Conservative Management of Osteoarthritis (OA) of the Knee

This is one of the most common knee complaints I see in my office, especially as the population ages. This sort of arthritis of the knee is the ‘wear & tear’ variety, where the cartilage lining the surface of the bones that make of the knee gradually wear away.

The cartilage lining the bones acts as in a protective way for the bones, and as it wears away it can become frayed and rough. With more cartilage worn away, the protective surface is now reduced, meaning the potential for increased pain and stiffness in the joint, especially if the joint becomes ‘bone on bone’ (aka there is almost no cartilage lining the bones anymore).

The image on the left shows a normal, healthy knee joint with beautiful articular cartilage and a good amount of joint space. The image on the right shows a knee suffering from osteoarthritis in the knee, with cartilage loss and joint space narrowing, accompanied by bony growths. Image courtesy of https://orthoinfo.aaos.org

Symptoms of Knee Osteoarthritis May Include:

-Knee stiffness, particularly in mornings (lasting less than 30 minutes)

-Knee stiffness after sitting for prolonged periods

-Mild knee swelling and/or redness

-Intense physical activity may cause increased knee pain

-May hear or feel a grinding noise (crepitus)

-May feel a locking or catching of the joint

-May cause a feeling of weakness

-May notice increase in joint pain in rainy weather

Signs of Knee Osteoarthritis May Include:

-altered gait (change in the way you walk)

-reduction in range of motion of the joint

-may notice bony enlargement the knee

-reduction in joint movement passively

While in most cases knee osteoarthritis can be a clinical diagnosis, an Xray is often ordered to determine the extent of arthritis in the knee. This helps determine prognosis of the condition as well. It is important to remember that while osteoarthritis may appear on an X-ray of the knee, it does not necessarily correlate with the symptoms and intensity of pain. Clinical judgement is always necessary. In general, the more severe the symptoms appear on an X-ray, the more severe the pain and other symptoms tend to be.

Conservative Management of Knee Osteoarthritis:

-Use ice on affected area

-lose any excess weight

-minimize activities that worsen the knee pain

-reduce high impact physical activities, and increase low impact physical activities (like swimming, cycling, etc)

-Increase strength and mobility to legs. The stronger and mobile you are, the less symptomatic you tend to be.

-Mobilizations to the knee joint by your Chiropractor

-Active Release Technique to the knee muscles by your chiropractor (often tightness in muscles surrounding the knee contributes to knee pain experienced by those with OA)

-Low Level Laser Therapy with our Bioflex Laser System. This is one of our best ways of managing symptoms associated with OA. And while it cannot reverse OA, it is excellent at providing longer term relief.

What happens if Conservative Management Fails?

It can, and does often. Unfortunately once the arthritic process begins it cannot be reversed, and will only progress. If pain becomes unbearable, and activities of daily living become compromised, it is best to speak to you physician regarding a surgical referral. An orthopaedic surgeon will be able to provide you with better information regarding what the course of action should be. While surgery is not a first line of treatment, in certain cases can be very effective.

Dr. Elaine Screaton (DC, BSc), is a Chiropractor in NW Calgary, currently practicing at Synergea Family Health Centre in Calgary, AB.

References:

1. https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf