. However, there are many simple ways to manage your symptoms and reduce pain to maintain your lifestyle. This article will explore several options for non-surgical treatment of knee osteoarthritis (1)

What is Osteoarthritis of the Knee?

The gradual wearing down of cartilage, bone and other tissues in our joints over time often leads to osteoarthritis. To some extent, we can think of this gradual wearing of our tissues as part of “normal aging.” Yet, osteoarthritis does not always mean “pain” and the rate of progression and severity of symptoms can vary from person-to-person. (2)

knee arthritis

There are three areas where osteoarthritis of the knee– and knee pain– will typically develop:

  • The inside of the knee (known as the medial line)

  • The outside of the knee (known as the lateral line)

  • Where the kneecap meets the thigh bone (the patellofemoral joint)

Medial compartment knee osteoarthritis affects the inner knee and is usually where knee osteoarthritis is first detected.

Tricompartmental knee osteoarthritis refers to degeneration in all three locations at once.

What Are Some Common Knee Osteoarthritis Symptoms?

Many people with knee osteoarthritis may not experience symptoms at all. One study looked at MRIs of people with no knee pain, yet found knee osteoarthritis present in 19-43% of people over 40 years old. (3)

On the other hand, many people with even mild to moderate OA will experience symptoms like joint stiffness, loss of mobility, pain, and swelling. These symptoms can lead to decreased activity as a means to avoid or lessen pain intensity.

When you are less active, your muscles become weaker, which can lead to more stress and strain on the joint. This can be a frustrating cycle, but let’s look at some simple exercises to reverse this slow decline so you can begin to regain physical function in your knees. (2)

Exercise-Based Options for Knee Osteoarthritis

Knee osteoarthritis treatment options include exercise, physical therapy, weight loss, knee braces, medications, and injections. There are also a handful of daily habit changes that can come in handy. Adding light aerobic activities, like walking with friends, can be helpful. It’s also important to make sure you get plenty of sleep to nourish and strengthen your body.

Let’s take a look at how good movement and exercise can help to prevent or manage your knee pain.

How Can Exercise Help?

One study found an 80% reduction in pain following exercise-based programs for knee osteoarthritis! These programs averaged three, 30-minute sessions per week, for eight weeks. (4)

Please note, it’s best to avoid high-impact activities like running if you are feeling joint pain in your knees or hips. As pain levels subside, returning to these activities is possible if it is within your personal goals.

Needs and preferences will vary, so it may be best to first seek aid from a physical therapist before beginning any program to manage knee pain. Here are a couple of simple ways to get started:

Strengthening for knee pain

Strength training for knee osteoarthritis should focus on the thighs and the muscles around the outer hip. The goal is to create greater knee stability and shock absorption during movement. Increased strength in the quadriceps has been linked to reduced cartilage loss in the knee joint. (4)

Here are a couple of simple exercises you can try at home to begin strengthening the large quadriceps muscles in your upper leg:

The straight leg raise is a common beginner’s quadriceps muscle strengthening exercise:

  1. Start by laying on your back with your leg out straight in front of you.
  2. Squeeze the muscle at the front of your thigh and lift your foot off the floor about 18 inches while keeping the knee straight.
  3. Repeat this exercise for several repetitions in a row until you feel fatigue in the thigh. 

Strength exercises can also imitate daily activities such as standing from a chair. Note, if this is difficult for you because of knee pain, start by sitting on an extra cushion or pillow to increase the height of your chair:

  1. Practice going from sitting to standing from this surface for several repetitions until fatigued.

  2. Gradually lower the height as you get stronger.

Mobility for Knee Pain

Other exercises can help with improving your range of motion. As arthritis progresses, it may become more difficult to bend or straighten your knee. For this reason, it is important to move your knee through your full range of motion as often as possible.

Here are a couple of mobility exercises that target the muscles around your hip and thigh to lessen knee osteoarthritis and knee pain:

  1. While laying on your back, bend one knee as much as you can without causing pain.

  2. Hold at the deepest part of the stretch for a few seconds then extend your knee back out straight.

  3. Repeat this exercise for up to ten repetitions at a time, a few times per day, especially after periods of inactivity.

The standing hamstring curl is another great exercise that focuses on both knee mobility and hamstring strength.

  1. Start standing, holding on to a steady surface if needed for balance, and bend your knee, as if trying to kick your heel to your butt.

  2. Pause at the point where you feel a strong engagement at the back of your thigh, then lower and repeat until you feel slightly fatigued.

Body Mechanics:

Knowing how to move your body is another key component in managing knee osteoarthritis to maintain ideal physical function and reduce pain.

Poor body mechanics can have a negative effect on movement, potentially leading to pain in other joints related, such as the opposite knee, the hips, or the back. Likewise, good body mechanics can help relieve stress on the knee joint and offer relief.

Body mechanics are also important with other common activities like squatting and lifting. When squatting, for example, allowing your knees to move forward past your toes can cause knee pain and eventual injury. If you have knee pain, it may be better to shift your weight back more during your squat to avoid this stress. (5)

If you find yourself limping due to knee pain, a cane may also help you maintain daily physical function with a little extra support. This change may only be necessary for walking longer distances and can be temporary until symptoms are better managed.

