3 Mistakes with Knee Osteoarthritis (OA)
- You tend to want to do less when you get a sore knee. You don’t want to go upstairs. You don’t want to go for that run. You don’t want to walk. It’s harder to bend down.
- We get overmedicalized. What does that mean? you go and get an x-ray and a doctor or someone says to you… “It’s bone on bone” or your cartilage is worn out contributes to point number one. If you hear something like that you’re more likely to do less.
- We need to go through the guided and graded exercise for at least 8 to 12 weeks. Sometimes when we get over medicalized we start to do less then we get a bit nervous about our knees. We don’t go through rehab and quite quickly we can end up seeing specialists, surgeons, and getting surgery.
So, if you’ve got a sore knee, if you’ve got that diagnosis of KNEE OA, read this blog below.
What You Need To Know
There is a huge body of ‘new’ evidence around Knee OA. This means that the advice you have previously received may now be old news. Firstly, Knee OA is a radiological finding. This means it is something that is reported on X-rays and MRIs. The reason I mention this is the distinction that it is not a description of your symptoms or pain.
This chart shows us that people who have never reported knee pain also have these findings when we image their knee. Thus showing that Knee OA is a radiological finding – not a symptom set nor is it a prognosis of how your knees will be for the rest of your life.
This chart shows courtesy of Adam Meakins, The Sports Physio, shows us that most knee degernation changes on the knee also occur in people with no pain.
Therefore we can conclude that the findings on your scan are “like wrinkles on your skin, a sign of time and age, but they are not painful, rather normal.”
Another great research finding to add here is that runners don’t have more knee OA than the general population and experience less knee pain. This shows us that loading the knee constantly is actually what keeps it strong and healthy.
‘Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative – Lo et al. (2018)’
- ‘Abnormal findings’ on your scan are not the reason you have knee pain.
- Many people who have ‘abnormal’ findings on their scan have never had knee pain.
- ‘Abnormal findings’ on your scan are like wrinkles on your skin, a sign of time not damage.
- Consistently loading your knee with activities like weights or running actually produces healthier knees.
Well Why Am I In Pain?
The simple answer is this. Your recent activities have exceeded the load tolerance of what your knees can handle. In other words, your knees and the environment around them aren’t strong enough to handle the load you are putting through them.
We know there are several factors and it’s not just one thing;
- Sleep and Diet can affect the pain you experience in your knees.
- Physical loading – how much you do – can affect the pain in your knees.
- Your weight can affect the pain in your knees. Some studies have shown weight loss can reduce pain by up to 50%.
- The strength and robustness of your knees also play a huge roll.
I know you want one simple answer, but the truth is, anyone who gives you that is lying. We need to consider all the factors above. The simplest place to start however is a guided and graded knee strengthening program.
When we strengthen your knees we increase their ability, and their buffer to handle the load you put through them throughout the day. This makes them much less likely to experience pain. In fact, we have seen huge research out of Denmark that 12 weeks of exercise, reduces both pain and symptom progression. This is known as the G: LAD program and is guided and graded exercises for 12 weeks.
What Usually Happens in Knee OA Cases
We like to call this the ‘over-medicalisation’ of imaging findings. You get pain in your knee. You get a scan. The doctor or radiologists report back to you that you have ‘meniscus degeneration’ or ‘knee OA’ – you see a specialist… and sometimes it can lead to unnecessary injections and surgeries.
Side note here is the best evidence we have shows no difference in outcomes between surgery and physio at 24 months. So why would you get surgery?
Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial (2018).
Secondly, because of those imaging findings and poor information passed on to you – we tend to do less and start to protect the knees… this leads to less robust and strong knees and further reduces the capacity of your knees to get through day-to-day life without knee pain.
What Not To Do
Research shows us that for meniscus and OA findings on imaging surgery is no greater than Placebo and that Physiotherapy and weight loss are very effective in reducing symptoms and pain.
- Knee ‘Clean Ups’ is no better than a placebo.
- Injections are just short-term relief but don’t fix the actual problem.
- Don’t get discouraged when your knees have a flare-up – you need to be exercising and getting flare-ups is a normal part of getting your knees stronger.
- Glucosamine and Chondroitin tablets have very limited and poor evidence.
Okay, So What Should I Do
The best evidence we have for Knee OA is this;
- Seek advice and education from a health professional who understands the modern research findings about knee OA.
- Bring your scans but they are likely to not be correlating to your pain at all.
- Guided and graded exercises for 12 weeks is the absolute minimum you need to do to know if you will have a great outcome without further intervention.
- Strength work and eventually simple weights is key!
- Consider your sleep, your weight loss and your diet. These 3 combined will all help each other and your knee pain.
