Introduction
This leaflet is designed to support your understanding of knee osteoarthritis (OA) and help you take an active approach in managing your symptoms. Please use this leaflet alongside the website links provided or scan the QR codes for more information. https://www.nhs.uk/conditions/osteoarthritis/
What is Knee OA?
OA is the most common form of arthritis, and the knee is the most commonly affected joint.
Everyone’s joints go through a normal cycle of wear and repair during their lifetime. As your joints repair themselves, their shape and structure can sometimes change. If this happens in one or more of your joints, it’s known as OA.
A joint is a part of the body where two or more bones meet. For your knee, this is the thigh and shin bones. There is also a small bone at the front of the knee called the patella or kneecap.
The ends of both bones in a joint are covered by a smooth slippery surface, known as cartilage. This is a soft but tough tissue which allows the bones to move against each other without friction and protects your joint from stress. Your knee also has two other rings of a different type of cartilage known as menisci or meniscus. These help to share weight evenly across your knee joint.
In OA, the cartilage in your knee joint becomes thinner and the surfaces of the joint to become rougher. This can cause swelling, pain and stiffness, but not everyone will have these symptoms.
The exact cause of OA is often not known; however it is more prevalent in females and some risk factors include being overweight, age >50 and previous surgery / injury to the knee.
How will Knee OA affect me?
While many people won’t have symptoms, those who do can have a wide range of experiences. Being diagnosed with OA doesn’t mean your condition will get worse, as there are things you can do to help manage your symptoms.
In knee OA, the pain usually comes on gradually, over a period of months or years. However, it could also be triggered by a recent injury. If you have osteoarthritis of the knee, you will probably feel your knee is painful and stiff at times. It may only affect one knee, especially if you’ve injured it in the past, or you could have it in both. The pain may feel worse at the end of the day, or when you move your knee, and it may improve when you rest. You might have some stiffness in the morning, but this won’t usually last more than half an hour.
The pain can be felt all around your knee, or just in a certain place such as the front and sides. It might feel worse after moving your knee in a particular way, such as going up or down stairs. Sometimes, people have pain that wakes them up in the night. You’ll probably find that the pain varies and that you have good and bad days. You might find you can’t move your knee as easily or as far as normal, or it might creak or crunch as you move it.
Sometimes your knee might look swollen. This can be caused by two things: Hard swelling: when the bone at the edge of the joint grows outwards, forming bony spurs. Or more of a soft swelling: when your joint becomes inflamed and produces extra fluid, sometimes called an effusion.
Sometimes OA of the knee can cause the muscles in the thighs to weaken, so your leg may look thinner. This weakness can make the joint feel unstable and could cause the knee to give way when you put weight on it.
Some people with OA find a lump appears at the back of their knee. This is called a Baker’s cyst. A Baker’s cyst is fluid-filled swelling at the back of the knee that happens when part of the joint lining bulges through a small tear in the joint capsule. This can then cause joint fluid to be trapped in the bulge. It can happen on its own but is more likely in a knee that’s already affected by OA. A Baker’s cyst doesn’t always cause pain, but sometimes they can burst so the fluid leaks down into your calf, causing sharp pain, swelling and redness in the calf. Commonly, these are now left alone due to risk of infection and re-filling of the cyst if it is drained (aspirated).
Sometimes the effects of OA can make people feel depressed or anxious. It can also affect your sleep pattern and even your relationships. It’s worth speaking to your doctor about these problems.
What can I do to help my Knee OA?
There’s no cure for OA, but there are things you can do for yourself that can make a difference to how the condition affects you. There are also some treatments available that could significantly reduce your pain and improve your mobility. It’s likely that you’ll need to use a combination of different things to get the best results.
1. Exercise
Joints need to be exercised regularly to keep them healthy. It’s very important to keep moving if you have knee OA. Whatever your fitness level, exercise should form a core part of your treatment. Exercise can improve your general health, improve knee range of motion, strengthen the muscles around your knee and help you to lose weight, all of which can help your pain and other symptoms.
It’s important to carry on with your exercises, even if you start to feel better. Stopping or reducing the amount of exercise you do could cause your symptoms to come back again. Try to start off slowly and gradually increase how much you do. Exercising little and often is a good place to start.
Exercises that reduce the load on your joints, such as swimming and cycling, are recommended for treating knee OA. Water-based exercises are also a good option, as the water takes the weight of your body and reduces the strain on your knee. It is however important to maintain weight baring activity for general bone health.
Ultimately, the best form of exercise is something you enjoy and will keep doing. Try different things and see what works best for you. This could be a class, or something you do on your own. You should try to do a combination of aerobic, strengthening and range of movement exercise
Aerobic exercise
This is any exercise that increases your pulse rate and makes you a little bit short of breath. This may include activities such as walking, cycling, seated pedals and swimming etc. Regular aerobic exercise should help you sleep better, is good for your general health and wellbeing, and can reduce pain by stimulating the release of endorphins, which are the hormones that help with pain relief. You should try to do 2 hours and 30 minutes of aerobic exercise each week, but you can spread this out over the week, instead of all in one go.
