Knee osteoarthritis – a common joint disease
One of the most common diseases of the knee joint is osteoarthritis (also called joint cartilage wear). The symptoms develop slowly and pain can torment you for years or decades. Because this is a degenerative condition, hospitals cannot do much for you. However, your doctor may recommend home physiotherapy devices. Heat therapy, TENS treatment, microcurrent, therapeutic ultrasond, magnetic therapy and softlaser treatment can help in different stages of osteoarthritis and in different ways.
The knee joint is formed by your femur and tibia, held together by ligaments and a joint capsule. The ends of the bones are covered by articular cartilage, and the joint space contains a lubricating substance. The stability of the joint, however, depends on the muscles of the leg, especially the thigh muscles. As long as the muscles are strong, there is adequate distance between the bones of the joint, allowing the bone surfaces to glide smoothly over each other during movement.
If the strength of the leg muscles decreases (due to lack of movement, overweight, surgery or illness, etc.), the bones are pressed together, and the cartilages slowly become damaged – first inflammation occurs, then the cartilages thin, their surface cracks, fragments and eventually is resorbed.
This is osteoarthritis.
When this happens, the two bones of your joint touch each other. Bone contacts bone directly.
This, on the one hand, hinders movement because the surfaces no longer glide easily. On the other hand, it damages the bone. Thirdly, it causes significant pain.
The balance between cartilage breakdown and synthesis is disturbed and breakdown proceeds faster than repair.
Forms of osteoarthritis
Primary osteoarthritis occurs more frequently in women and generally develops after the age of 45. Its cause is unknown.
Secondary osteoarthritis can occur at any age and is caused by another disease, condition or predisposing factor. Examples include…
- diabetes, rheumatoid arthritis or gout
- overloading of the joints (work or sport that stresses the joint, overweight)
- conditions remaining after accidents (loss of muscle strength) or certain occupational hazards (vibration)
- congenital developmental abnormalities such as hip dislocation or joint laxity
- long-term lack of movement (absolute decrease of muscle strength) or obesity (relative decrease of muscle strength). Even a few kilos of excess weight increase the risk!
II – The joint space is narrowed. The cartilage surface covering the joint begins to fragment. A few bone spurs are present.
III – The joint space is moderately narrowed. The cartilage surface is fragmented and bone is visible in places. Bone spurs increase.
IV – The joint space is almost gone, cartilage volume is reduced by more than 60%. Large bone spurs at the joint rim.
Symptoms of osteoarthritis
Knee osteoarthritis (joint cartilage wear) usually develops slowly over years; however, there are signs worth paying attention to. The main symptoms of osteoarthritis are:
- joint pain during movement
- a feeling of joint stiffness (so-called "start-up pain" when movement after rest is accompanied by pain)
- change in the shape of the joint, deformity
- limited joint mobility, reduced range of motion
Prevention of knee osteoarthritis
If appropriate treatment is not started after the onset of knee pain, cartilage wear can rapidly worsen and may even progress to inability to walk. Pain allows less movement, which further weakens the thigh muscles and reduces joint stability. You will be able to do less movement and that with increasing pain.
Treatment usually involves medication, but these do not have a meaningful effect on the process because they do not treat the cause, only aim to eliminate symptoms. Not to mention that most osteoarthritis drugs cause side effects when taken long-term.
Often small things, such as replacing poorly supportive shoes or correcting foot arch deformity with an insole, can work wonders. If you wear out your shoes unevenly, it indicates that your weight is loading in the wrong place. This small postural error can cause huge damage over the years, so do not underestimate it.
Regular exercise is extremely important for your joints. Maintaining the absolute and relative strength of your leg and especially thigh muscles is fundamentally important to spare the knee. If you are overweight and your knee hurts, that is an obvious sign that your knee cannot bear the load. Reduce your weight before it's too late.
If pain already limits your movement, use a muscle stimulator. In a few weeks you can strengthen the thigh muscles enough that your pain will disappear and you can move more.
Treatment of knee osteoarthritis
If you ignored my advice and missed these opportunities, then symptom control may become your goal because there is currently no way to replace worn cartilage. Joint replacement (prosthesis) is usually recommended in advanced stages – but until then you will have to struggle with pain for a long time.
Home physiotherapy treatments aim to avoid frequent visits to doctors or clinics. Nevertheless, directing the treatment and judging when and how much to treat is your doctor's responsibility.
TENS treatment uses electrical impulses to block the transmission of pain signals to the brain, so after the treatment you may be free of pain for many hours. TENS treatment has no curative effect, so it provides only relief, not improvement.
Because osteoarthritis can torment you for a long time, buy a TENS device that has a MODULATED TENS program. This prevents habituation, unlike older TENS devices. The Dolito or Myolito devices are suitable for this.
Microcurrent treatment has a stronger pain-relieving effect, but it can do "more". Especially in the early stages of osteoarthritis. Microcurrent has regenerative effects, so if started in time it can support regeneration and slow cartilage destruction. Microcurrent devices are considerably more expensive than simple TENS devices.
Muscle stimulation is also worth using in this case. Strengthening the leg muscles reduces symptoms because strong muscles keep the bones apart and they are less compressed against each other, which reduces pain during movement.
Therapeutic ultrasond can help in the early, inflammatory stage of osteoarthritis. It has no role in regenerating already worn cartilage.
PEMF (pulsed electromagnetic field) therapy can also be used to treat osteoarthritis. It improves blood circulation and oxygen supply around the joint and stimulates regenerative processes.
Softlaser has a similar effect, however more and more evidence and experience are accumulating regarding high-dose joint treatment. Delivering 20–50 Joules/session of electromagnetic energy into the joint space stimulates cartilage regeneration. Devices suitable for such treatment include the Personal-Laser L400 and the Energy-Laser L500 Pro devices.
My recommendation
Take knee pain very seriously! Start treatment at the first warning signs, because then improvement or even complete recovery is still possible. If you let the cartilage surfaces wear away, there is little or no way back.
