Enabling patients with OA knee
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Enabling Patients with Knee Osteoarthritis (OA) to Stay Active
We’ve long known that patient education is critical—especially when encouraging people to remain physically active despite ongoing pain. While much has been written about empowering those with low back pain, it's important to enable all our patients. In this blog i will write about enabling patients with osteoarthritis (OA) of the knee.
What do I want my patients to understand and do?
Many patients with OA knee worry that using their knees will make things worse. But in reality, regardless of the severity, it’s important to stay active. Patients need to understand that the knee, and the body as a whole, is not as weak or fragile as they might think. Avoiding movement often does more harm than good. The goal is to start with low-impact activities or exercises and then gradually progress toward moderate-impact ones, as tolerated. This gradual approach reduces disability and pain. This needs to be understood by our patients and inspite of being in pain and
The Myth of "Don't Move the Leg"
Why is it so important to enable our patients? Because many are afraid. They fear that using a painful joint will make it worse. Unfortunately, this fear is often reinforced—sometimes unintentionally—by healthcare professionals who themselves have received only partial or outdated education on the topic.
A common belief is: “Since the joint is degenerating and inflamed, more use will accelerate the damage.”
As a result, much of the advice given promotes disability rather than activity.
Typical noiceboic advice includes:
"Don’t sit on the ground."
"Avoid walking." – which directly contradicts advice they receive for managing diabetes and hypertension. A perfect example of modern medicine’s contradictory messaging.
"Do not climb stairs." – to which patients often reply: “But I live on the first floor, and there’s no lift.”
Basically avoid deep flexion activites
To make things worse, some well-meaning but misguided clinicians show patients their X-rays, describe the extent of the "damage," and make the patient more disabled with fear.
So after expert advice, the patient come to you. What do we do?
We can go with the flow and teach them isometric exercise and and avoid encouraging walking or deep knee flexion. join the bandwagon of making people with OA knee worse.
Well, I believe we should do the opposite: enable the patient to be active, and, when appropriate, gradually reintroduce deeper flexion activities based on their ability and needs.
Reframe the X-ray story
The first thing to help patients understand is that X-ray findings don’t always match the severity of their condition. There may be lots of changes in the ray but little clinical symptoms and vice versa.
Patient: “No, I saw it on the X-ray. Do you want to see it? My joints are degenerated, my doctor showed me.”
Clinician: “I’m sure the X-ray shows changes. But let’s first see how well your joints can move.”
(after s short assessment)
Clinician: “That looks pretty good. Let me explain: an X-ray is just a picture—it can’t tell us how well the joint works. Imagine I show you a picture of your phone—can you tell if it’s a good phone, or even if it works? No, you’d need to test it. That’s what we’ve done with your knee, and it’s performing better than the X-ray suggests. Let’s try some exercise and see how it responds. Are you okay with that?”
Patient: “Are you sure? I’m afraid—everyone told me not to exercise.”
Clinician: “I understand. How about we just try something gentle?”
Experiential learning, positive first experience
Clinician: “Why don’t you sit on this recumbent cycle and try pedalling for a 5 minutes? If it feels difficult, we can stop anytime. Want to try?”
Patient: “Hmm… okay.”
After a few minutes
Clinician: “Your knees feel a little freer, don’t they?” I always ask a leading question, probably to make the patient fell more secure.
Patient: “Yeah, but the pain’s still there.”
Clinician: “Of course—pain is not going to go away that easily. But that freer feeling is progress. Want to try another five minutes?”
Patient: “Okay.”
This is an example of how we can guide a patient toward starting low-impact knee exercises. Contrast that with the standard low value isometric quadriceps exercises—well-intentioned, but for most patients, about as effective as doing nothing.
We need to help patients understand that how much time they spend sitting or standing can influence their pain and disability.
Whenever, i ask my female patients, how long they are doing house hold chore especially cooking, the answer ranges from 2 to 4 hours. They may walk around during those time, but it is predominantely standing with limited movements of the lower limb joints. That’s why it’s important to make them aware that their joints need movement, not prolonged standing.
I assume you’re standing in the kitchen for hours while cooking and cleaning?
Patient: Oh yes, I do. There’s always a lot of work.
I know—it’s hard work. But most of the time, you’re standing still, which may not be ideal for your knee pain.
Patient: Yes, but what should I do? I can’t stop working. My husband can’t help, so I have to cook and clean for both of us.
I understand. That’s why it’s helpful if you bend and extend your knees occasionally instead of standing still for long periods. Joints need to move to stay healthy, and movement helps the production of synovial fluid, which keeps your joints lubricated.So, what do you think you could do to add more joint movement while still managing your household work?
well… why dont we try to find some solutions. One of the solutions many our patients find it useful………. and it goes on
Please note: These may not be the only issue our patients have about the disease. Everytime, there is a flare up or recurence, they will always questions there belief. They will always go back to, should i take rest rather than do exercise. Again the reframing has to be done, the process may not be that simple as i write. Hwever thats the job we have, to keep on encouraging our patients to do exercise.