Treatment For Osteoarthritis In The Knee
Prevent Crunching Knees By Halting Osteoarthritis TODAY.
The Short Answer –
The lack of stability and weight bearing role of your knees makes them extremely vulnerable to osteoarthritis.
Finding the right treatment for osteoarthritis in the knee is then a matter of symptom management, whilst maintaining as much mobility as possible and strengthening your joint to prevent your condition from progressing.
Finding The Right Solution For You…
The latest understanding around what causes osteoarthritis in the knee, suggest it is not just about overuse (‘wear and tear’), but actually a problem with your entire joint matrix. This means supporting muscles, ligaments and tendons.
In the case of hip osteoarthritis, the surrounding matrix gives it a great deal of strength, but for your knees, this is often a problem.
Your knees perform a unique role that is both extremely versatile but extremely fragile at the same time.
The right treatments need to not only deal with any missing cartilage or associated damage to the knee, but also re-stabilise it to ensure the damage doesn’t continue to worsen (or at least gets worse at a much slower rate).
We can sum up the key goals of treating knee osteoarthritis as being –
- Pain Relief to provide some degree of ‘normal’ life
- Strengthen The Knee ‘Matrix’ (all parts of the joint including muscles, joints and tendons) to slow down the progression of osteoarthritis
- Maintain Or Restore Mobility In Your Knee (to help slow the progress of osteoarthritis and provide support to your knee, therefore getting extra pain relief)
With no actual cure for osteoarthritis in the knee, getting an early diagnosis and starting a treatment plan to halt or control your symptoms is absolutely key.
We’ll review all the various potential treatments below and mark which ones are designed to help pain relief, strengthening or for mobility (or a combination of each)
- Over The Counter Drugs
- Prescribed Medications
Medications are very much one of the traditional ways of dealing with osteoarthritis. However, in recent years the real risks of taking painkillers on a long-term basis have been revealed to everyone. (The Dangers Of Ibuprofen Usage)
NSAIDs (such as ibuprofen) and Opioids (such as morphine) have been found to carry serious risks with prolonged usage, which has led both patients and clinicians to look for more patient-led therapies for managing of your condition.
Indeed, pharmaceutical solutions are no longer the first choice treatment for for osteoarthritis in the knee – being superseded now by self-administered treatments
Over The Counter Drugs…
1. Acetaminophen/ Paracetamol. (Pain Relief)
This drug is great for mild pain relief and carries a relatively good safety profile for prolonged use. Often sold under the brand name ‘Tylenol’
2. NSAIDs (Non Steroidal Anti Inflammatory Drugs). (Pain Relief and Mobility)
Examples include Ibuprofen and Naproxen. Anti inflammatories work (as the name suggests) by reducing the inflammation in your knee joint. Inflammation is a major cause of the pain you feel.
By reducing the inflammation you can make your knee less stiff and reduce the pain you feel.
3. Creams (topical preparations). (Pain Relief)
These normally containing either Capsaicin (made from hot chilli pepper seeds) or NSAIDs. The advantage of creams is that they can be applied locally to only the affected area.
1.Higher Strength NSAIDs (Pain Relief)
Some doctors still prescribe from a relatively new class of NSAIDs known as Cox2Inhibitors. Some of these have been withdrawn due to serious safety concerns, but one or two remain (Celebrex as an example) depending on which country you live in.
2. Opioids. (Pain Relief)
Opioids such as Tramadol or Morphine are increasingly being prescribed for chronic pain from conditions such as miscellaneous back pain and arthritis. Whether this is in the best interests of you as a patient is very much up for debate.
On the one hand, if your pain is so debilitating that it seriously affects your standard of living, then arguably you don’t have that much to lose.
But on the flip side, opioids are traditionally only used short-term use immediately after a major surgery or when a patient has a terminal diagnosis (such as a cancer). The reason for this is that even medium term use can present some horrendous side effects (beyond just addiction).
I have already debated the case of severe pain medication and it’s application for chronic back pain.
