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Overview

What is Osteoarthritis?

Osteoarthritis is a condition that affects the joints, causing pain and stiffness.  It is the most common form of joint disease, and knee is one of the most commonly affected joints.

Symptoms of Osteoarthritis

You can experience these if you have osteoarthritis :-

  • Pain
  • Stiffness
  • Grating or grinding sensation when the joint moves (crepitus)
  • Swelling (either hard or soft)
  • Sometimes your knee may lock or give way when you put weight on it.

 

Who gets it?

Almost anyone can get osteoarthritis, but it’s most likely if :

  • you are in your late 40s or older
  • you are overweight
  • you are a woman
  • your parents, brothers or sisters have had osteoarthritis.
  • you’ve previously had a severe knee injury.
  • your joints have been damaged by another disease.

Self - help measures - What to do to help yourself?

There are several ways you can help yourself, including :

  • losing weight if you are overweight.
  • exercising regularly (both muscle strengthening and general aerobic exercise).
  •  reduce stress on the affected joint (for example using a walking stick or a walker, as shown in the picture.
  • using pain – killers or anti – inflammatory creams, gels and tablets.
  • Change in lifestyle, to reduce weight on the affected knee.

What are the treatment options?

If you still have pain after trying self – help measures, your doctor may recommend the following treatments :

  • capsaicin cream
  • stronger painkillers, for example tramadol.
  • Injections into the joints
  • Surgery, including joint replacement.

How does a normal joint work?

A joint is where two or more bones meet.  The joint allows the bones to move freely but within certain limits.  

The Knee Joint

The knee is the largest joint in the body and also one of the most complicated.

The knee joint needs to be strong enough to take our weight and must lock into position so that we can stand upright.

It also should move when we walk and must be able to bear the stress when we twist or turn.

Know you knee joint!

  • Bones – Thigh bone and shin bone.  Thigh bone is called as the femur.  The shin bone is called as the tibia.
  • Sliding surface covering the bones – The smooth slippery surface that allows the ends of the bones to move against each other almost without friction.  This is called the cartilage.
  • Shock absorbers – To spread the load evenly across the joint.  These shock absorbers are called menisci.
  • Bands for support – Thick, strong bands to support the joint structure and hold it in place.  These bands are called as ligaments.
  • Bands for muscle attachment – Your muscles are attached to your bones by strong connecting tissues called tendons.  These tendons run on both the sides of the joint and help them keep in place.  When you contract the muscles or do any movement, they help the bones and joint move.

Figure – Knee joint explained in simple language

What is Osteoarthritis?

Osteoarthritis is a disease that affects your joints.

The surfaces within your joint become damaged so the joint does not move/glide as smoothly as it should.

The gliding surface/cartilage covering the bones gradually roughens and becomes thin.

The bone under the cartilage reacts by becoming thicker and broader.

The body tries to repair the damage, so all the other parts of the joint become more active than normal.

The changes that you may notice are :-

  • There may be growth of bony spurs from your thigh bone, shin bone or kneecap.
  • The joint coverings may swell and produce effusion/water on the knee.
  • The bands that support the joint become thick to try to stabilise the joint.  This makes the joint stiff.
  • The damage to the joints also leads to pain.
changes in the knee joint in mild osteoarthritis

Picture showing knee joint with mild osteoarthritis.

Symptoms of Osteoarthritis

  • Pain – Worse with movement, better with rest.  You may have pain all around your knee or just in a particular  place, most likely at the front and sides, or after a particular movement, like climbing the stairs.

You may have some good and some bad days.

  • Stiffness
  • Swelling around the knee joint.
  • Creak or crunch when you move.
  • In severe osteoarthritis, your knee may bend and bow.
  • The joint may give way, either because the muscles have become weak or the joint structure has become less stable.
  • Swelling behind the knee – Fluid collection in a small pouch may feel like a lump or swelling behind the knee.  Your doctor may call it as a ‘Baker’s cyst/popliteal cyst’

What causes osteoarthritis?

  • Age – Usually starts in late 40s.  This may be due to wearing of the joints with age and weak muscles in old age.
  • Gender – Twice as common in women as in men.
  • Obesity – Being overweight is an important factor in causing osteoarthritis.
  • Joint injury – Very hard or physically demanding jobs increase the risk of osteoarthritis.
Myth - Exercise leads to osteoarthritis.
  • Exercise – Normal activity and exercise don’t cause osteoarthritis.
Myth - It may spread to other joints.
  • Osteoarthritis does not spread to other joints like an infection or bug does.  But pain in one joint can lead to uneven loading of the other joints and excess damage of those joints leading to osteoarthritis of those joints.

How will you know if you have Osteoarthritis?

  • Symptoms of osteoarthritis.
  • Blood tests – there are NO blood tests to diagnose osteoarthritis, however, your doctor may suggest some blood tests to rule out other types of arthritis.
  • X – ray of the knee joint – to assess damage in joint.
  • MRI Scan of knee joint – to assess damage of parts of the joint, not seen on X – ray.

Help yourself

Reduce strain on your knees

  • Pace your activities through the day – don’t tackle all the physical jobs at once. Break the harder jobs up into chunks and do something more gentle in between. Keep using your knee, but rest it when it becomes painful.
  • Wear low – heeled shoes with soft, thick soles (trainers are ideal).  Some patients find pain relief with shock – absorbing shoe inserts.
  • Use a walking stick or walker for support.
  • Use the handrail for support when going up or down stairs. Go up stairs one at a time with your good leg first.
  • Don’t keep your knee still in a bent position for too long as this may
    eventually affect the muscles.
  • Learn to relax your muscles and get the tension out of your body.  Applying warmth to a painful knee often relieves the pain and stiffness of osteoarthritis.

