Knee osteoarthritis: what it is and how to manage it

The diagnosis of knee osteoarthritis can be alarming for active people. Osteoarthritis is a term that tends to elicit fear and concern, as our association with the term overall tends to be a negative one.

We all know of someone (often elderly) who experiences pain and resultant functional constraints due to joint osteoarthritis (knee or hip).

However the diagnosis of joint osteoarthritis is steadily being removed from medical vernacular due to the nocebic nature of the term, and being replaced by the term ‘arthropathy’.

Use of this less threatening term reduces the potential psychological impairment someone may feel upon being told they have an osteoarthritic joint.

What is osteoarthritis?

Osteoarthritis, or degenerative joint disease, is a group of joint disorders of the articular cartilage which wears down over the time.

Who’s at risk of developing osteoarthritis?

The risk factors for osteoarthritis include age, weight-bearing activities or sports that place repetitive stress on the joints, high bone mass or density, increased body weight (obesity) and hyperlaxity syndromes.

Developing osteoarthritis in our joints is a typical age-related process, similar to accruing wrinkles across our lifespan. Many studies highlight that we accrue joint changes across our lifespan, with the incidence rising decade on decade.

However, what is interesting is that a large percentage of people who have identified osteoarthritis of joints via medical imaging will be asymptomatic and not experiencing functional impairments or quality-of-life reduction.

One study highlighted that 43% of adults > 40yrs had knee osteoarthritis on imaging but no symptoms.

Is osteoarthritis curable?

Unfortunately, underlying osteoarthritis cannot be reversed but symptoms can effectively be managed to prevent the condition worsening and improve quality of life.

Lifestyle changes, weight loss, physiotherapy and low-impact exercise are the most important factors you need to consider to avoid or delay surgical treatment options.

Is running bad for knees?

When it comes to sports and fitness science clearly shows that running is ‘not bad for our knees’. In fact, running can have marked protective effects on the likelihood of developing knee and hip osteoarthritis, and the progression of osteoarthritis.

Science has shown that recreational runners, in fact, have a 300% reduced risk of developing knee and hip osteoarthritis compared with non-runners.

The same study did show that runners with a long history of running (>15yrs) had the same risk of developing hip and knee osteoarthritis as sedentary people. However, these were elite runners who had represented their country in international competition.

It should also be pointed out that risk is different from ‘rate’, whereby having a heightened risk does not necessarily mean osteoarthritis would ensue for the elite runner.

Will I still be able to run with knee osteoarthritis?

For those with known symptomatic knee osteoarthritis we know that pain experienced is not reflective of further tissue ‘damage’ but rather sensitisation of the tissues, which will not necessarily have a deleterious effect long-term on joint health.

A clinical guideline for the symptomatic knee osteoarthritis individual is to ensure pain levels settle to pre-run pain levels within one hour of running.

People can be fearful of ‘wearing out’ cartilage with activities such as running. In fact, the opposite is true. The cartilage in knees and hips will get stronger and more tolerant to loading with running.

Despite the above, running is still commonly associated with longer-term negative joint outcomes. Individuals with symptomatic knee osteoarthritis should consult with health practitioners to help determine their appropriate amount of running.

Can I still do triathlon with knee osteoarthritis?

The good news is that your triathlon days are not numbered. In fact, entering events and remaining active is likely one of the very best things you can do to manage your knee symptoms.

Other considerations can be gait retraining – whereby increasing cadence while running can substantially reduce knee loads.

Additionally, targeted-exercise therapy – both home and gym-strength programmes – can improve knee function, and ultimately your confidence in your knees and body.

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