This is further backed up by the fact that The American College of Rheumatology and The Arthritis Foundation do not recommend the use of opioids, so your knee osteoarthritis would have to be severely debilitating to warrant their use.
2. Lifestyle Changes…
- Lose Weight
- Exercise Regularly
Lose Weight. (Mobility/ Pain Relief)
Weight is one of the few key causes of osteoarthritis in the knee that you can change. This only applies however if you are overweight. Various studies have been done that show going on a strict calorie controlled diet if you are already on a normal or low BMI, will have no effect.
However, if you are even slightly overweight, then it is likely to be having a disproportionately large effect on your knee osteoarthritis.
This is because not only is the extra weight increasing the force on your damaged knee, but it’s also likely to be hindering/ restricting efforts to get more exercise.
Furthermore, fat cells have actually been noted in the Journal Of Pain Research to be a source of inflammation – a key part of developing osteoarthritis (although it’s exact role is still discussed)
Exercise Regularly. (Strengthening/ Mobility)
This is another one of those ‘generic treatments’ that does not always get explained properly and can do more harm than good if not considered properly.
Exercise (in the early stages of knee osteoarthritis) is essential to keep your knee mobile and the supporting matrix of muscles/ tendons/ ligaments strong.
However, impact or weight-bearing exercise such as running or contact sports are likely to cause further erosion and damage to your knee.
Instead, you should focus on building up the muscles in your leg (around your knee) and stretching/ building the tendons and ligaments.
This means the following activities are perfect for osteoarthritis in the knee –
- Hydrotherapy (specific exercise in a swimming pool)
- Yoga (Special stretches for mobility and strength building with zero impact)
- Tai Chi (Dedicated stretches and positions to increase mobility)
Both yoga and tai chi also have the added benefit of being great for reducing stress levels. Stress itself has been proven to increase your sensitivity to pain – so reducing your stress levels is actually to reduce your feelings of pain and discomfort as well.
3. Self-Administered Treatments
- Hot and Cold Therapy
- Hypnosis/ Self-Hypnosis
- Tens Machine
- Cognitive Behavioral Therapy
- Take A Rest
- Keep A Diary
- Fish Oil
- Knee Braces
- Walking Aids
- Sleeping Aids
Hot and Cold Therapy. (Pain Relief)
This is the age old (and highly effective) method of applying hot or cold therapy.
A hot wrap when applied, promotes extra blood flow to the supporting muscles and promotes healing.
A cold wrap constricts blood flow, restricting inflammation and reducing your pain.
Given that osteoarthritis is not reversible, there is some debate as to how effective heat therapy might be. However, plenty of people find warmth to be relaxing and in that sense, it relieves stress which is known to heighten pain sensitivity.
The key however, particularly with your knee, is to make sure that your knee is fully covered.
Hypnosis/ Self-Hypnosis. (Pain Relief/ Mobility)
Self-hypnosis is an extremely powerful method of pain control.
Normal hypnosis can convince people to think they are almost anything or help them give up smoking.
Self hypnosis is a mix of normal hypnosis and mindful therapy.
There is substantial evidence emerging around it’s successful use even in an acute hospital.
On example of the brain’s power to control to pain is this – stub your toe and you’ll be in agony. Chop your foot off and you wont feel a thing. Why? Because your brain is controlling your pain. Cut your foot off and it becomes a life or death situation.
Your brain automatically uses adrenaline to block the pain signals to give you the maximum chance of survival. Stub your toe however and it’s pain all the way to make sure you don’t do it again.
If the brain can change your pain levels that effectively, it could certainly reduce the pain from your knee osteoarthritis. Self hypnosis helps to teach you how.
I also scored hypnosis for mobility, because many people’s objection to moving becomes as much a mental block as a physical one and well-directed hypnosis can also help cure this.
You can learn more here ‘self hypnosis for pain management’
TENS Machine. (Pain Relief)
‘Transcutaneous electrical nerve stimulation’ involves treating your pain with small electric charges, delivered through pads that attach to your affected area. It is particularly effective when treating back pain, but has been effective on knees as well.
