Brief overview of the condition
Osteoarthritis (OA) is the most common form of arthritis in the knee. Other forms include Rheumatoid, Psoriatic and Gout. Although it can occur at any age, osteoarthritis is a degenerative, "wear-and-tear" type of arthritis that occurs most often in people 50 years and older, although it may occur in younger people, too.
In the simplest terms, with osteoarthritis the cartilage in the knee joint gradually wears away. As this cartilage wears away, it becomes frayed and rough, decreasing the protective space between the bones. This can result in bone rubbing on bone and produce painful bone spurs.
Possible Symptoms
A knee joint affected by arthritis may be painful and inflamed. Generally, the pain develops gradually and worsens over time, although sudden onset is also possible.
The most common symptoms are:
As the joint may become stiff and swollen, it becomes difficult to bend and straighten the knee.
Pain and swelling may be worse in the morning, or after sitting or resting.
Vigorous activity may cause pain to flare up.
The knee may "lock," "stick" or “make noise” during movement.
Pain may cause a feeling of weakness or buckling of the knee.
X-rays of an arthritic knee may show a narrowing of the joint space, changes in the bone and the formation of bone spurs (osteophytes).
Types of Treatment
Treatment of OA may consist of medication, injections, activity modification, over-the-counter analgesic creams and/or physical therapy. Typically recommended as a last resort, surgical intervention may be needed when other less invasive options have been exhausted. The patient's quality of life and ability to do everything they enjoy is the primary reason for a surgical consultation.
With the numerous treatment options available for arthritis, it can be EXTREMELY overwhelming. It is, therefore, important to have an advocate on your healthcare team – someone skilled and able to help you manage your complaints. This can be a primary care physician, orthopedic physician, nurse practitioner or physician’s assistant. A knowledgeable physical therapist experienced in all areas of non-surgical and surgical orthopedic management of OA can also advocate for you.
Nonsurgical Treatment
Goal: To have you doing what you love for as long and with as little discomfort as possible.
Activity Modification: Some changes in your daily life can protect your knee joint and slow the progress of arthritis. Losing weight, modifying activity, adjusting exercise programming and changing diet can all directly impact your knee's health.
Physical Therapy: Specific exercises can help increase range of motion and flexibility while simultaneously strengthen your leg muscles. PTs are movement specialists. They can identify the restrictions on your knee that may be holding you back.
Medications: Several types of drugs are useful in treating arthritis of the knee. Because people respond differently to medications, your doctor is the best resource for these types of interventions.
Injections: From reducing pain and inflammation with cortisone to gel shots that can help “plug” any holes or smooth the rough parts of joint surfaces, injections are a popular treatment option. However, people respond differently, at various stages of OA, your doctor is in the best position to determine what is available for you.
Surgical Treatment
Your doctor may recommend surgery if your pain from arthritis causes disability and is not relieved with nonsurgical treatment. As with all surgeries, there are some risks and possible complications with different knee procedures. Your doctor will discuss these potential issue and any other concerns with you before the operation.
Following surgery, you will need physical therapy. It is important to recognize that not all physical therapy is the same and physical therapists have varying levels of expertise. It makes sense to work with a PT experienced in this area of rehabilitation as well as total knee replacement (TKR) treatment.
In closing, an experienced advocate in the care of osteoarthritis of the knee is important for appropriate management. There have been so many advances in medicine and treatment of arthritis in adults – the amount of information is endless. As experienced physical therapists, we are trained to evaluate the knee and determine what the restrictions are and how to handle them. Often a few simple exercises can mitigate the pain and get you back on track.
Of note: New Jersey is a direct access state for physical therapy, which means you do not have to see a physician in order for us to evaluate your knee or any other condition treatable by a PT.