To reduce pain, following can help :-

  • Heat lamps are popular, but a hot fomentation bag or a reheatable pad are just as effective.  This can be helpful when you have pain after excess work.
  • An ice pack may also help.  Don’t apply ice/heat packs or hot – water bottles directly to your skin.
  • Knee braces – More evidence to support the use of knee braces for osteoarthritis is becoming available.
  • Massaging oil – Many patients find this helpful.  It may help relax the muscles.
  • Complementary medicines like Glucosamine and chondroitin tablets – Many different complementary medicines are available and people do feel better when they use them.  However, there’s no conclusive evidence that they’re effective.
    1. Glucosamine and chondroitin tablets contain compounds that are normally present in joint cartilage and some studies suggest taking them may improve the health of damaged cartilage or supporting bands.
    2. You’ll need to take 1.5gm of glucosamine sulphate a day, possibly for several weeks before you may say if they are making any difference.
    3. Glucosamine hydrochloride doesn’t seem to be effective according to our clinical experience, so check that you’re taking the sulphate.
    4. Most brands of glucosamine are made from shellfish.  If you’re allergic to shellfish, make sure you take a vegetarian alternative.
    5. Precautions – These medicines should not be taken in pregnancy and when breast-feeding.  They may increase the blood sugar levels, watch out if you have diabetes.  You should see your doctor for regular blood checks if you are taking the blood – thinning medicines, like warfarin.

Daily Life with Osteoarthritis

  • Sleep – If pain is a problem, heat may help. Try a hot bath before going to bed, or use a hot – water bottle, wheat bag (which you can heat in a microwave) or electric blanket.  Placing a pillow between your knees can also help to ease pain.
  • Dealing with stress – Living with a long – term condition like osteoarthritis can lower your morale and may affect your sleep.  It’s important to tackle problems like these as they could lead to depression and will certainly make the osteoarthritis more difficult to cope with. 

Exercises :

1. Straight leg – raise (sitting) : Get into the habit of doing this every time you sit down. Sit well back in the chair with a good posture. Straighten one leg, hold for a slow count to 10 and then slowly lower your leg. Repeat this at least 10 times with each leg.  If you find you can do this easily, straighten and raise one leg, before holding for a count of 10. As you improve, try the exercise with light weights on your ankles and with your toes pointing towards you.

Shows how to do the straight leg raising exercise in sitting position
  1. Straight leg – raise exercise (sitting)

2. Straight leg – raise (lying) :  Get into the habit of doing this in the morning and at night while lying in bed.  Bend one leg at the knee.  Hold your other leg straight and lift your foot just off the bed.  Hold for a slow count of five, then lower.  Repeat five times with each leg every morning and evening.

Shows how to do straight leg raise exercise in lying position

2. Straight leg – raise exercise (lying)

3. Muscle stretch :  Do this atleast once a day when lying down.  Place a rolled – up towel under the ankle of the leg to be exercised.  Bend the other leg at the knee.  Use the muscles of your straight leg to push the back of your knee firmly towards the bed or the floor.  Hold for a slow count of five.  Repeat atleast five times with each leg.  This exercise helps to strengthen your quaadriceps and prevents your knee from becoming permanently bent.

shows how to do muscle stretch exercise in lying position for osteoarthritis of knee

3. Muscle stretch exercise

4. Leg stretch :  Sit on the floor with your legs stretched out in front.  Keeping your foot to the floor, slowly bend one knee until you feel it being comfortably stretched.  Hold for five seconds.  Straigthen your leg as far as you can and hold for five seconds.  Repeat 10 times with each leg.  If you can’t get down to the floor, sit on a sofa and use a board or tea tray as a surface to slide your foot along.

Shows how to do leg stretch exercise for osteoarthritis of knee

4. Leg stretch exercise

5. Step ups :  Step onto the bottom step of stairs with your right foot.  Bring up your left foot, then step down with your right foot, followed by your left foot.  Repeat with each leg until you get short of breath.  Hold on to the bannister if necessary.  As you improve, try to increase the number of steps you can do in one minute and the height of the step.

5. Step – ups exercise

6. Knee squats :  Hold onto a chair or work surface for support.  Squat down till it is comfortable.  Return to standing.  Repeat atleast 10 times.  As you improve, try to squat a little further.  Don’t bend your knees beyond a right angle.

Knee squats exercise

6. Knee squats

7. Leg cross :  Sit on the edge of the table or bed.  Cross your ankles over.  Push your front leg backwards and back leg forwards against each other until our thigh muscles become tense.  Hold for 10 seconds, then relax.  Switch legs and repeat.  Do four sets with each leg.

Leg cross exercise for osteoarthritis of knee

7. Leg Cross

8. Sitting and standing exercise: Sit on a chair.  Without using your hands for support, stand up and then sit back down.  Make sure each movement is slow and controlled.  Repeat for one minute.  If the chair is too low, start with rising from a cushion on the seat and remove when you  don’t need it any more.  As you improve, try to increase the number of sits/stands you can do in one minute and try the exercise from lower chairs or the bottom two steps of a staircase.

sitting on a chair and standing without support

8. Sitting and standing exercise

Keeping active

  • It is important to keep active – you should try to do the exercises that are suitable for you every day. Try to repeat each exercise 5 – 10 times and perform the exercises 2 – 3 times each day.
  • Start by exercising gradually and build up over time.

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