Knee Osteoarthritis (OA) has quite the reputation.
It just sounds scary, like Diabetes or Scleroderma, and lots of folks assume that once you have it, it will worsen until you finally cave and opt for that total knee replacement. A lot of this reputation has to do with the words we medical people have used to describe the disease. Bone-on-bone, wear and tear, degeneration. If you had a car that your mechanic called “degenerative”, would you want to drive it? Probably not.
But lots of pain free people have OA.
Did you know that of people over the age of 40 without pain, up to 43% show osteoarthritic changes in their knees on MRI. Think about that - in adults without pain, four out of ten might have OA-looking knees!
This means that you CAN live a meaningful life WITHOUT loads of pain and disability AND have OA!
Knee scans can look this bad..
...and not be painful!
What we used to call “degeneration” or “wear and tear”, is now known as “what happens to our body as we age.”
It’s like wrinkles on your face. Only in your knee. It’s like wrinkles on the inside of your knee. Not a bad thing, it’s just there.
Pain is more about sensitivity than damage.
So, then why do your knees hurt? Structure may be one ingredient to pain, but it definitely isn’t the entire recipe.
It turns out that the things we thought only mattered for general health - sleep, stress, anxiety, depression, work, beliefs, expectations and more - also immensely influence our pain intensity.
Say I have been diagnosed with knee osteoarthritis. My mom had OA and it was really bad, so of course I will assume mine will be too.
A medical person called my knee “bone-on-bone” or “degenerative”, so I stopped using it. Add in the fact that I don’t sleep well and stopped bowling 3x per week or doing my normal gardening - activities that matter to me.
My nervous system adds all of these factors together, combines it with information from the knee and concludes, “Trev, we see a lot of threat here, here is pain to spur you to do something about it!”
Don’t get me wrong, the structure of your knee can contribute to your pain, just less than we originally thought.
Turning down the pain -
Since pain has loads of drivers, there are loads of solutions. Most people find that a successful treatment looks like a sample platter of options as opposed to a 2kg block of just one thing. Based on that,
Here is my Knee-OA To-Do list:
Move your body!
Regular, meaningful physical activity can do heaps for reducing pain and improving your ability to do things. Just do things you like to do! The most important thing to remember is that physical activity and exercise does not damage your knees! In fact, it’s likely protective.
Get enough bed-time.
We health people harp on sleep because it is so radically important. Sleep is when your body recovers and adapts, so if you want to maximize your knees' ability to cope with the demands of the day, you better prioritize your sleep.
Weight control - scales don’t matter, but they can.
Sure, losing weight can take stress off of your knees, and that can be helpful. But when we lose weight our body changes chemically and metabolically in ways that can reduce our overall sensitivity. You don’t even necessarily have to actually lose weight to get the benefits associated with trying to lose weight, it’s the healthy habits that matter.
You can’t go wrong getting strong.
We can’t talk about knee OA and NOT mention getting stronger. Along with increasing activity, improving the strength of your quads, hamstrings and glutes increase your knee’s capacity to handle load, and your overall ability to do things!
Wait to call your surgeon.
Research has found that NOT having knee arthroscopy (surgery) is just as effective as having one. The ideas above are JUST as effective as having surgery, only they cost less, are less invasive, and can result in a ton of other positive health benefits! Going under the knife has its place in extreme circumstances, but it by no means should be your first option.
Making the above changes can be just as effective as invasive medical interventions. But, similar to medicine, it’s extremely important to get the dosage right.
Taking ½ of a panadol isn’t helpful, and taking a whole box is probably harmful. So make sure you find a balance between challenging yourself and overdoing it.
If you would like some guidance on how to get started on your own journey, or have any questions about the things I mentioned please give me a call or book in for an appointment by clicking here:
Take care,
Trevor McCracken
Physiotherapist
NSCA Strength Coach
Jenkins Physiotherapy