Knee Osteoarthritis: Is it a Lifetime Sentence for Pain?

by Dr. Troy Vander Molen, Doctor of Physical Therapy

Tell me if this story sounds familiar.December Newsletter Picture

For years you’ve been healthy and active. You prided yourself on your strong work ethic and ability to get things done. You have loved going on adventures and seeing the world. Nothing could stop you from doing what you set your mind to. For years, you’ve enjoyed a dynamic, energized lifestyle.

Then you began to experience knee pain. At first, you could ignore it. It would come and go. Sometimes you limped a bit, but most of the time you could hide it.

Eventually, it became too common, too significant. So, you broke down and scheduled an appointment with your doctor. X-rays confirmed what you feared: You have degenerative knee osteoarthritis.

Your medical provider probably told you that this is a “wear and tear” phenomenon, that your cartilage has worn away. For too many years, the pressure you’ve exerted on your knees with every step resulted in cumulative trauma that has left you with less cushion in your knee joint, and now each step is painful. You may have to change your lifestyle.

I have a confession to make. I used to counsel people in this way too. I used to tell people that knee osteoarthritis is a mechanical wear and tear process. Then, I’d tell them that there’s good news. If you exercise, it can get better.

Sometimes people responded to my message with a look of relief. All too often, though, they would give me a skeptical look.

Looking back, I can appreciate why someone would be skeptical with my mixed message. If knee osteoarthritis is a wear and tear process, why in the world would you want me to exercise more? Won’t that do more harm?

As time has gone by, I’m happy to report that we know more about knee osteoarthritis, and the newest research is a great cause for hope. The good news is that our old theories about knee osteoarthritis were wrong. If osteoarthritis is a wear and tear phenomenon, why is osteoarthritis of the knee and hip found to be less common in runners?

Osteoarthritis does involve thinning or loss of cartilage on the ends of your bones at the articular cartilage. But it turns out that in people that develop knee arthritis without prior injuries, knee osteoarthritis is actually a biological inflammatory process, not a mechanical process.

You see, in our joints we have hundreds of biological markers that are made by the lining of the knee joint. In a healthy state, the chemicals that are created actually support cartilage health and nutrition.

But, in an unhealthy state – whether it’s due to injury, metabolism, weight, or diet – the knee joint changes in ways that are similar to what we see in other chronic disease states. The unfriendly chemicals produced in the diseased state are hostile to the health of our cartilage, and over time the presence of those unhealth chemicals eventually cause injury to the articular cartilage cells. And then the cartilage is not equipped to handle physical stress.

Osteoarthritis is actually a low-grade chronic inflammation, the same type of inflammation that causes Type 2 diabetes, heart disease, fatty liver, and other metabolic diseases.

So, what are we to do about it? Here are seven things we can do to combat knee osteoarthritis:

  1. Stay active. Walking, playing tennis, and most weightbearing activities are extremely healthy, and you should continue them as long as the pain is mild. Engaging in these activities with mild pain will not shorten the lifespan of your knee. In fact, it’s quite the opposite. If you maintain or gain strength, flexibility, and endurance, you will delay or eliminate the need for more aggressive medical interventions.
  1. Forget about what your x-ray looked like and the awful words often contained in the x-ray report. Isn’t it funny how we refer to changes to the joint using the scary term degenerative joint disease, but we never refer to wrinkles as degenerative skin disease! Changes to our joints over time are as normal as developing wrinkles on our skins. Most people that do not experience knee pain would have evidence of arthritic changes if their knees were scanned. The presence of arthritis is not closely correlated with knee pain, which means that you can feel and function exceptionally well even if you have been told you have knee arthritis.
  1. Perform strengthening activities. Research shows that weakness of thigh muscles is associated with a higher incidence of knee pain. Strengthening exercises (as well as other forms of exercise) have been shown to have significant anti-inflammatory effects. In fact, exercise will have a positive impact on your entire body, not just your knees. And, strengthening improves your stability, balance, and proprioception, which will decrease your injury rate.
  1. Commit to doing aerobic exercise. Doing activities that increase your heart rate will stimulate the production of your natural anti-inflammatory chemicals, which reduces joint pain.
  1. Work on your balance. The trauma caused by a fall from catching your toes on the carpet can create a painful arthritic joint experience. Usually these balance issues are the result of a combination of things: loss of muscle mass, delayed neurological input from our limbs, and potentially inner ear changes. All of these things can be strengthened with appropriate balance training, just like an arm curl makes our biceps muscle stronger.
  1. Learn more about the impact of diet and metabolism. Did you know that only 12% of Americans are considered metabolically healthy? You can’t out-exercise a bad diet. In addition to a large variety of metabolic disorders – heart disease, diabetes, fatty liver disease, and dementia to name a few – your metabolic health affects your risk of developing osteoarthritis. Processed foods and sugar are not our friends, and processed foods are way too common in America. Consider consulting with a licensed dietician to learn more about joint healthy food choices to reduce your knee pain.
  1. Be positive. A positive attitude will help you get through challenging experiences. Remember, you are in control of your knee pain. There are many things that you can do to feel better and function better. Find people with whom you can surround yourself to stay positive and commit to an active approach to eliminating the pain of knee osteoarthritis.

Don’t get me wrong. The pain you experience in your knee due to osteoarthritis is real. The cartilage in the knee itself does not have nerve endings, so it will not hurt in and of itself. But the issues we’ve discussed above can create changes to the thin tissue that wraps around your bone (periosteum), the lining of the joint (synovium), or the bone itself, and all of those structures have lots of nerve endings that can cause pain.

If you do have pain because of these issues, it will often calm down after a few weeks or months, especially if you take a positive, active approach using the strategies outlined above. If you are looking for guidance on how to reduce knee pain as quickly as possible, contact us to pursue a course of physical therapy at any one of our clinic locations (Pella, Des Moines, Oskaloosa, Newton, Ames, Centerville, or Waukee) by calling 866-588-0230.