OA knee and exercises
Why are we afraid of the big bad wolf
Experiencing knee pain due to a diagnosis of osteoarthritis (OA) in the knee is probably on the rise. The likelihood of developing OA in the knee increases as you age, particularly when coupled with a sedentary lifestyle. However, the management of OA knee is riddled with myths, poor treatment solutions and plain stupid advices.
What’s OA knee and why do you get it?
OA knee is a disease of the joint, not necessarily the articulating surface. People who suffer from it usually will have pain during rest and various activities like standing, climbing stair and walking. As time progress, joints tend to get sticky and moving the joint becomes harder and sometimes severely restricted.
Why do we get OA knee? We have no clue. The exact cause remains elusive. It's commonly linked to joint wear and tear, much like how a car or bike tire deteriorates with use. However, this explanation serves more as a risk factor than a definitive cause. As previously mentioned, prominent risk factors encompass age, persistent mild inflammation - which worsens due to lack of physical activity, dietary habits, and others (although I'll focus on just a few). In such a scenario, individuals often seek advice from either a doctor or a physical therapist (PT).
As it is thought wear and tear is the causal agent- the first thing we tell patients after they are diagnosed with OA knee is “ you are using the knee more and it has degenerated”. Don’t ask me what that means. Then as you are using the knee more they are told to stop certain activities, mostly deep flexion activities and all round weight bearing activities
Lets hear some “advice” between the medical professional and the patient:
Change your toilet to western commode - you cant squat and shit you idiot that will damage your knee.
“But doctor i am living in a rented house” you protest,
“I don’t know what you do, you need to change”
No more sitting on the floor. Alright, time to pay a visit to Home Centre and explore some elegant couch options.
"Excuse me, but the temple I frequent lacks comfortable seating. What's your suggestion?"
"Let's not resort to facetiousness here, simply avoid sitting on the floor."
"Very well, Your Majesty."
Some are told also walk less.
That’s good advice doc, the other doc was such a task master always telling me to walk for my BP and sugar
what? no no you have to walk
You are completely confused and thinking may be I should buy a hover boardAnd then most confusing of all “reduce your weight” Now you are completely floored. Okay I never thought I can reduce weight without doing the above activity. Sadly you are too chicken to ask your Doc how.
Go and see the therapist and show him this- otherwise he will not know what to do. Okay you come out confident your therapist will help you.
In addition, you'll be guided through exercises aimed at "protecting" your knee as we think wear and tear is the main culprit. From the time Akbar got OA knee to today- you will get the same “exercise” . Take a towel, keep it under your knee and press it, hold for 5 release and variations of this. Basically exercises which are done without moving the joint. Along with it you will always get some comically useless treatment like wax or IFT. So, you pop the pill, diligently go to the therapist for 10 days ( not 9 or 11- 10 is the magic number) and voila - something happens to you due to random chance.
If you belong to the group of perceptive patients, you might find yourself questioning how on earth you're going to adhere to such advice that appears to lack any logical basis. In response, you might simply take your prescribed medication and continue with your daily routine. Some take it to the heart and “take rest” and do less activity- especially stair climbing, sitting on the floor. Sadly, individuals find themselves in the unfortunate situation of becoming more debilitated after seeking assistance from medical practitioners. So this is for you and the one therapist who has not heard me rant about this.
Why these are myths or plain stupid.
can you protect your knee joint by not doing sitting on the floor or walking or avoiding exercises like stepping, squatting or cycling. The answer seems to be no - why because for a simple reason if you stop these in real life natural either you become restricted at activity level or participation level. That is the patient may stop going out, may become homebound more, feel constricted and so on. You may say pray, that will happen any way as it is a degenerative disease. Well the basic premise of medicine is to make patients able not more disable or restricted.
When you have reached this point of this write up and thinking what the hell do you want us do? not isometric? what then weight bearing exercises?
‘will that not make the joint worse, idiot, always finding fault not telling what to do”
Okay lets understand:
Are we not aware from our learning in physiology, biomechanics, and pathology that restricting movement in a joint isn't necessarily beneficial? Haven't we learned that inadequate joint movement can lead to stiffness and reduced efficiency? We understand that to maintain joint health, mechanical stimulation is crucial—meaning the joint needs to experience movement and bear weight. Without this, like any biological structure, the joint can deteriorate due to disuse, causing cartilage breakdown and impacting overall joint physiology.
Therefore, it's essential to emphasize that joint movement is indeed important. Given that it's a weight-bearing joint, discontinuing exercise and activity is not recommended. However, it might be wise to avoid prolonged static positions, such as sitting or standing for extended periods, as they could contribute to joint pathology.
Here are the best approaches for managing knee osteoarthritis (OA):
Stay Active: Being physically active is key, except in cases with specific red flags. Inactivity seldom leads to improved health, so avoid sitting around excessively and engaging in prolonged phone scrolling.
Low-Impact Aerobic Exercise: Incorporate low-impact aerobic exercises into your routine, such as stair climbing, cycling (an effective and favored exercise), and walking.
Time filling Therapies: if you are forced by the system- keep in mind if you are a patient it is a completely joke and a therapist to make your patient understand these are not as important as the exercises
No Need to Cease Activities: Don't halt your regular activities. If certain activities like stair climbing, walking, or rising from the floor pose challenges, work with a therapist to create a tailored exercise plan. There's ample literature available to guide this process; you just need to seek it out.
Promote Exercise Adherence: Find ways to ensure that your patients adhere to their exercise routines for at least 6 to 8 weeks. Consistency is key in reaping the benefits of exercise.
Weight Management: Instead of simply advising weight loss, which may not be well-received, assist patients in planning and embarking on a weight reduction regimen if feasible. Mere mention of weight loss can sometimes lead to dissatisfaction, so offer support and guidance.
Surgical Consideration: In more severe cases, surgery might become an option. Ensure that you understand the criteria for when surgery should be considered and discuss this with your healthcare provider.
These strategies can be effective in managing knee osteoarthritis and improving overall quality of life.
Awesome.