How to Cope with Osteoarthritis and the Knee
Arthritis or degenerative joint disease is so common I am sure we all know someone or of someone who suffers from arthritis. There are over 100 different forms of arthritis. The most common form is osteoarthritis. But other forms of arthritis include: Anklosing spondylitis, gout, juvenile arthritis, Paget’s disease, Psoriatic arthritis and rheumatoid disease.
Today’s article is about osteoarthritis, and more specifically osteoarthritis of the knee. We are going to cover basic knee anatomy, pathophysiology of osteoarthritis and what forms of exercise with specific reference to strength training will benefit someone suffering from osteoarthritis.
Basic Knee Anatomy:
The knee is a joint which has three parts. The thigh bone (femur) meets the large shin bone (tibia) forming the main knee joint. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third joint, called the patellofemoral joint.
The knee is an example of “diathrotic” joint, and is classed as a hinge joint. These are moveable joints that contain synovial fluid and are enclosed by joint capsules. The joint capsule consists of ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (anterior and posterior cruciate ligaments). These ligaments provide stability and strength to the knee joint.
The bones do not actually come in contact with one another. Articular cartilage caps the articular surface of each bone. Synovial fluid circuilates through the joint during movement. Both of these help to minimize friction as well as cushion the articulating bones. Ligaments help to bind the joint and tough, fibrous menisci are located within the joint and act as cushions as well as to guide the articulating bone.
The knee joint is surrounded by fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons.
Pathophysiology of Osteoarthritis:
Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a “cushion” between the bones of the joints
Primary osteoarthritis is mostly related to aging. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints.
The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint.
Some of the symptoms of osteoarthritis of the knee are:
- pain when moving the knee
- grating or catching when moving the knee
- pain when walking up and down stairs or getting up from a chair
- pain that prevents exercise
- weakened leg muscles (quadriceps)
There are various treatment modalities for osteoarthritis from physical therapy to medication therapies. But, for the purpose of this article, we are going to discuss exercise, it’s necessity and specifically strength training and suggested exercise protocols.
Goal of an Exercise Program:
The goal of any exercise program is to develop mobility, stability and strength in all muscles and joints. With arthritis the goal is to:
- reduce stress to the affected joint/joints
- increase muscle strength to deload the joints affected
- decrease presence of pain
- maintain joint mobility
- maintain a quality of life
With osteoarthritis of the knee, you want to avoid any exercise/movement that causes stress to the joint. High impact movements such as jogging, running, plyometric exercises need to be avoided. All exercises need to be within a pain free range of motion. Stationary bike or swimming or great for conditioning purposes.
So, just what should a person with osteoarthritis of the knee do? Ultimately pain will be the guide. You must work within a pain free zone at all times. Range of motion for any squats or split squats need to be limited to what can be performed without pain. For some, these two exercises may be contraindicated entirely.
The beginning of any workout should begin with soft tissue work. Foam rolling for the quadriceps, adductors and glutes needs to be done daily.
Mobility exercises must be included for ankles, hips and thoracic spine.
Exercises for the posterior chain (glutes, hamstrings, spinal erectors, extensors) should be the mainstay of any strength program. Romanian deadlifts, single leg romanian deadlifts and kettlebell swings are safe to include.
Limited range of motion squats, split squats and wall sits should be included to increase quadricep strength which in turn will help to support and deload the knee.
Core stability and strength should also be included using planks, side planks, bridges, superman (or birddogs) as well as Pallof Press are excellent examples of great core building exercises.
It is possible and necessary to keep the muscles strong that support the knee. However, choose the exercise carefully or enlist the services of a fitness professional to help design a safe program that will protect the knee while providing stability and strength.
Till next time,
Source: Concepts of Human Anatomy and Physiology, Van DeGraaff & Fox,