Osteoarthritis is one of the most common forms of Arthritis. It currently affects millions of people across the globe.
It can cause widespread pain and dysfunction and can disrupt lives.
In this article, I will take you through the best and most up-to-date evidence-based advice to help you cope with your knee osteoarthritis. Where possible you should do all that you can to manage your knee osteoarthritis without surgery.
As a clinical specialist physiotherapist, I treat people with knee osteoarthritis every day. My goal is to always do this conservatively without referral to Orthopaedic Surgeons for surgical evaluation if at all possible.
What I have noticed having treated thousands of people over a long career is that successful management cases need a multimodal approach. But first, let’s define osteoarthritis.
What is Osteoarthritis?
Our bones in the joints are covered by a protective, cushioning layer called articular cartilage. It provides the integrity for the joints, such as our knees, to move smoothly and provide a shock-absorbing layer.
With Osteoarthritis, the cartilage starts to wear. This can lead to pain, joint stiffness and swelling. When this happens it becomes difficult to move the joint and complete many of the daily activities we enjoy doing.
We now know that other factors contribute to worsening the condition.
OA is not just the wearing of our cartilage but is also affected by our metabolic health and internal levels of inflammation.
Our blood pressure, blood sugar levels, triglycerides, excess fat around our middle and cholesterol are our metabolic markers. When the levels of these markers rise to increased levels they can lead to an increase in your risk of heart disease, stroke and diabetes. Crucially we now understand that these can play a role in the development of osteoarthritis.
Recent research has shown that people with Metabolic Syndrome have a worse progression of osteoarthritis.
Osteoarthritis cannot be reversed and if left untreated it will worsen. In this article, I will set out the treatment options available to you and hopefully in the process show that it requires a multi-modal approach to achieve the best outcome.
Metabolic Syndrome and Osteoarthritis
When people have excess weight around their stomachs, there is a physical increase in demand on the body’s weight-bearing joints such as the knees. We know that for every pound of weight that we carry, there is a corresponding increase in demand of 4 times through the knees and hips.
So if you are 10 pounds overweight, you potentially have an increase of 40 pounds of load through your knee. This can lead to increased wearing of the articular cartilage, worsening your Osteoarthritis.
The research has also shown an increase in Osteoarthritis for those who are carrying excess weight around their stomachs in the non-weight-bearing joints of the body such as the wrists and fingers. This is not a load-bearing issue here so what is the link?
The link is chronic inflammation.
Obesity is associated with chronic inflammation in the body. I’m not talking about the type of inflammation that occurs when you sustain an injury, but the inflammation that occurs when fat tissue metabolises releasing chemicals which lead to low-grade inflammation. This type of chronic inflammatory response can invade our joints and lead to advancing Osteoarthritis.
On another level obesity can also interfere with our bodies’ capacity to repair and remodel cartilage and in some cases may lead to breaking it down.
This chronic cycle of metabolic dysregulation and systemic inflammation can in turn lead to more inflammation and more demand on the articular cartilage.
When we have a diet high in sugar this can lead to further inflammatory-producing chemicals leading to worsening Osteoarthritis symptoms. This can happen with a diet rich in saturated fats. High levels of fat in the bloodstream lead to increased knee pain and osteoarthritis.
Surely it can’t be as simple as losing weight to lessen the effect of Osteoarthritis?
Non-surgical treatment option 1: Address your Metabolic Factors
The research is very clear that if you are overweight and then lose weight, you will reduce the inflammatory chemicals in your body. You will also reduce the effects of the compounds that break down our cartilage and reduce the physical demands on our joints. A 10% reduction in body weight will have a significant impact on your knee pain and knee health as well as conveying a whole host of metabolic positive factors.
Reduce your weight by 10% and you will significantly reduce knee pain and the effects of Osteoarthritis
Lifestyle factors are very important and can make a huge difference when addressed appropriately. By doing so we can reduce the mechanical stress on the knees and decrease the causes of chronic systemic inflammation.
The biggest way we can address these issues is through our diet.
There are foods which are pro-inflammatory and should be limited in our diet. Foods such as processed and fried foods.
Try to reduce the intake of sugary foods too. Instead, we should be trying to eat more fruits and vegetables such as berries, citrus fruits, cauliflower, broccoli, cabbage and leafy greens. For the majority of our meals, we should be choosing lean protein sources such as chicken and fish as well as nuts, seeds and legumes.
We should also consume healthy fats like those derived from olive oil, fatty fish and avocados.
All of these foods would be classified as an Arthritis Friendly Diet and would lessen the potential for inflammatory build-up systemically.
Studies have shown that by eating this way we can limit the effects of arthritis significantly. This is also a way of eating that would promote the maintenance of a healthy weight.
Non-surgical Treatment Option 2: Exercise
Exercise can result in reduced pain and dysfunction and is my number one recommendation for overcoming pain and dysfunction and halting the effects of knee osteoarthritis.
I recommend performing cardiovascular exercises such as walking, cycling or swimming.
Aim for around 30 minutes every day. Cardiovascular exercise is best combined with strength training for the best outcome.
By maintaining good leg muscle and gluteal strength we can reduce our pain and improve function. Weaker leg muscles have been shown to worsen the effects of osteoarthritis.
Doing basic strength training such as:
- Straight leg raises
- Partial Squats
- Glute Bridges
- Wall Sits
- Standing Hip Extensions
You can read my article on three of the exercises that saved my knee from surgery for an explanation of how to complete three of the above exercises.
3 Exercises that Saved my Knee from Surgery
Non-surgical Treatment Option 3: Medication
Paracetamol
This is often prescribed as a front-line medication for the pain associated with osteoarthritis. For most people, it is a relatively safe short-term option. For those suffering from liver disease, paracetamol may be contra-indicated. Before starting any medication, you should always consult your doctor.
