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Knee osteoarthritis (OA) is a common degenerative condition that affects the cartilage within the knee joint. As the cartilage wears down over time, the bones of the knee joint begin to rub against each other, causing pain, stiffness, and decreased mobility. Knee OA is particularly prevalent in older adults but can also develop due to injury or overuse. This condition can significantly impact daily activities, such as walking, climbing stairs, and standing, and is a leading cause of disability in Australia.

The GLA® (Good Life with osteoArthritis: Denmark) program has been highly successful in managing knee OA. It combines exercise and education to help reduce symptoms, improve function, and delay the need for joint surgery. The program has been widely adopted in Australia, showing promising results in helping patients regain mobility and quality of life.

Signs & Symptoms

Knee osteoarthritis symptoms often develop gradually but can worsen over time. Common signs and symptoms include:

  • Knee pain: Pain is typically felt in the knee joint, especially during weight-bearing activities like walking or standing. The pain often worsens after prolonged activity or at the end of the day.
  • Stiffness: Morning stiffness or stiffness after sitting for long periods is common. This can make it difficult to start moving, though the stiffness usually improves with mild activity.
  • Swelling: Fluid can accumulate in the joint, leading to swelling and inflammation. Swelling may worsen with prolonged activity or standing.
  • Reduced range of motion: As the condition progresses, bending or straightening the knee fully can become difficult, limiting everyday movements like getting up from a chair or climbing stairs.
  • Crunching or grinding sensations: The sensation of bone rubbing against bone may cause a grating sound (crepitus) when moving the knee.
  • Muscle weakness: The muscles around the knee, especially the quadriceps, may weaken over time due to decreased activity and ongoing pain.

These symptoms can be intermittent, with flare-ups causing increased discomfort and stiffness. Over time, they may become more constant and debilitating.

Causes and Contributing Factors

The development of knee osteoarthritis is influenced by several factors:

  • Age: Knee OA is more common in people over 50, as joint tissues naturally degenerate with age.
  • Previous injuries: A history of knee injuries, such as fractures, meniscus tears, or ligament damage, can predispose individuals to osteoarthritis later in life.
  • Obesity: Excess weight places additional stress on the knee joint, increasing the wear and tear on the cartilage. Weight management is a critical factor in reducing knee OA risk.
  • Genetics: A family history of osteoarthritis can increase the likelihood of developing the condition.
  • Gender: Women, particularly after menopause, are more prone to knee OA due to hormonal changes and differences in joint structure.
  • Overuse and repetitive stress: People with jobs or activities that involve repetitive knee movements or heavy lifting may be at greater risk of developing knee OA.

Grading

Knee osteoarthritis is typically assessed using imaging, such as X-rays, which can reveal the extent of joint damage. The Kellgren-Lawrence grading scale is a common tool used to classify the severity of OA:

  • Grade 0: No signs of osteoarthritis.
  • Grade 1: Doubtful joint space narrowing and possible bone spurs (osteophytes).
  • Grade 2: Definite bone spurs and possible narrowing of the joint space.
  • Grade 3: Multiple bone spurs, clear joint space narrowing, and possible deformities in the bones.
  • Grade 4: Large bone spurs, severe joint space narrowing, and definite deformity in the joint.

These grades help guide treatment decisions, with higher grades indicating more advanced OA.

Prognosis

Knee osteoarthritis is a progressive condition, meaning symptoms tend to worsen over time. However, the rate of progression varies among individuals. While OA cannot be cured, early intervention can slow its progression and improve quality of life. Participation in structured exercise and education programs, such as GLA®, has been shown to significantly reduce pain and improve joint function. Many individuals can manage their symptoms effectively with conservative treatments, allowing them to maintain an active lifestyle.

In more severe cases, surgical intervention such as knee replacement may eventually be necessary. However, with appropriate management, many people are able to delay or avoid surgery altogether.

Treatment

Treatment for knee osteoarthritis focuses on symptom relief, improving joint function, and enhancing overall quality of life. Both conservative treatments and medical interventions can be effective, with a strong emphasis on physiotherapy.

Physiotherapy and Rehabilitation

Physiotherapy plays a critical role in managing knee OA. The GLA® program, widely implemented in Australia, has demonstrated that a combination of supervised exercise and education can significantly reduce symptoms and improve physical function. Key physiotherapy interventions include:

  • Exercise therapy: Regular exercise helps strengthen the muscles surrounding the knee, improving joint stability and reducing pain. The GLA® program focuses on neuromuscular exercises that target strength, balance, and movement control. These exercises are tailored to each individual’s needs and abilities, making them a safe and effective option for people with knee OA.
  • Manual therapy: Techniques such as joint mobilisation, soft tissue massage, and stretching can help reduce pain, improve range of motion, and enhance overall joint function.
  • Hydrotherapy: Exercising in water provides a low-impact environment that reduces the strain on the knees while still allowing for strength and flexibility training. This is particularly beneficial for people who experience pain with weight-bearing activities.
  • Assistive devices: Physiotherapists may recommend braces, orthotics, or walking aids to offload pressure from the knee joint, allowing for more comfortable movement.

Your treating Physiotherapist will work closely with you to create an individualised program based on your symptoms and goals.

Other Treatments

  • Weight management: Maintaining a healthy weight is one of the most effective ways to reduce stress on the knee joint, slowing the progression of OA and alleviating symptoms.
  • Pain management: Medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can help control pain and reduce inflammation. However, these should be used with caution, especially in long-term management, due to potential side effects.
  • Injections: Corticosteroid injections can provide short-term relief by reducing inflammation within the knee joint. Another option is hyaluronic acid injections, which aim to improve joint lubrication, though the effectiveness varies among individuals.
  • Surgery: For advanced cases where conservative treatments are no longer effective, surgical options may be considered. Total knee replacement (arthroplasty) is the most common procedure for end-stage knee OA and is highly successful in relieving pain and restoring function.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional for advice on managing knee osteoarthritis or any other medical condition.

References:

  1. Dantas, L. O., Salvini, T. F., & McAlindon, T. E. (2021). Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian journal of physical therapy, 25(2), 135–146. https://doi.org/10.1016/j.bjpt.2020.08.004
  2. Skou, S. T., & Roos, E. M. (2019). “Good Life with osteoArthritis in Denmark” (GLA): Evidence-based education and supervised neuromuscular exercise improve pain, function, and quality of life in patients with mild to severe osteoarthritis. British Journal of Sports Medicine, 53(13), 746-750.
  3. Skou, S.T. et al. (2018) ‘Physical activity and exercise therapy benefit more than just symptoms and impairments in people with hip and knee osteoarthritis’, Journal of Orthopaedic & Sports Physical Therapy, 48(6), pp. 439–447. doi:10.2519/jospt.2018.7877.