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Knee Osteoarthritis (OA)

Knee Osteoarthritis is the most common knee problem. It is diagnosed during a physical assessment and usually does not need imaging to confirm diagnosis.

Causes and symptoms

In osteoarthritis, over time the protective cartilage on the ends of your bones can become thinner, causing pain, swelling and problems moving the joint. It can be experienced as pain at the front or either side of the knee usually when walking. It can often affect both knees. It can make walking on inclines and stairs difficult. In some cases, it may also be associated with the knee giving way, locking or making creaking sounds. Being overweight and a history of injury are risk factors.

Self-management

Continue to stay as active as possible.

The most effective self-management strategies are:

Exercise– strengthening the surrounding muscles helps to protect the joint, reduce pain and improve overall function.
Weight Management– being overweight or obese directly impacts the pain experienced with knee OA and makes everyday activities more difficult.

Exercises

Experiencing some discomfort can be normal when exercising with arthritis. This should not be excessive, allowing you to breathe normally and shouldn’t affect how you walk later or tomorrow.

Aerobic exercise (eg. walking, cycling, rowing and water-based exercise), yoga and Tai Chi are all safe and effective for managing pain and improving function. Build up slowly with the eventual aim of more than 150minutes weekly at a pace you can maintain a conversation.

As a starting point to dedicated strengthening, try the following exercises x3days/week. Once you feel this is quite easy, try and increase how many repetitions you can do gradually over time.

Static Quads

In sitting or lying with your leg straight. Push your heel away and bring your toes towards your shin. Contract the muscles on the front of your thigh, firmly. Hold this for 5-10secs. Repeat 10 times. Either recover for 1min or repeat on the opposite knee. Complete 3 rounds (sets) in a session.

Knee Extension

In lying with a soft object underneath your knee. Push your heel away and bring your toes towards your shin. Extend your knee straight whilst pushing the back of your knee down. Hold for 5-10secs. Repeat 10 times. Either recover for 1min or repeat on the opposite knee. Complete 3 rounds (sets) in a session.

Alternatively, you can sit in chair with the back of your knee at the edge of the seat and follow the instructions above.

To advance this exercise you may want to add a small ankle weight.

Straight leg raise

In lying, with one leg straight and the other bent. Push your heel away and bring your toes towards your shin on the straight leg. Then slowly lift the leg to approximately 45 degrees, pause and lower. Repeat 10times. Either recover for 1min or repeat on the opposite knee. Complete three rounds (sets) in a session.

Static hamstring

Sitting or lying. Bend one knee to approximately 90degrees. Lift your toes so only the heel is touching. Dig your heel into the ground as if you were trying to bend the knee. Hold this pressure for 5-10secs. Repeat 10 times. Either recover for 1min or repeat on the opposite knee. Complete 3 rounds (sets) in a session.

Sit-to-stand or Squat

Using a seat initially. Begin by bringing your bottom forward in the seat. Keeping your feet and knees hip width apart, slide your feet underneath as far as you can whilst still keeping your heels on the ground. Tilt your upper body forward. Use your arms if required and push through your legs to stand up tall. Slowly lower yourself back into the seat. Repeat 5-10 times initially. Recover for 1-2mins. Complete 3 rounds (sets) in a session.

Once you find this easy, you can repeat this movement without the chair. You may want to use a countertop for some balance support and only go to a depth you are comfortable with.

Step-up

Start with one foot on a step. Shift your weight forward onto the foot. Tilt your upper body forward slightly. Push through your front leg to stand tall on the step. Allow the knee to bend and slowly lower. Either repeat, keeping this foot on the box or alternate legs. Repeat 5-10 times initially. Recover for 1-2mins. Complete 3 rounds (sets) in a session. Initially, support your hands on a countertop or bannister and gradually reduce use of hands over time.

Heel raise

Begin standing with hands supported on a countertop or back of chair. Feet hip width apart. Raise your heels off the floor as high as you are able. Repeat 10-15times initially. Recover for 1-2mins. Complete 3 rounds (sets) in a session. Reduce use of hands gradually over time.

What’s next?

Your GP may prescribe medication (usually topical or oral NSAIDS) to manage the pain. Further tests – such as x-rays or blood tests – are not usually necessary, but may be used to rule out other possible causes of pain.

If you have tried the above advice and feel you need a physio to give you more tailored guidance, you can self-refer or seek referral via your GP. Surgery is often not required but your physio or GP will be able to direct you if you have significant issues.

If your knee pain is long standing and you have already consulted your doctor or physiotherapist, it is worth considering the other factors which contribute to your pain experience.

Further information about persistent pain