Osteoarthritis of the Knee

There are lots of different types of arthritis that can affect people. The following information will focus on osteoarthritis, which is the most common type of arthritis.

What is osteoarthritis of the knee?

Osteoarthritis in general is often misunderstood and as a result there are a lot of mistruths and myths about it.

In simple terms, it is best to consider osteoarthritis as the aging process of your joints. If you look in the mirror, you may find that you do not look like you did when you were 18 years old. You may have a few more wrinkles and a few more grey hairs than back then and these are generally accepted by most people as the outward signs of aging. Your joints undergo an aging process and you are exactly the same age on the inside as you are on the outside, therefore, it isn’t realistic to expect your joints to look like they did when you were 18 either! Perhaps thinking about osteoarthritis as the grey hair and wrinkles of your knees may help you understand it better.

Why have I heard it described as ‘wear and tear’?

As with many other things, sometimes when certain words or phrases are used to describe something, they stick. Unfortunately, the term ‘wear and tear’ is used very regularly to describe osteoarthritis and it is not very helpful. Nothing in your knee is ‘worn’ or ‘torn’, therefore the phrase can be misleading as it suggests that osteoarthritis is damage to the knee.

Does it really matter what you call it?

We really think it does. Words are incredibly important as they help us understand what might be going on in our knee and what we are dealing with. If you have been told that you have osteoarthritis and that it's something you need to be concerned about, then it is only human to find yourself worrying about it. If things are explained correctly and words, phrases and images are used appropriately, you are likely to understand the issue better and be in a better frame of mind to do something about it.

Scrabble letters spelling out 'Words have power'.

What are the common symptoms of osteoarthritis of the knee?

This is a really important question and it is useful for you to know what is normal for a knee that may have osteoarthritis. We’ve broken the answer down into things that are found most commonly:

Osteoarthritis can cause pain but equally so, sometimes doesn’t cause any pain at all. In most cases where the knee is sore, the discomfort will stay around the knee, but sometimes in can travel into your shin or up your thigh. This is called ‘referred pain’ which in other words means that the pain is travelling away from the knee. Pain when standing on your knee (walking/standing still) is very common.

In some cases of knee osteoarthritis, the knee may feel stiff. It is often reported that stiffness is most common first thing in the morning and after any period of resting. Usually, the stiffness doesn’t last longer than 30 minutes.

This is normally as a result of one or both of the things mentioned above i.e. pain and stiffness. In a lot of cases, an osteoarthritic knee will be most uncomfortable when you put weight on it and if walking, you may find that your knee will get tired more quickly.

As part of your body trying to help deal with the changes occurring in your knee as it ages, you may find that it looks different. In some cases, osteoarthritic knees will be bigger and may have a lean either inwards or outwards. This is best thought of as your body trying to keep your knee working as it deals with the ‘grey hair and wrinkles’ of time.

Clicks, pops, clunks and grinds are very normal in all joints and in the vast majority of cases is nothing to worry about. People often find themselves worrying that they are ‘wearing the knee out’ because of the noises it makes. This is simply not the case and your knees, along with all of your joints, are strong, robust and designed to last you a lifetime. Noises are often gas bubbles popping in the joint or friction between the moving surfaces. Noises from an osteoarthritic knee are normal and not to be worried about.

Although not a common feature of osteoarthritis, sometimes an osteoarthritic knee will either look or will actually be swollen. In most cases this is normal and is due to your knee being irritated, or perhaps the loss of muscle size giving the appearance of a swollen knee. Generally, swelling of the knee is nothing to worry about.

How is osteoarthritis diagnosed?

In most cases, osteoarthritis can be suspected or diagnosed through the clinical features (what it looks like and how it behaves), your symptoms (what you tell us about your knee) and the clinical assessment (testing the movements etc.). An X-ray of the knee is often used to help diagnose osteoarthritis but is not always required.

Why are X-rays/scans not always required?

In a lot of cases, the information we as healthcare professionals can get from asking you questions and testing the knee is enough to make a decision. X-rays are a very useful tool as they show you what your knee looks like on the inside. however, in some cases what your knee looks like on the inside doesn’t really marry up with what your problem might be.

There is growing evidence (experiments and clinical studies) that demonstrate what you see is not always what you get with X-rays and scans, and that a lot of the so-called ‘worn out’ or ‘abnormal’ findings are seen commonly in people with no pain, stiffness or symptoms.

In a large study of over 700 people, Geurmazi et al. (2012) demonstrated that most of the common ‘problems’ found in knee scans/imaging are seen as much, and sometimes more, in people WITHOUT any pain, stiffness or symptoms as those with symptoms.

X-ray of a partial knee replacement with front and side view of the knee bones.

What causes osteoarthritis of the knee?

This is a difficult question and the simplest answer is that it is complicated. As we’ve explained in the last question, what you see is not always what you get, and just because an X-ray says you’ve got osteoarthritis of the knee, doesn’t mean you’ll actually have any problems.

There are many factors that will influence the development of osteoarthritis including increased weight, low activity levels, previous injury, diet, genetics and negative beliefs. It is unlikely that just one of these factors will cause osteoarthritis, however, they may influence whether a person experiences symptoms or not.

What can I do to help myself?