Non-steroidal anti-inflammatories (NSAIDs)
Again these can be effective in the short-term management of pain but they have much greater risks if taken long-term. They are routinely prescribed by doctors in the UK and form part of the National Institute for Health and Care Excellence (NICE) recommendations for the early management of Osteoarthritis.
They can cause issues with the heart, kidney or stomach and should only be viewed as an option to reduce pain to enable more conservative therapies such as exercise to be undertaken.
Topical Ibuprofen such as gels rubbed into the skin is a safer alternative and avoids many of the side effects of taking NSAIDs orally.
Opioids
I see people who have been prescribed and are using opioids to try to manage their knee pain. The evidence is quite clear that they provide limited benefit or relief from Osteoarthritis symptoms – you can read the paper here.
There are much better and safer options for managing the symptoms of knee osteoarthritis. However, when pain is severe and when considered for short-term relief only, doctors may prescribe a short course.
Supplementation
Many supplements are reported to help with the symptoms of knee Osteoarthritis.
Here is the low down on the most popular ones:
- Glucosamine 1500mg and Condroitin 800-1200mg. Although these are not actively recommended by many doctors, there is some evidence to support their use as a supplement to help with the conservative management of knee osteoarthritis.
- Turmeric and Curcumin 1000mg. Good evidence to support their use as a natural anti-inflammatory
- Omega 3. > 1000mg Little evidence to support it’s use as a way of treating arthritis pain. However, there is better evidence to support its use when taken as a joint health supplement.
- Boswellia Serrata. 100mg. Mixed evidence with strong support from some medics who believe that the supplement is a must for those struggling with Osteoarthritis pain and stiffness.
- Collagen. No evidence to support it’s use for managing Osteoarthritis symptoms.
- Vitamin D. Small levels of support from the evidence for its use.
- Green-lipped Mussel Extract. 200-400mg. This is an interesting option with some evidence suggesting that it can help with pain management in the short to medium term.
When considering starting a supplement for the first time, you should always seek the advice of your doctor or pharmacist as some supplements can interact adversely with other medications.
Supplementation should not be used in isolation for managing your knee osteoarthritis and should only be considered when used as part of a multimodal approach.
Non-surgical treatment option 4: Heat and Ice
The Arthritis Foundation recommends the use of heat and ice for the conservative management of arthritis symptoms read the article here.
They suggest that heat can help to lubricate and loosen stiff and painful joints whereas ice can help with inflammation and swelling. Although the evidence does not necessarily support this claim you can read my article on icing here.
I advise my patient to use heat to help with improving lubrication and therefore pain of arthritic knees. I also advise my patients to use Ice as a way of managing pain.
Non-Surgical Treatment Option 5: Alternative Therapies
The Versus Arthritis website has a great list of all the alternative therapies that might be considered for managing Osteoarthritis symptoms. Versus Arthritis.
I have a lot of patients who like to use options such as massage, reflexology, acupuncture or magnet therapy. Although I use acupuncture as a treatment option for some of my patients in very specific circumstances, I do not recommend alternative therapy as a front-line management technique for arthritis.
Non-Surgical Treatment Option 6: Injection Therapy
Popular injection options for knee Osteoarthritis include:
- Corticosteroid
- Hyaluronic
- PRP
What is the best conservative management protocol for Knee Osteoarthritis?
Conservative Treatments for Knee Arthritis
| Knee Arthritis Treatment | Short Term Benefits | Long Term Benefits | Structural Changes | Risk of Knee Replacement | Risk of Major Side Effects |
|---|---|---|---|---|---|
| Exercise Therapy | Mild | High | Yes | None | None |
| Load Management | Mild | High | Yes | None | None |
| Topical NSAID’s | Mild | None | None | None | None |
| Paracetomol | Mild | None | None | None | Low |
| NSAID’s | Mild | None | None | None | Low |
| Opiates | Mild | None | None | None | High |
| Heat and Ice | Mild | None | None | None | None |
| Supplementation | Mild | Mild | None | None | None |
| Alternative Therapies | Mild | None | None | None | None |
| Steroid Injection | Mild | None | None | Increased Risk | Low |
| Hyaluronic Injection | Moderate | Mild | Mild Changes | None | Low |
| PRP Injection | Moderate | Mild | Mild Changes | None | None |
The above table summarises the conservative treatment options for Knee Osteoarthritis.
When used in isolation they can be effective but the evidence supports a multimodal approach for the very best outcomes.
As the table shows the best long term outcomes and the strategies for avoiding total knee replacement, is to incorporate exercise therapy alongside load management and activity modification whilst addressing any other metabolic factors present.
I’ve been fortunate to have helped many patients manage their arthritis and avoid joint replacement surgery.
The people who do the very best are the people who make a distinct change to their lifestyle. If we do the same things every day and expect change to happen then we are fooling ourselves.
Managing Knee Osteoarthritis requires a dedicated change to:
- Eat better
- Maintain adequate hydration
- Lose weight if you need to
- Manage activities so as not to overload the joint
- Get stronger
- Exercise to improve cardiovascular function
Alongside this the use of medication and pain management strategies such as heat or ice to help us through the times when Osteoarthritic pain flairs.
People who embrace these wholesale changes see the biggest results. But you can start small.
Daunted by the idea of eating differently or losing weight? Start slowly making small changes to your diet and incorporating a small daily walk every day. These changes alone will make a massive difference.
I’ve seen many people achieve remarkable things when taking my advice and I know that you can too.
Good luck!
