To my fellow Boomers out there ….. How are your knees doing? We are an active sector of the population and we want to remain that way for the health benefits (and the fun!) thereof. Knee pain due to osteoarthritis, whether one or both knees, has a dramatic impact on a person’s ability to continue with their chosen active lifestyle and, if it gets painful enough, may impact activities of daily living such as getting into and out of a car or a chair, cooking a meal or simply walking.
WHY KNEE OSTEOARTHRITIS?
Osteoarthritis affects 25 million North Americans and is symptomatic in 13% of people aged 55 years and older. It has been shown to be the most frequent cause of functional disability including being dependent on alternative forms of mobility due to the tremendous pain with walking. Ouch! The prevalence of osteoarthritis is rapidly increasing due to two main factors. Firstly, the aging of the American population (that includes us!) is increasing the share numbers of people older than 55 years. Secondly, the rapidly increasing obesity in our population is increasing the rate of joint degeneration. One study reported 83% of males who had knee osteoarthritis were obese compared to 42% of males without it. Wow! Now there is a statistic that says a lot and leaves nothing to the imagination as to what we need to do to address the issue.
WHAT IS IT?
Osteoarthritis is the joints response to structural damage caused by mechanical problems. It is the body’s attempt to repair a joint under unusual stress and often leads to a stable, pain free joint. If this process fails (is insufficient for the magnitude of mechanical stress placed on the joint) the knee becomes symptomatic and hence functionally debilitating.
MECHANICAL STRESS YOU SAY?
Pathological mechanical stress of the knee joint may be due to:
- Increased overall load through the weight bearing joint surfaces (e.g. obesity).
- Reduced load bearing surface area thereby increasing the pressure (same force through a smaller area) exerted through the joint (e.g. misaligned joint: bandy or bow-legged).
- Repetitive impulsive loading of the joint (e.g. trauma, doing moguls).
Obesity increases the overall load through the joint and overwhelms the joint tissues resulting in osteoarthritis. Being bandy or bow-legged reduces the weight bearing surface area in the knee joints (shifts it from throughout the knee to one side or the other of the joint) and results in excessive wear and tear of the joint on the outer or inner surfaces respectively. Sustaining a serious injury to the knee in which ligaments are torn and the joint surfaces are banged together in the injury may initiate the osteoarthritic “repair” process as well. Thus, when stress on the joint tissues exceeds their physiological tolerance breakdown ensues and osteoarthritis begins.
HOW CAN WE ADDRESS THE CAUSATIVE FACTORS?
Weight loss in an effort to attain a normal body weight for your frame is paramount in reducing the forces through the knees. Walking results in a force through the knee equal to 3 – 4 times your body weight each step. If you lose 20 – 50 pounds in an effort to attain your normal weight, you reduce the forces through your knees by 80 – 200 pounds each step you take! Talk about happier knees! An 11.2 pound weight loss over a 10 year period has been shown to reduce the likelihood of developing knee osteoarthritis by 50%.
For misaligned knee joints (those of you who are bandy or bow-legged) there are unloading braces to modify (increase) the load bearing surface and hence reduce stress to the one side of the affected knee.
In all osteoarthritic knee joints muscle weakness, joint stiffness and poor balance are factors. Muscles around the knee joint serve to cause movement in bending and straightening the knee, can reduce mechanical stresses to the joint by absorbing loads applied to the limb (e.g. cushioning during landing a jump or when skiing) and stabilize the knee joint during daily tasks of walking, running, lifting and carrying to name a few. Patients with knee osteoarthritis are 20% to 40% weaker in their quadriceps than people without the condition. As the disease worsens the knee muscle activation patterns become less efficient and less specific and joint proprioception (the brain’s ability to know what is happening at the joint and react accordingly) is suppressed. A well constructed, evidence-based physical therapy program will improve strength, range of motion and proprioception and result in improvements in physical function, pain and quality of life. Modifying the mechanical problems causing the osteoarthritis together with addressing the inflammatory and pain aspects of the disease process through pharmacological intervention from your physician can result in an 86% success rate in improving your function. Who would not like that!?
All our physical therapists at Custom Physical Therapy have undergone specialized training for treating osteoarthritis. The therapists work as part of a team comprised of you the patient, your physician and the physical therapist. Using physical therapy interventions to modify the mechanical factors impacting the progression of osteoarthritis together with the physician addressing the pharmacological aspects and the patient being compliant with an exercise and stretching program (see our very first post on this blog) as well as brace use, if prescribed, the team of patient-physical therapist-doctor minimizes the effect of the disease process on your function.
YOUR CALL TO ACTION!
- If you are overweight start a simple lifestyle change that entails weight loss (Call Joe Dibble, dietician at Sierra Strength and Speed, for a consult. He is really knowledgeable and practical.)
- Call Custom Physical Therapy so we can evaluate your arthritic knees and set you up with appropriate treatment.
- Forward this post to someone you know who has sore knees or you think may be interested in the information.
You are encouraged to call Custom Physical Therapy to talk to one of our accredited physical therapists about your knee pain. You may be a candidate for this customized evidence-based program specifically developed to improve your function which deteriorated due to knee osteoarthritis.