Knee osteoarthritis (OA), also known as degenerative joint disease of the knee, is typically the result of wear and tear and progressive loss of articular cartilage. It is most common in the elderly. Knee osteoarthritis can be divided into two types, primary and secondary. Primary osteoarthritis is articular degeneration without any apparent underlying reason. Secondary osteoarthritis is the consequence of either an abnormal concentration of force across the joint as with posttraumatic causes or abnormal articular cartilage, such as rheumatoid arthritis (RA).
Osteoarthritis of knee is divided in 4 stages:
Grade 1: Very minor bone spur growth and is not experiencing any pain or discomfort.
Grade 2: This is the stage where people will experience symptoms for the first time. They will have pain after a long day of walking and will sense a greater stiffness in the joint. It is a mild stage of the condition, but X-rays will already reveal greater bone spur growth. The cartilage will likely remain at a healthy size.
Grade 3: Moderate OA. Frequent pain during movement, joint stiffness will also be more present, especially after sitting for long periods and in the morning. The cartilage between the bones shows obvious damage, and the space between the bones is getting smaller.
Grade 4: This is the most severe stage of OA. The joint space between the bones will be dramatically reduced, the cartilage will almost be completely gone and the synovial fluid will be decreased. This stage is normally associated with high levels pain and discomfort during walking or moving the joint.
Osteoarthritis knee management: I. Conservative management: The primary treatment for OA knee conservatively is through exercises and physiotherapy.
Exercise therapy
Activity modification
Advice on weight management: BMI around 25.
Knee bracing: in obvious cases of varus or valgus deformity
Pharmacological management:
Topical non-steroidal anti-inflammatory drug (NSAID) for knee osteoarthritis.
Consider oral NSAID (Ibuprofen/Naproxen) if topical medicines are ineffective or unsuitable along with gastroprotective treatment.
Consider intra-articular corticosteroid injections for short-term relief when other pharmacological treatments are ineffective or unsuitable or to support therapeutic exercise.
Note: Long term anti-inflammatory and pain medication dependency is not advised, an appropriate rehab plan needs short term medication input. As medications do not heal/reverse the degenerative changes in side the knee joint.
Routine warmup/stretches
Phase 1: 1-4 weeks
Focus is on open chain exercises to strengthening: quadricpes, hamstrings, glutes and calf muscles.
Note: In the first 4 weeks of exercise plan, people experience muscle soreness, it is perfectly natural as the muscles adapt to the new movements and exercise load. Consider applying ice to the muscles to reduce the muscle soreness.
Phase 2: 4-8 weeks
Note: Consider applying ice to the muscles to reduce the muscle soreness and accelerate recovery.
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