The importance of addressing Knee Health in treating knee OA
Osteoarthritis (OA) is a degenerative process involving the break down of cartilage at a joint leading to pain, swelling and loss of function. The prevalence of knee OA has doubled in the last 50 years and is a major burden on health care services around the world. As a result researchers and health organisations are constantly looking at the best ways to manage this condition. Clinical practice currently suggests that treatments should be directed away from structural/mechanical models which are based on restoring the knee structure and instead should be directed more towards addressing the health of the knee. Understanding that OA is more than just tissue breakdown and that if treatments can control the inflammatory process and tissue sensitivity associated with OA, that there will be an improvement in knee function, pain levels and patient quality of life.
Cartilage is not related to pain
Historically treatments have been structurally and mechanically based, directed towards restoring the lost cartilage either through different types of injections or supplements. However we know that the breakdown of cartilage is not correlated to knee pain and therefore focusing treatment on restoring cartilage will not necessarily make the knee feel or function any better.
So why doesn’t my exercise routine work?
Since I qualified as a physiotherapist back in the early 2000s exercise has been one of the first line treatments for the condition with focus on restoring range of motion and improving muscle strength. Studies have shown that it can effectively reduce pain and improve function and when you add this to the extensive list of health benefits that are associated with exercise it is not surprising that it is the first port of call. However even with exercise we need to ensure that it is being directed at improving knee health rather than purely strengthening the knee or replenishing articular structures. Exercise alone is not a sufficient intervention. It needs to be incorporated into addressing knee health and failure to do this is a major reason why prescribed exercise routines sometimes do not work.
How do we incorporate an exercise program into a knee health model?
The exercise program itself is not the initial priority. When treating a symptomatic OA knee the clinician is not trying to purely restore muscle strength but instead is addressing a complex inflammatory process being driven and influenced by many factors and comorbidities. Addressing these is the first step and once the patient has a good understanding of this and the clinician has an understanding of the goals and beliefs of the patient then a suitable exercise program can be prescribed. As a result the exercises are specific to each patient rather than a generic ‘recipe book’ style program. They can be pilates based, gym based, yoga based, home based, water based or any combination of different exercises, what ever works for the patient and is suitable for their knee and their general health at that point. It is therefore beneficial that when starting a program aimed at helping an OA knee that the individual seeks guidance from a trained health practitioner, such as a Physiotherapist, to ensure that the program fits a ‘knee health model’ rather than purely focusing on structural deficits. Unfortunately in some cases knee replacement surgeries are still required but even post surgery following this model will ensure the best rehabilitation.