What is osteoarthritis of the knee?

Knee arthritis is a condition characterized by a degenerative process whereby there is gradual eroding of the surfaces of the knee joint with subsequent inflammation. It is something that we see frequently in our clinic and because it is a condition that affects our ability to keep our legs and hips strong. We take this condition very seriously.   Osteoarthritis (OA) may occur following a specific injury or due to repetitive forces going through the knee beyond what it can withstand over a period of time. In a normal knee, joint surfaces are smooth and there is cartilage between the bone ends which allows for efficient shock absorption. When the knee is damaged or overloaded, particularly with excessive weight-bearing or twisting force, degeneration of the cartilage occurs which reduces the knee's shock absorption capacity. As the condition progresses there is eventual wearing down of the bone ends so that the surfaces are no longer smooth and may have small bony processes called osteophytes. This condition is known as knee arthritis.   Arthritis of the knee usually occurs after the age of 50 years. It is more common in those patients who are overweight or have a past history of injury or trauma to the knee. Athletes are another populations that suffer from significant arthritis and these individuals find it especially frustrating because they want to be active.    

What is the prognosis of osteoarthritis of the knee?

Patients with this condition usually experience symptoms that develop gradually over time. Active individuals fortunately get help early because they notice them sooner. As the condition progresses, there may be increasing knee pain with simple weight bearing activity and joint stiffness - particularly after rest and first thing in the morning. Swelling, decreased flexibility (i.e. an inability to fully straighten or bend the knee), severe joint pain, pain at night and grinding sensation during certain movements may also be experienced. Symptoms can sometimes fluctuate from month to month with patients reporting an increase in symptoms with colder weather. In more severe cases, muscle wasting (especially of the quadriceps), a visible deformity of the knee joint, and a limp may also be present. It’s never too late to safely gain strength and endurance, however; going from being an inactive person to one that has to gain fitness with OA is a greater challenge and requires a strong commitment.

   

What about surgical and or knee replacements for severe OA?

In more advanced cases of knee arthritis, where symptoms are severe, patients may require surgical intervention. This may involve a knee arthroscope or partial or complete joint replacement surgery. The treating physiotherapist or doctor can advise if this may be required and will refer to an orthopaedic specialist for an assessment and opinion.   Following a total knee joint replacement, patients are normally in hospital for 5 to 10 days and require physiotherapy treatment and rehabilitation over the following months. Resumption of normal daily activity can usually be achieved 3 – 6 months following surgery.    

How can physiotherapy and massage therapy help osteoarthritis of the knee?

Manual Physiotherapy

Typically knee flexion (bending) is lost as well as knee extension.  This limitation in range of motion occurs with moderate to severe arthritis. Joint mobilization techniques work to decompress the joint and restore the gliding/sliding motion of joint surfaces to promote both flexion and extension of the knee joint. In addition, the kneecap movement will be assessed and treated for stiffness as well as the important musculature such as the quads and IT Band. General massage techniques, such as effleurage, can also be effective in reducing significant swelling and may be performed by your massage therapist and your physiotherapist.   Whilst little can be done to reverse the degenerative changes to the knee associated with this condition, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. Treatment should be directed at improving knee range of motion, reducing swelling and pain, and restoring normal function. In addition, establishing foot, knee and hip stability and strength is important to remain physically active.  The exercises prescribed initially by your physiotherapist for knee arthritis will depend on whether you are acutely inflamed or not. When inflammation is high, exercises will focus on the restoration of range of motion and activation of the major stabilizers of the knee, such as the quadriceps, adductors and hamstrings. As range of motion increases, the bike will be introduced and there will be a focus on functional strengthening and transitional balance exercises. Examples of these types of exercises are weighted sit-to-stands, leg press, and body squats with emphasis on both technique and resistance.  It is very important to attain sufficient strength in the major muscles to minimize torqueing, shearing, and compression inside the knee joint. You will be progressed through a personalized exercise plan over many months to reach a higher level of function and strength.   Most minor to moderate cases of knee arthritis can be managed with an appropriate personal improvement exercise program so the patient can remain relatively symptom free and active. The success rate of this program is largely dictated by patient compliance. It requires flexibility and sometimes doing an activity that you may not enjoy. One of the key components is that patients understands what the aggravating activity and what the corrective activity and balance their weight bearing activity with periods of active rest (biking instead of walking) to keep symptoms to a minimum. This prevents further damage and deterioration and allows the body to clear any swelling or inflammation. Continuing to participate in painful weight bearing activity is likely to lead to a poor outcome. It is important, however; to keep as active as possible by choosing activities that do not increase symptoms. Better activities for knee arthritis include swimming, hydrotherapy or bike riding.

   

Massage Therapy

The goal of the Massage Therapist with Arthritis clients is to help improve joint stiffness, decrease pain and increase range of motion. During a flare up, the use of moderate Swedish massage techniques can affect the spasms in the supporting musculature, decrease stress and increase the production of naturally occurring pain killing endorphins. When the arthritis is not in a flare up deep tissue, myofascial and trigger point techniques are introduced to decrease adhesion in muscles and ligaments affecting the joint.  

How can exercise and physical development help after osteoarthritis of the knee?

Exercise and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your painful arthritis, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:  
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home
   

How can low intensity laser therapy help osteoarthritis of the knee?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.    

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