The NHS has some great information and tools available to assist you which can be accessed via their website, https://www.nhs.uk/better-health/get-active/
This free app is available in both the apple app store and android play store.
It is a tool to help you track your steps, monitor your progress and give you tips on how to boost your activity levels safely.
Strengthening exercise
This type of exercise is important, as it strengthens the muscles that control your knee, and helps to stabilise and protect the joint. Try to do strengthening exercises at least two days a week.
Range of movement exercise
These are good at helping to keep your joints flexible. These exercises can be something as simple as stretching. Make sure your joint moves through a range of motion that comfortably stretches the joint with the aim to increase this slightly further each time.
Please see the website below or the end of this leaflet for some suggested exercises.
2. Weight management
Being overweight increases the strain on your joints, especially your knees. This makes it more likely that you’ll develop OA and that your condition may get worse over time. Losing weight if you’re overweight could really help reduce your pain and other symptoms.
There’s no special diet that is recommended for people with OA. However, if you need to lose some weight, you should try to follow a balanced, reduced-calorie diet, combined with some regular exercise.
The NHS has a great weight loss program that you may find useful. You can read more on their website. https://www.nhs.uk/better-health/lose-weight/
This free app is available in both the apple app store and android play store which can be a useful tool to support you.
The Association of UK Dieticians also has some useful information to support your diet if you have OA. Please visit https://www.bda.uk.com/resource/osteoarthritis-diet.html for more information.
If you have tried to lose weight by yourself but continue to find this difficult, it may be worth checking with your GP to see if you would benefit from a more specialised weight management service to offer you some extra support.
One way you can monitor your progress is by regularly checking your body mass index (BMI). This is a calculation between your height and weight. This can be a good tool to check if your weight is within a healthy range. Please see this BMI calculator to further support your weight loss journey. https://www.nhs.uk/health-assessment-tools/calculate-your-body-mass-index/calculate-bmi-for-adults
3. Reducing the strain on your knee
Apart from keeping an eye on your weight, there are a number of other ways you can reduce the strain on your knee:
- Wear shoes with thick soles and enough room for your toes. Good shoes should reduce the shock through your knee by absorbing some of the impact when walking. Try to avoid wearing high heels. If you need extra support, sometimes insoles can be useful.
- Use a walking stick if needed to reduce the weight and stress on a painful knee. Hold it in the hand on the opposite side of the body to your affected joint. Try to avoid carrying items on the same side as the affected knee.
- Use a handrail for support when going up or down stairs. Go upstairs one at a time with your good leg first but go downstairs with your bad leg first.
- Think about making changes to your home, car or workplace to reduce unnecessary strain. An occupational therapist can advise you on special equipment.
- Some people find that knee braces help. You can buy knee braces from sports shops and chemists, but you should speak to your doctor or physiotherapist first, as they might be able to recommend the best one for you. Importantly, knee braces are not a stand-alone treatment and should be used in conjunction with other treatments such as exercise and weight loss, if appropriate.
4. Pacing your activity
It is common for patients with knee OA to experience occasional flare ups of pain. Doing things a bit at a time can help you manage your hip symptoms better and help prevent a flare up occurring. Consider breaking up harder activities into chunks or even spreading them out across the week as you may find it useful to not tackle all of your physical jobs at once.
Pain can affect how you do everyday activities. It’s very common to fall into an unhelpful trap of ‘boom and bust’ patterns. This is where on days with less pain you find yourself doing more and on bad days doing very little activity.
This pattern of activity leads to you being stuck in the vicious cycle of pain which can be difficult to manage. Learning to find your personal balance of activity, breaks, relaxation and activities can boost your confidence as you can do more of the things in life you want more consistently.
5. Coping with low mood and sleep problems
You might find that living with OA can make you feel depressed or anxious. Speak to your doctor if you’re feeling low. They may be able to recommend psychological therapies to help you, such as cognitive behavioural therapy (CBT) and a few stress-relieving techniques. If your sleep is disturbed because of knee OA, this could make your pain feel worse. However, there are things you can do for yourself that might help, such as:
- Keep a sleep diary to work out if there are any patterns to your sleep problems.
- Sleep at regular times to allow your body to get into a routine.
- Try to limit screen time 1 hour before sleep
- Try to limit eating in the 2-3 hours leading up to sleep.
- Reducing caffeine intake and considering decaffeinated drinks can help your body prepare for sleep.
- For a more comfortable sleeping position, use a pillow between your legs if lying sideways.
6. Ice and Heat therapy
Using a heat pack or something similar on a painful knee might help to relieve the pain and stiffness of OA. An ice pack can also help but be careful not to put ice packs, heat packs or hot water bottles directly on your skin – wrap them with a tea towel or cover.
7. Medication
Pain relief can be used to help ease the pain and stiffness caused by OA. You’ll have the best results if you keep active, reduce the strain on your knee, and take medication for your condition as you need them. Simple over-the-counter pain relief such as paracetamol may help, but your doctor may prescribe you stronger pain relief if needed. A short course of anti-inflammatories, such as ibuprofen, can help reduce pain, inflammation and swelling. However, they aren’t suitable for everybody, so make sure you speak to a pharmacist or GP before taking them.
Example of some exercises
