“Your knee joint is bone on bone” or “you have the knees of someone twice your age”. This is usually followed by an explanation of how all that “wear and tear” is finally catching up to you. Sound familiar? I’m sure many of you have heard these phrases before. Some of you may have even had them said to you. These can be scary thoughts to have to ponder. You may be left wondering what, if anything other than surgery can be of benefit to you? Read on and I’ll try and shed some light on this often misinformed subject.
First off, knee osteoarthritis is actually quite common with some studies showing up to 10% of the population being affected. Secondly, clinical signs of OA are even more common. These markers identified on radiographs (x-rays) include osteophytes (bone spurs), cartilage damage, joint space narrowing, subchondral cysts, etc. However, these signs often do not actually correlate with the individual’s symptoms. In fact, knee OA features are present in nearly half (43%) of healthy and asymptomatic individuals! When put another way, that means that only 1/2 of people with clinical signs of OA actually complain of symptoms.
Now let’s say you are one of the 50% of people with clinical signs of OA and are experiencing symptoms. What hope do you have given all the “wear and tear” your knee has undergone has led to “bone on bone”? The good news is knee OA is much more than just a physical process. Sure it involves certain biological processes such as inflammation and muscle weakness, but it also has a number of other influencers. These include psychological factors including lack of confidence, emotional stress and/or a depressed mood. Other lifestyle components such as poor sleep, lack of physical activity or obesity also play a large role in an individual’s pain experience.
The fact that knee OA is not just a structural issue, but involves multiple processes needs to be remembered when interventions are sought out. This is where a focus only on the physical side of OA and the myth that the joint is “bone on bone” becomes problematic. This misconception leads many people to disregard exercise-based interventions due to a belief that it will not change structure and also that it may further damage their joint. Surprisingly patients are not alone in this incorrect belief. The common misconceptions surrounding OA also leads to many health professionals referring their patients for surgical consults. In fact, GPs are 3x more likely to refer their patients for surgical opinion, than to pursue nonsurgical management!
So we’ve determined that knee OA is a multifaceted process and that findings on imaging do not correlate with symptoms. Now what? If surgery it not necessarily always required, what option(s) are there? The answer is actually relatively straight forward. Education about knee health, progressive exercise therapy, regular physical activity, weight loss if indicated and reassurance that not only is exercise and knee strengthening safe, but it is extremely beneficial. In fact exercise has been shown to reduce pain by 30% in individuals with moderate to severe OA. Furthermore, those same individuals that participated in a targeted exercise program improved to such an extent that 3 out of 4 people decided to not have their knee joint replaced!
If you’re one of many people dealing with a stiff and sore knee, or if you’ve had knee issues in the past and have been told that your joint is “bone on bone” feel confident there is still hope. Visit a physiotherapist and have your knee examined and talk about your options. An individualized, progressive exercise program, lifestyle modification options, self-management strategies and more will be provided to you. And the great news is, the research says that it will more than likely be of great benefit to you!
For more information or to schedule a consult contact REP Physio at one of our two Edmonton locations:
REP Physio Summerside: 780-395-9170
REP Physio Westbrook: 780-244-1095
References available on request.