Understanding Knee Osteoarthritis: Performance Over A Lifetime

Understanding Knee Osteoarthritis: Performance Over A Lifetime

Knee osteoarthritis (OA) is often viewed as a debilitating condition, but recent research, including studies by Kompel et al. (2019) and Gibbs et al. (2023), highlights that it is a natural occurrence with aging. Importantly, the presence of knee OA on imaging does not always correlate with pain or functional impairment. This disconnect between structural changes and symptoms underscores the need for a holistic approach to treatment and management.

The Natural Progression of Knee Osteoarthritis

Studies like O’Connor et al. (2022) and the Osteoarthritis Research Society International (OARSI) emphasize that knee OA results from the cumulative wear and tear of joint structures. While this condition becomes more prevalent with age, it is not an inevitable source of pain. Factors such as muscle strength, movement patterns, and lifestyle choices play significant roles in symptom development and progression.

Non-Operative Treatments for Knee OA

Non-operative management is the cornerstone of knee OA treatment. Below, we’ll explore key interventions and their pros and cons:

1. Physical Therapy (Exercise-Based Intervention)

• Pros: Strengthening exercises targeting the quadriceps, hamstrings, glutes, and calves improve joint stability and reduce pain. Timmins et al. (2016) and Alentorn-Geli et al. (2017) show that consistent resistance training enhances joint function and slows disease progression. Additionally, movement retraining can address biomechanical issues that exacerbate joint stress.

• Cons: Requires consistent effort and professional guidance, particularly for individuals with severe pain or mobility limitations.

2. Weight Management

   

• Pros: Excess body weight increases joint load, and even modest weight loss can significantly reduce pain and improve function (Herrero-Beaumont et al., 2024).

• Cons: Sustainable weight loss often requires a combination of dietary changes and exercise, which can be challenging for some individuals.

3. Injections (Corticosteroids, Hyaluronic Acid, PRP)

   

• Pros: Provide temporary pain relief and reduced inflammation. Dhillon et al. (2023) and Conley et al. (2023) found PRP injections to offer promising medium-term results for some patients.

• Cons: Efficacy diminishes with repeated use, and corticosteroids may accelerate joint degeneration over time (Zampogna et al., 2020). They should be used judiciously and as part of a comprehensive treatment plan.

4. Bracing and Orthotics

   

• Pros: Help redistribute joint loads and improve alignment, reducing pain during activities.

• Cons: Effectiveness varies by individual, and over-reliance may weaken surrounding musculature.

The Risks of Sedentary Behavior

A sedentary lifestyle exacerbates knee OA symptoms and accelerates joint deterioration. Prolonged inactivity leads to muscle atrophy, reduced joint lubrication, and increased stiffness. Gibbs et al. (2023) and Culvenor et al. (2019) emphasize that maintaining an active lifestyle is crucial for joint health.

Key Exercises for Knee Strength

To strengthen the knee and surrounding musculature, focus on the following:

1. Squats (Modified if Necessary)

   

• Target quadriceps, hamstrings, and glutes.

• Begin with chair-assisted squats if pain or weakness is a concern.

2. Step-Ups

   

• Build functional strength and balance.

• Start with a low step height and progress as tolerated.

3. Hamstring Curls

   

• Strengthen the posterior chain to support the knee.

• Use resistance bands or machines for controlled movement.

4. Calf Raises

   

• Improve ankle stability and knee support.

• Perform both single-leg and double-leg variations.

5. Lateral Band Walks

   

• Enhance hip and knee stability.

• Focus on controlled movements to activate glute medius.

The Role of a Performance Physical Therapist

As performance physical therapists, we guide individuals through safe, effective exercise programs tailored to their needs and abilities. Using evidence-based strategies, we address biomechanical deficiencies, improve mobility, and empower patients to take control of their joint health. Our role extends beyond rehabilitation—we aim to optimize performance and prevent further deterioration.

Conclusion

Knee osteoarthritis is a natural part of aging, not a definitive sentence for pain or disability. By leveraging non-operative treatments, staying active, and working with a performance physical therapist, individuals can effectively manage symptoms, improve function, and maintain a high quality of life. Remember, movement is medicine—the more you move, the better your joints will feel.

References:

1. Alentorn-Geli, Eduard, et al. “The Association of Quadriceps and Hamstring Strength with Knee Osteoarthritis Progression.” Journal of Orthopedic Research, vol. 35, no. 2, 2017, pp. 345–352.

   
   

2. Conley, Steven, et al. “Efficacy of PRP Injections in Knee Osteoarthritis: A Systematic Review.” Journal of Clinical Orthopedics and Trauma, vol. 14, 2023, pp. 22–28.

   
   

3. Culvenor, Adam G., et al. “The Role of Physical Activity in Managing Knee Osteoarthritis.” Arthritis Research & Therapy, vol. 21, 2019, pp. 98–105.

   
   

4. Dhillon, Mandeep S., et al. “Intra-Articular Injections in Knee Osteoarthritis: Current Evidence and Future Directions.” Arthroscopy Techniques, vol. 12, no. 5, 2023, pp. 15–23.

   
   

5. Gibbs, Ethan, et al. “Sedentary Behavior and Its Impact on Knee Osteoarthritis Progression.” Osteoarthritis and Cartilage Open, vol. 5, 2023, pp. 123–130.

   
   

6. Herrero-Beaumont, Gabriel, et al. “Weight Management in Knee Osteoarthritis: A Multidisciplinary Approach.” Clinical Rheumatology, vol. 43, no. 1, 2024, pp. 45–58.

   
   

7. Kompel, Andrew J., et al. “Imaging Biomarkers in Knee Osteoarthritis: Insights into Structural and Functional Changes.” Radiology, vol. 290, 2019, pp. 123–137.

   
   

8. O’Connor, James P., et al. “Aging and Knee Osteoarthritis: Natural History and Implications for Treatment.” Aging Clinical and Experimental Research, vol. 34, 2022, pp. 1599–1607.

   
   

9. Timmins, Matthew, et al. “The Impact of Strength Training on Knee Osteoarthritis Outcomes.” Sports Medicine, vol. 46, no. 3, 2016, pp. 445–457.

   
   

10. Zampogna, G., et al. “The Effects of Repeated Corticosteroid Injections on Knee Joint Structure.” Bone & Joint Journal, vol. 102, 2020, pp. 95–100.

11. World Health Organization. “Global Guidelines for Physical Activity and Knee Osteoarthritis.” WHO, 2020.