Osteoarthritis of the knee (knee osteoarthritis)
Rehab for the injury
Description of osteoarthritis of the knee (knee osteoarthritis)
Chances of developing osteoarthritis of the knees increases the older you become, even though young people can also get it. Osteoarthritis is in fact a slightly misleading word, since it often occurs because the knee is not used properly, because it is being overloaded unilaterally, has been burdened by overweight over the years, or has had some diseases that broke down the cartilage.
The knee is one of the joints of the body that is subjected to the hardest load, and the ends are covered with cartilage (hyaline), which supports the joint so that no friction (heat) occurs during movement so that the joints slide easily and the bones do not bump into each other . Joint cartilage is very thin in all joints however it can withstand very high loads. In the knee the average thickness is approx. 2 millimeters of cartilage, and it can withstand enormous impact. Typically, there is pressure of about 400 kg of weight for a person of 75kg running, and this pressure increases with the weight and load, respectively. There may be several tons to be absorbed by the knee on a run. In this way cartilage at the ends of the bone can be compared to the asphalt which is worn down on a road. The asphalt is only quite thin, and below that there is gravel and sand which absorbs the weight of the cars. Similarly, the joint cartilage must prevent wear, but because it is thin, the pressure loads pass through and are absorbed into the bones, the fluid in the joints, etc.
Cartilage is called avascular, which means it does not contain blood vessels or nerves. That’s why pressing a joint together does not hurt, for example during jumping and running, etc. But since the cartilage does not contain blood vessels, it must get its oxygen supply from somewhere else, as all cells must have oxygen in order to live. Most tissue gets oxygen through the blood, by red blood cells which transport the oxygen around to all the cells. But in the joints, it is different, as these blood vessels would be destroyed by the impact of joint compression, which is what the cartilage is designed for.
Cartilage is found on each end of the bone both of the thigh and shin. The ends themselves are wrapped in a joint capsule, and the inside of this joint is made up of a synovial membrane. The membranes secrete synovial fluid into the joint cavity when moving, lubricating the cartilage; Just think of the mucous membranes in the mouth etc. which when you move the mouth (talking) the mucous membranes produce spit which cleans the oral cavity. The fluid that is created inside a joint capsule is used for several things. Among other things, the joint becomes shock absorbent because of the liquid between the bones, and it also acts as a kind of lubricant that makes sliding on the cartilage much easier, just as the engine oil in a car makes the pistons move smoothly. Most importantly the synovial fluid also supplies the cartilage with oxygen. When the cartilage is pressed firmly together, the fluid is poured out of the joint and when there is no compression in the joint, a vacuum is created which sucks oxygen into the cartilage. In this way, the joints actually get oxygen and nutrition when used. The problem is that if you do not use your joints or there are areas in the joints that are not loaded, this exchange will not occur, which over time will cause the cartilage to break down.
It is precisely for this reason that highly recommended training is given to patients who have osteoarthritis, in order to stimulate the joints to get fluid and thus oxygen, to nourish the cartilage. The problem is, however, that when the cartilage is worn down, pain is experienced when using the joint which has osteoarthritis. Therefore, many people who have osteoarthritis lose the motivation for exercise before having reaped the effect. However, movement is the only way forward, and in a short period of time most people will feel an effect as the pain decreases and the mobility becomes better. It is, however important that the training is structured correctly.
As explained it becomes evident that osteoarthritis can affect everyone, and as previously described, several factors may be involved, though it is most common for people over 45 years old and most often women. In most western countries, surveys have been conducted on the population over 45, where more than 10% suffer from osteoarthritis. Also, the knees are evidently also most commonly area affected by osteoarthritis.
Symptoms of osteoarthritis in the knee
Symptoms of osteoarthritis may vary from area to area, but there are some classical symptoms:
- Pain in the knee when active which gets a little better with rest.
- The knee swells if it has been overloaded.
- Feeling of heat in the joints.
- Stiffness in the knee, especially in the morning or when you have been sitting for a while.
- Lack of mobility, making it difficult to get in and out of cars, get up from a chair, walk up and down stairs or up a hill.
- When you move your knees, there may be creaking and crackling sounds.
Examining for osteoarthritis in the knee
A doctor often becomes suspicious of arthritis in the knee, based on the classical symptoms especially if the patient is over 45 years old. There is also an aging tendency which is applied.
The cheapest and most secure method of diagnosis is X-ray examination that can show bone and cartilage damage as well as the presence of bone fractures that occur when the cartilage is gone.
Sometimes the doctor may also order an MRI scan (magnetic resonance imaging) if the X-ray examination shows nothing but the patient is in pain. This is most often done in order to exclude other injuries or damage to other tissues.
Blood samples will not show where osteoarthritis is present, but a doctor may order a blood test to exclude other conditions that could cause the pain, like rheumatoid arthritis or any other disorder of the immune system may be ruled out.
Treatment for osteoarthritis of the knee
The primary goal of the therapist is to increase mobility and reduce pain, which often can be done by combining different therapies.
Based on the previous explanation of how joint cartilage is nourished, the absolute most important treatment is exercise-therapy. As mentioned joint movement is sometimes so painful that training is not possible and, in these cases, it would make sense that the doctor prescribed some analgesic and anti-inflammatory medications.
Other medications that may be prescribed are:
Steroids that are a powerful anti-inflammatory drug.
Injections of corticosteroids or hyaluronic acid in the knee.
If the primary reason for the osteoarthritis is overweight, it would of course make sense that the patient experienced a weight loss. Even a small weight reduction can significantly reduce knee pain from the osteoarthritis.
Glucosamine and Chondroitin with MSM (methylsulfonylmethane) are also used by many. It has been found that animals have a significant effect, while studies on knee meniscus have not shown any effect. The reason is thought to be the fact that animals produce C vitamins themselves, while people need to get it through diet. Therefore, it is recommended that if you take Glucosamine and Chondroitin with MSM, you should also take at least 1000 mg. vitamin C. Vitamin C is important for building connective tissue.
Therapeutically, one can use:
Class 4 laser (possibly K laser)
Re5 magnetic resonance therapy.
Acupuncture.
Massage (to increase blood flow in the area).
Some patients may be offered an artificial knee, which will make sense if all other options are exhausted or do not seem to work.
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