The pain relief is only fairly short-term, but with small, efficient, mobile battery packs they can be used whenever it is convenient.
Furthermore, providing they are used properly they are a very safe form of pain relief and many doctor’s surgeries now have them as standard for joint pain relief.
I have covered their use a lot more in the following articles –
Aromatherapy. (Pain Relief/ Mobility)
This is one treatment that very few people think about when suffering with knee pain, let alone osteoarthritis in the knee.
However, there is considerable clinical trial evidence that certain oils (lavender oil in particular) can help.
To take lavender oil as one example, there is data supporting it’s use in achieving relaxation, reducing stress (therefore reducing sensitivity to pain), reducing chronic pain (albeit tested on rheumatoid arthritis patients) and reducing inflammation – another key part of osteoarthritis.
However, perhaps the most conclusive evidence was a trial carried out on patients suffering directly with knee osteoarthritis by Nasiri et al in ‘Complementary Therapies In Clinical Practice’.
In concluding the study of 90 sufferers they summarised conclusively that,
“Aromatherapy massage with lavender essential oil was found effective in relieving pain in patients with knee osteoarthritis.”
The other advantage with some oils, including lavender essential oil. Is that it has been proven to have a specialist anti-inflammatory effect, which also helps with improving your mobility.
Check out our article on ‘Lavender oil for arthritis’ for more information.
Cognitive Behavioral Therapy. (Mobility/ Strength)
Cognitive Behavioural Therapy (or CBT) is about altering your innermost feelings by breaking down seemingly impossible challenges into smaller, bitesize achievable tasks.
The theory is that you decide on a challenge that is really important to you (this may be playing a sport you love, walking a mountain or just managing to drive again) and break it down into a series of small jobs.
By planning an effective ‘route map’ and starting to achieve the 1st task, your mental approach will subconsciously change and with it, your chances of reaching the overall goal.
This works really well for losing weight or recovering from major surgery (learning to walk again etc), but also has a role in pain relief – since the same challenge could be anything that your pain has previously restricted.
In planning, you take each element of the task and work out how to achieve it. In the case of knee osteoarthritis, this could be the 3 goals – pain relief, mobility and strength. A plan for each aspect could lead to you getting back to an old activity that you used to love.
Acupuncture. (Pain Relief)
There is some evidence that acupuncture can actually work as a treatment for osteoarthritis in the knee. Indeed, a review of the current trials specifically around the use of acupuncture on knee osteoarthritis (Selfe et al) concluded,
“On the basis of the findings of the 10 randomized, controlled trials identified by this review, there is evidence that acupuncture is an effective treatment of pain and physical dysfunction associated with osteoarthritis of the knee.”
Take A Rest! (Pain Relief)
Osteoarthritis pain typically gets worse throughout the day. This is because the effect of regular use gradually wears it worse and produces a higher level of inflammation.
Scheduling regular rest breaks throughout the day can help greatly with your pain levels by the end of it.
Keep A Diary. (Pain Relief/ Strengthening)
This can help in a number of ways. Firstly, by keeping ahead of your social calendar, you can plan better how to spend the time each day so that you can cope with periods when you may have to stand up.
Attending a child’s sports day for example, is a much more pleasant experience if you’ve planned to have a period of rest before and after. As can even normal activities like shopping.
Each will feel better with a rest, but typically this only happens if you’ve planned it in well in advance.
Secondly, by keeping a diary and planning forward you can break jobs up into smaller tasks, making them less tiring and much less painful.
And finally, a diary helps you to avoid stressful surprises. It is medically proven that stress heightens pain by tensing muscles and making you more tired. So if you can reduce stress, you reduce your pain from osteoarthritis.
Fish Oil. (Mobility/ Pain Relief)
Fish oil has been considered for many years to be a great supplement for the human body.
One of its many benefits concerns the additional lubrication of joints.
This lubrication will help your joints to become more mobile as well as relieving some of your pain.