Reassuringly, there are lots of things that you can do to help get your knee going and start your rehabilitation.

The following points have been written from the NICE guidelines (2014) – Osteoarthritis: care and management.

Taking time to read and digest the information above will hopefully help you understand that osteoarthritis isn’t something that should be feared, that it’s safe to be sore and that you can do something about it. Understanding the problem is halfway to dealing with it.

Exercise, including strengthening exercise (working against something like a weight, gravity or exercise bands) is considered one of the key treatments for osteoarthritis.

Exercise comes in many shapes and forms and there is no ‘best’ exercise. Often it is best to think of the most effective exercise as the one you enjoy and will actually do. Current recommendations on exercise and how often we should be looking to do it can be found here: Understanding Exercise

Exercise, even lifting weights or attending a gym, is safe for your joints. Bricca et al. (2019) looked at a number of other experiments on exercise and the effects on osteoarthritis of the knee. Their findings were that exercise, in whatever shape it takes, is safe and does not harm knees. In fact, they suggested that exercise may even improve the cartilage health alongside other benefits to general physical and mental health.

We have included a series of exercises at the bottom of the page that will be able to help you move forwards with managing your knee complaint.

Some people will choose to manage this pain with pain relief, whilst some may choose to avoid medication. Applying something cold to your knee may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).

Weight loss is recommended as something that is important for the management of most muscle and bone issues. Losing weight is difficult and we understand that.

Often people will think that simply putting more weight through their joints is the reason why they get problems and being closer to their ideal body weight will simply stop their symptoms. Unfortunately, it isn’t that easy. It is worth knowing that fat cells are very active cells and they produce chemicals that can affect pain sensitivity (Tashani et al, 2017).

By looking at diet, exercise, sensible goal setting and establishing a good support network, a weight loss journey is more likely to succeed, and the benefits to your knee are more likely to be influenced by the journey you take to lose weight, rather than being lighter.

If you would like some support to help you with your weight loss journey, please contact our partners at Feel Good Suffolk or Active Norfolk.

Will it get better?

In a lot of cases, it is very much possible for you to improve the symptoms you have with your knee. Obviously, you cannot turn back the clock and the osteoarthritis will still be there even if you feel better but by being stronger, fitter, more confident and closer to your ideal bodyweight, you can start to regain some more control over your knee.

How long will it take before I feel something?

This is a very difficult question, but it is best to think about how much time and effort you are going to throw at the challenge and how confident and motivated you are to do something about it. If you work hard and are consistent with what you do, often people will notice signs of positive response within weeks to months. If you are not committed to the challenge it will take longer or may not respond at all.

Frequently asked questions

Below are some of the common questions that are asked when talking about knee issues that haven’t been covered in the information above.

Q: I don’t have any weights at home, how am I supposed to do the exercises?

A: This doesn’t matter. Most, if not all, of the exercises below can be modified or adapted using heavy bags, bottles of water or even books.

Q: It hurts when I walk, are you sure I should be doing exercise?

A: Yes. As mentioned above, exercise is the best medicine for most things, including sore knees. Think of your knee as being strong and robust but irritated. Starting exercise might cause a bit of irritation but it will not damage your knee. It is safe to be sore.

Q; How many exercises should I be doing?

A: Good question. For strengthening, it doesn’t matter too much as long as you work until your muscles can’t give you anymore. In other words, you exercise until your muscles start to tire. It is worth noting that your muscles will get sore as they tire, but this is okay and it often means you are pushing things as hard as you should.

As a rough guide, we often recommend 8 to 12 repetitions completed 3 to 4 times (i.e. in 3-4 sets). You should complete these sets together (i.e. within a 15-20 minute time frame) rather than spread throughout the day. Try to do this on 3 to 4 days over the week.

Q: Shouldn’t I rest a painful knee?

A: Rest is not evil and can be very useful if you’ve ‘overdone’ it, but rest doesn’t change you for the better and rest will not change your knee for the better.

Q: What happens if I do all of this and it just doesn’t get better?

A: Firstly, ask yourself if you’ve really done everything you can to try and move your knee issue forwards. If the answer is no, consider re-reading the information above and seeking some guidance from your physio.

If you really have worked hard at the above advice and guidance, then some people do find benefit from steroid injections into the knee joint, but it is worthwhile remembering that steroids are drugs and there is always the possibility of side effects and it not working. Injections should not be used to manage your knee pain long-term. You can discuss this option with your GP.

If you still don’t find any benefit from your injection, then you may be referred to the hospital to have a discussion with the Bone and Joint teams about your options.

Movement Exercises

Strengthening Exercises

Need more help? Refer yourself here.

References:

Guermazi A, Niu J, Hayashi D, Roemer FW , Englund M, Neogi T, Aliabadi P, McLennan CE & Felson DT. (2012). Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study. BMJ 2012 Aug 29;345:e5339.doi: 10.1136/bmj.e5339.

Bricca A, Roos EM, Juhl CB, Skou ST, Silva DO, Christian J & Barton CJ. (2019) Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation. BJSM. DOI: 10.1136/bjsports-2019-100727

National Institute for Health Care Excellence (2014). Osteoarthritis: care and management (NICE guideline 177). Available at: https://www.nice.org.uk/guidance/cg177 (accessed 27/10/2020).