Other Non-surgical Treatments for Knee Osteoarthritis Patients

Weight Loss:

Weight loss should be one of the first things to consider for knee osteoarthritis. Force absorbed by your knee joint can be up to three-to-six times your body weight, based on the activity you are performing. (4)

Losing only ten pounds could reduce the impact on your knee joint by 30-60 pounds, leading to a reduction in knee pain while slowing the progression of your osteoarthritis symptoms.

Knee Braces:

In some cases, a brace will provide external support so that you can remain active and reduce the risk of further injury. Many knee braces (such as knee sleeves) also provide compression to the joint to help reduce or manage swelling.


OUR RECOMMENDATION

Ossur Unloader Knee Brace

The Ossur Knee Unloader Brace

An Unloader brace relieves pressure and can be useful to help offload the painful side of the joint. This type of brace will shift forces from the painful side of your knee to the healthy side as a means of sharing the work.


Heat or Cold

Heat or ice modalities can also be helpful for managing short-term pain. These should be used in addition to other treatments and not as a stand-alone treatment. Apply for 15-20 minutes at a time. Closely watch the temperature and your skin to avoid burns. Please note, you should not use either of these methods if you lack sensation around your knee.

Talk to a Healthcare Professional

Finally, there are many things your doctor and/or physical therapist can do to help you manage knee osteoarthritis. It is always best to contact your healthcare professional if your pain is beginning to interfere with your daily life.

Physical Therapy

Physical therapy can be beneficial for managing knee osteoarthritis, as well as many other common conditions. A physical therapist will analyze your movements and determine the best treatment for your knee pain. Your PT will focus on careful exercise selection, as well as prescribing the proper amounts to match your ability and your needs.

Exercise is very important for improving symptoms of knee osteoarthritis, but the exercises must also be the right fit for you. A physical therapist will help you find a starting point and will provide meaningful progressions as you get stronger.

Treatments may also include ultrasound, manual therapy, or dry needling. These techniques can help with improving your range of motion and provide short-term pain relief so you can get back to doing the things you love.

Injections

In certain cases, your doctor might also recommend intra-articular (inside-the-joint) injections. These may include corticosteroids, hyaluronic acid, and platelet-rich plasma. Please note that there are pros and cons to all of these treatments and some may not be an option for all patients with knee osteoarthritis.

Injections for knee osteoarthritis are usually utilized to help reduce pain and inflammation in the joint. The length and amount of relief can vary between patients and injection types. Injections are best utilized as an adjunct to other treatments to maximize your results.

Steroid injections help to reduce inflammation in your knee and are designed to provide short-term relief. Due to the potential side effects of long-term steroid use, the number of injections you can receive is typically limited. (6)

Hyaluronic acid is a naturally occurring substance in healthy joints. Since it assists with lubrication and shock absorption, this type of injection can help to restore knee function. Hyaluronic acid can also aid in lessening inflammation. Results vary for these injections, ranging from several months of relief to no change at all. Hyaluronic acid injections also tend to be expensive. (6)

Platelet-rich plasma (PRP) injections are developed and modified from samples of your own blood. Platelets assist in preventing the progression of osteoarthritis to reduce pain and potentially assist with the regeneration of cartilage. Success is mixed, and more research is necessary to determine the overall effect of these types of injections on patients with knee osteoarthritis. (6)

Wrap-Up

Although painful knee osteoarthritis may seem overwhelming, there are many options to consider before resorting to orthopaedic surgery. Daily lifestyle alterations like adding light exercise, eating for weight loss, and getting plenty of sleep can be beneficial in a variety of ways.

Talk to your doctor or physical therapist to help determine the best set of exercises, or other modes of treatment to suit your lifestyle. All patients with knee osteoarthritis will differ, so it’s important to seek out the best care plan for your needs.

References

  1. Kawano, M. M., Araújo, I. L., Castro, M. C., & Matos, M. A. (2015). Assessment of quality of life in patients with knee osteoarthritis. Acta ortopedica brasileira, 23(6), 307–310. https://doi.org/10.1590/1413-785220152306150596

  2. Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoarthritis. Accessed November 20. 2022

  3. Culvenor AG, Øiestad BE, Hart HF, et alPrevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysisBritish Journal of Sports Medicine 2019;53:1268-1278.

  4. Bhatia, D., Bejarano, T., & Novo, M. (2013). Current interventions in the management of knee osteoarthritis. Journal of pharmacy & bioallied sciences, 5(1), 30–38. https://doi.org/10.4103/0975-7406.106561

  5. Schoenfeld, B. Squatting Kinematics and Kinetics and Their Application to Exercise Performance. The Journal of Strength and Conditioning Research. 24(12):3497-506

  6. Ayhan, E., Kesmezacar, H., & Akgun, I. (2014). Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World journal of orthopedics, 5(3), 351–361. https://doi.org/10.5312/wjo.v5.i3.351

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