Knee Braces. (Mobility)
Knee braces work by providing greater stability for your knees.
However, the structure of the knee brace is crucial.
Knee braces range in level of protection and stability from a level 1 to a level 3+. I cover in much more depth what design and level of knee brace you need, depending on the stage of osteoarthritis you have in another article.
Needless to say, getting the right style and level of support is essential if they are going to work properly and provide the mobility they are designed to offer.
Walking Aids. (Mobility/ Pain Relief)
For osteoarthritis in the knee, this basically means either a walking stick or a crutch. According to scientific experiments, a walking stick can deflect your weight from the bad knee by approximately 25%.
Step that up to a forearm supporting crutch and the amount of weight on your damaged knee reduces by as much as 56% (The Archives of Physical Medicine and Rehabilitation).
Again, selecting the right walking aid can make all the difference to your success. If you are looking for a crutch, consider one with a really good forearm grip.
They may be a little more expensive, but they’ll stop you putting too much pressure on your wrist (and potentially developing osteoarthritis there) as well as offering superior stability and weight transference.
Sleeping Aids. (Mobility/ Pain Relief).
A painful knee can easily keep you awake at night. And we know that being kept awake at night will heighten your feelings of pain.
In order to try and reduce this, try a hot bath before you go to bed and place a cushion between your knees (if you sleep on your side) or under your knees if you sleep flat.
Make sure you get it comfortable, but little touches like this can make all the difference. In the winter, you can even lay a hot water bottle (with warm NOT hot water in it) between your knees for added heat therapy while still getting the soft cushioning.
4. Occupational Therapy. (Mobility)
This involves making your home and workplace as easy as possible to use, so that you can continue to be as active as you want.
Some people use an occupational therapist, who comes out to your home to discuss what you struggle with, what you want to achieve and tries to find ways of facilitating this.
In the case of osteoarthritis in your knee, this could involve putting ramps into your property, fitting a stairlift (if you struggle getting upstairs) or looking at getting a specially fitted car for the disabled (automatic with more buttons and less foot pedals).
This is all designed to help you maintain a quality of life, even in the later stages of the disease.
5. Physiotherapy. (Strength/ Mobility)
A physiotherapist will work on two key aspects – manipulating your joint to achieve the maximum mobility/ range of action and getting you to carry out a series of strength-building exercises.
Physio sessions can be expensive, but they are essential if you have just had replacement surgery. For milder versions of knee osteoarthritis, it really depends on you and your preference.
Their advice can be gleaned from various pages on this site, but sticking to the exercise regime is essential to get the full benefit.
6. Gait Training. (Pain Relief)
A physio or doctor can evaluate how you walk to see if your early osteoarthritis is caused by an imbalance in posture or walking style.
If this is the case, then a specialist shoe insert (orthotic) can be made to rebalance your walking style and even out the pressure on one side of your knee.
This may help to reduce your pain levels overall, by spreading your weight over a much wider area.
7. Injections (Pain Relief)
For intense pain often accompanied with severe inflammation, a final option before surgery is injecting steroids.
This involves a doctor injecting corticosteroids or glucocorticoids into your knee joint.
Typically this will provide some temporary pain relief – however the pain will return as a number of steroids have been shown to offer only short-term freedom (McAlindon et al – JAMA Network)
Steroid injections are by far the most used type of painkilling injection for osteoarthritis, but there are a few more experimental procedures…
- Platelet Rich Therapy (injecting elements of your own blood to reduce pain)
- Hyaluronic Acid (Injecting lubricating fluid into the joint)
- Prolotherapy (Injecting an ‘irritant’ designed to create more inflammation to start a supposed ‘healing’ process)
- Stem Cell (Injects cells from fat or bone marrow of the same person to encourage new tissue growth)
I have not covered these alternative injections in much detail (yet) as I am not suggesting these are a realistic treatment option.
This is for two key reasons –
- 1. They are experimental treatments very much still being developed with little evidence yet to suggest they work.
- 2. Not only are they not approved, but they are not even available in many highly developed countries.
