Knee osteoarthritis (OA) is one of the most common causes of chronic knee pain, particularly in individuals over the age of 50. As a degenerative joint disease, it primarily affects the cartilage—the cushioning tissue at the ends of bones—leading to pain, stiffness, and reduced function. While the progression of OA can vary from person to person, early and effective physiotherapy management plays a crucial role in maintaining mobility, managing symptoms, and enhancing quality of life.
What is Knee Osteoarthritis?
Osteoarthritis is a type of arthritis caused by wear and tear of joint cartilage. In the knee joint, this degeneration leads to a narrowing of the joint space, formation of bone spurs (osteophytes), inflammation of surrounding tissues, and sometimes, fluid accumulation in the joint.
Knee OA often develops gradually and may affect one or both knees. It is more likely to occur in individuals with certain risk factors, such as:
- Ageing (typically over 45-50 years)
- Obesity
- Previous knee injuries
- Repetitive stress on the knees (due to occupation or sports)
- Genetics
- Joint deformities or misalignment
Common Symptoms
The hallmark symptoms of knee osteoarthritis include:
- Pain that worsens with activity and improves with rest
- Stiffness, especially in the morning or after periods of inactivity
- Swelling or tenderness around the knee
- Reduced range of motion
- Grinding or cracking sound during movement
- Weakness or instability in the knee
These symptoms can range from mild to severe. They may progressively impact daily activities like walking, climbing stairs, and even sitting or standing for long periods.
Diagnosis of Knee OA
A diagnosis is typically based on a combination of medical history, physical examination, and imaging tests such as:
- X-rays to show joint space narrowing, bone changes, and osteophytes
- MRI in select cases to assess soft tissue and cartilage
- Functional assessments by physiotherapists to evaluate movement and strength
Early detection is important to delay or prevent further degeneration and maintain functional ability.
Physiotherapy: A Cornerstone of Management
While there is no cure for osteoarthritis, physiotherapy is a highly effective non-surgical treatment that can help control symptoms, slow disease progression, and improve quality of life.
Goals of Physiotherapy in Knee OA:
- Reduce pain and inflammation
- Improve joint mobility and flexibility
- Strengthen muscles supporting the knee
- Enhance balance and proprioception
- Support weight management and lifestyle changes
- Prevent disability and maintain independence
Let’s look into the key physiotherapy interventions:
1. Exercise Therapy
Regular, structured exercise is the foundation of physiotherapy management for knee OA. It helps reduce stiffness, improve joint nutrition, and strengthen the muscles around the knee—especially the quadriceps, hamstrings, and glutes.
Types of Exercises:
- Strengthening Exercises: Focus on lower limb muscles to reduce the load on the knee joint.
- Range of Motion (ROM) Exercises: Gentle movements to maintain or improve flexibility.
- Aerobic Conditioning: Low-impact activities like walking, cycling, or swimming enhance cardiovascular fitness and support weight control.
- Balance and Proprioception Training: Improves joint stability and reduces the risk of falls.
Example:
Simple exercises like straight leg raise, wall squats and heel slides can be easily done at home under physiotherapist guidance.
2. Manual Therapy
Hands-on techniques such as joint mobilizations, soft tissue massage, and myofascial release may be used to:
- Improve joint mobility
- Reduce muscle tightness and spasms
- Decrease pain sensitivity
These are typically combined with exercise therapy to achieve better outcomes.
3. Modalities for Pain Relief
Physiotherapists often use adjunct modalities to manage pain and inflammation, such as:
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Heat Therapy
- Cold Therapy
These modalities are helpful in the short term and may enhance participation in active rehab.
4. Gait and Posture Correction
Abnormal walking patterns and posture can contribute to increased stress on the knees. A physiotherapist can assess and correct issues such as:
- Limping or altered gait
- Overpronation (flat feet)
- Hip or pelvic misalignment
Orthotics, braces, or walking aids (like canes) may also be recommended to offload the joint and improve mobility.
5. Education and Lifestyle Advice
Empowering patients with knowledge is a vital part of physiotherapy. Patients are educated on the following:
- Joint protection techniques
- Proper body mechanics during daily activities
- Weight loss strategies if overweight
- Importance of pacing activities and taking breaks
A customized home exercise plan ensures patients stay active outside clinical settings.
6. Hydrotherapy (Aquatic Therapy)
Exercising in water reduces joint stress due to buoyancy, making it ideal for people with significant pain or obesity. Water-based exercises help in:
- Building strength with less joint load
- Improving flexibility and cardiovascular fitness
- Enhancing psychological well-being
Surgical Options and When Physiotherapy Is Not Enough
In advanced stages of OA, where joint damage is severe and conservative treatments are no longer effective, surgical options like total knee replacement may be considered. However, pre-and post-operative physiotherapy significantly influences recovery outcomes:
- Prehabilitation helps improve strength and range of motion before surgery
- Rehabilitation aids in restoring function and mobility after the operation
Final Thoughts
Knee osteoarthritis doesn’t have to mean the end of an active life. With early diagnosis and a well-designed physiotherapy program, many individuals can manage their symptoms effectively and maintain independence for years.
It’s important to consult a qualified physiotherapist who can tailor a program based on your specific condition, needs, and lifestyle. With consistency and the proper support, you can reduce pain, improve mobility, and return to doing what you love.
Stay moving, stay strong!
If you’re experiencing persistent knee pain, don’t wait—early intervention is key to a healthier, more active future.