Arthritic Knee Pain

The knee is a complex joint, which can suffer from many types of injury.

Knee pain can be local; from the hip joint; the lower back; and it may also develop as a result of an ankle injury or a change in the mechanics of the foot, which can affect the soft-tissues that traverse the joint from above and below. We must also be very aware of pain originating from serious pathology, blood vessels or nerve tissue and refer accordingly if appropriate.

Degenerative changes are common behind the knee-cap (patello-femoral osteoarthritis), but we generally think of 'knee arthritis' as being within the main hinge joint itself, typically towards the medial (inner) joint line more than the lateral (outer) joint line.

Although also common to other knee injuries, initial symptoms are frequently described on the medial joint line and deep inside the joint itself. This is often associated with a restriction in movement, especially a reduction in being able to crouch, weight bear or to turn corners in a direction that causes a sharp pain. Chronic knee arthritis often reveals an inability to fully straighten or bend the knee due to excessive bony overgrowth that has developed over some years. It is also very common to observe that the knee generally looks 'thicker' as it starts to change shape.

Arthritic changes develop slowly over time and the first symptoms are usually minor and are passed off as "only a twinge or stiffness", but it can be associated with kneeling down or walking on uneven surfaces, such as fields. It can also develop from compensations that the body is undergoing from elsewhere in the body.

The knee is particularly susceptible to 'wear and tear' from increased forces associated with a patient being overweight and this is compounded with age. This is not the only risk of course, as a history of medial meniscal tears or surgery also gives a high correlation to the predisposition of osteoarthritis within the knee. Interestingly, there is less of a hereditary link with knee arthritis than there is with hip arthritis.

Leg mechanics and pronating feet ('dropped arches' or pes planus) will also affect the knee joint, as the medial portion of the knee will start to twist more than usual while also increasing its 'valgus', the natural bend at the side of the knee joint. This increased torsion through the knee joint strains the local knee soft-tissues and creates more problems for an already over-used joint.

Medication can help with some of the inflammation, but if your goal is to avoid a knee replacement, you need to consider how to fix it NOW rather than when it is too late. The debilitating pain and immobility that many suffer is often only treated symptomatically with drugs, rather than tackling the biomechanical and musculo-skeletal issues that are maintaining the ongoing degenerative processes.

My typical approach to arthritic knees is to give relief and restore function quickly. Techniques that tend to work well involve local soft-tissue and articulatory techniques combined, but this will not be enough unless it is quickly followed by a wholesale approach to the lower extremity mechanics from the low back to the feet.

We have not found a way to prevent arthritis yet, but one of the easiest approaches is to slow it down before it overtakes our daily lives. Do not resign yourself to surgery just yet, as help is at hand. Many experienced osteopaths like myself are able to pick up the initial joint changes associated with large joint arthritis well before any x-ray or scan, as we are able to recognise the early signs and symptoms.

Additional references:

The image above is courtesy of Zimmer and shows the anterior (front) right knee with the patella (knee-cap) removed.

"Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes", from Arthritis Research and Therapy, December 2005. (Click for further reading)

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