8. Surgery (Pain Relief and Mobility)
If you’ve tried most of the options above, your doctor may feel the only option left is surgery. In this instance there are 3 basic options available for treating osteoarthritis of the knee –
- 1. Arthroscopic Surgery
- 2. Osteotomy
- 3. Total Replacement
A surgeon uses an arthroscope (a type of camera on a long probe) to look into your knee without cutting it right open.
They then use minimally invasive surgery to remove any loose bits of broken bone, cut away any obvious bone spurs and repair any old injuries.
This type of surgery will typically clean out a damaged knee and give you a period with less symptoms, but will often still result in a complete replacement being required in the future.
If you have an uneven knee joint (either because of osteoarthritis or, most likely, the cause of your knee osteoarthritis), then an osteotomy is a potential option.
An orthopedic surgeon will purposefully reshape your bones to make them equal. This will take pressure of the longer side and allow much better alignment of the bones around your joint.
The American Academy of Orthopaedic Surgeons (The AAOS) suggest it will help if you early-stage osteoarthritis affecting just one side of your knee.
Key criteria for you to be suitable include –
- Have pain on just one side of your knee
- You are not overweight
- Remain active
- Under the age of 60
- Mostly feel the pain if you have to stand for a while or after activity.
The main problem with this surgery is it effectively reduces your pain by shaving your knee down to it’s shortest point. This will rebalance your knee, but if the cartilage is worn already, will not stop your osteoarthritis progressing quickly across both sides of your knee.
It may well slow the damage by spreading your weight across the full joint, but replacement surgery may still be the long-term solution.
Complete Knee Replacement.
This is the most complete surgical solution, where a surgery removes your entire knee and replaces it with an artificial joint.
Replacing your entire joint is a last resort and will not be considered in all patients. The overall health of the person has to be considered – as will the chances of success.
For very large patients for example, knee replacement is unlikely to be successful. The same can be said of those who inactive for other reasons as well.
The Final Word –
Finding the right treatment for osteoarthritis in the knee can be a difficult task.
In truth there probably is no one single treatment that will solve all your problems.
The best advice is to try a number of different treatments, assess which ones work for you and form a ‘basket’ of treatments that make up your regime/ plan.
This may be several self-administered treatments with a back-up medication for bad days and a program of exercises to build up your strength (and help to prevent your osteoarthritis getting worse).
Early diagnosis is always key too – because they earlier you catch it, the easier it is to stop.
But combine early diagnosis with an aggressive treatment plan (with a the last resort of surgery) and you should be able to manage your knee osteoarthritis very well.
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References Used –
1. Kolasinki et al. (Jan 2020). Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. American College of Rheumatology together with Arthritis Care & Research.
2. Juan C Mora, Rene Przkora, Yenisel Cruz-Almeida. (Oct 2018). Knee osteoarthritis: pathophysiology and current treatment modalities. Journal of Pain Research
3. Ahmad Nasiria, Mohammad Azim Mahmodi and Zohre Nobakht. (Nov 2016). Effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee: A randomized controlled clinical trial. Complementary Therapies In Clinical Practice.
4. Terry Kit Selfe, DC, PhD and Ann Gill Taylor, EdD, RN, FAAN. (Sept 2008). Acupuncture and Osteoarthritis of the Knee. A Review of Randomized, Controlled Trials. Family & Community Health.
5. James W Youdas, Brian J Kotajarvi, Denny J Padgett, Kenton R Kaufman. (Mar 2005). Partial Weight-Bearing Gait Using Conventional Assistive Devices. The Archives of Physical Medicine and Rehabilitation
6. Timothy E. McAlindon, DM, MPH, Michael P. LaValley, William F. Harvey, MD1, Lori Lyn Price, Jeffrey B. Driban, PhD, Ming Zhang, PhD, Robert J. Ward, MD. (May 2017). Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis. JAMA Network
7. www.orthoinfo.aaos.org. Osteonomy of the Knee. The American Academy of Orthopaedic Surgeons.
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