Knee Osteoarthritis: Understanding the Condition, Risk Factors, Management & the Role of Osteopathy , Dr Guy Wolton

Knee osteoarthritis (OA) is one of the most prevalent presentations that we see in the clinic. Knee OA contributes majority of the populations knee pain and is the  cause of chronic joint pain and disability. It results in progressive degeneration of the knee joint, impacting daily function and making simple activities difficult. (Oneil & felsion, 2018)

Pathophysiology of Knee Osteoarthritis: What Happens in the Knee Joint

Knee OA is the progressive degeneration of articular cartilage, changes in subchondral bone, synovial inflammation, and formation of bony spurs called osteophytes. Cartilage loss reduces the knee joint’s ability to absorb shock and maintain smooth movement, leading to pain and stiffness. Synovial inflammation contributes to joint effusion which is excess fluid that causes pain and further loss of cartilage. (Hunter & Zeinstra, 2019)

As the OA progresses the joint spaces narrows, and the bony spurs (osteophyte formation) occur. This is what X-ray imaging helps to diagnose through these findings. The condition is driven by both mechanical wear and inflammatory processes.

Risk Factors for Knee Osteoarthritis

OA risk is influenced by a combination of biological, biomechanical, and lifestyle factors. There are some risk factors that can’t be avoided and these include age, as cartilage health diminishes over time, genetics, with family history playing a role in susceptibility.

The Modifiable risk factors include:

• Obesity: Increases joint loading and systemic inflammation.
• Joint injury: Prior trauma (e.g. ACL tears) increases OA risk due to altered biomechanics.
• Occupational stress: Repetitive kneeling or squatting contributes to cartilage wear.
• Muscle weakness and alignment issues: Poor quadriceps strength and varus/valgus deformities raise OA risk.

(Blagoeievic et al, 2010)

Management Strategies for Knee Osteoarthritis

There is no cure for OA, but symptom management and functional improvement are achievable. These include:

1. Education and Lifestyle Modifications

• Weight management is crucial; even a 5% body weight reduction can significantly reduce pain.
• Activity modification helps prevent flare-ups. (Altering seated positions, work stations)

2. Exercise Therapy

Structured exercise programs focusing on strength, mobility, to reduce pain and improve joint function. Strengthening the musculature around the knee will help support and de-load the joint therefore leading to increased function and decreased pain. Some of the exercises include Sit to stands, Glute bridges, Calf raises, hamstring slides and step ups.

3. Manual Therapy –

Hands on techniques and guided rehab support improved mobility, reduce stiffness and pain and educated patients about the condition.

4. Pharmacological Management

Analgesics such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and intra-articular corticosteroids are commonly used. Another option that is effective in decreasing pain and symptoms in patients with knee OA is a hyaluronic acid injection which is a gel that provides support and cushioning to the joint which will decrease symptoms felt. However, this is only used for moderate to severe knee OA with patient that have no cartilage or bone on bone contact.

5. Surgical Intervention

Reserved for end-stage disease, total knee arthroplasty (replacement) can restore function and reduce pain.

(Bannuru et al, 2019)

How Osteopathy Can Help Manage Knee Osteoarthritis

Osteopathy provides a holistic, hands-on approach to managing the patients symptoms with knee OA, as osteopaths we will assess the whole bodies mechanics and movements patterns to identify what may be exacerbating the patients symptoms.

Osteopathic techniques may include:

• Joint mobilisation to reduce stiffness and improve range of motion in the knee, hip, and ankle.
• Soft tissue therapy for surrounding muscles such as quadriceps, hamstrings, and calf muscles.
• Muscle energy techniques (METs) to reduce asymmetry and muscle imbalance.
• Postural and gait analysis, addressing compensatory patterns that contribute to joint overload.
• Rehabilitation exercise prescription, supporting strength and neuromuscular control.
• Dry needling and taping, to release muscles that may be causing pain and taping to support the knee.

(Robertson et al, 2013)

Summary

Knee osteoarthritis is a chronic, progressive condition with significant physical and psychosocial impacts. Early intervention, including exercise, education, manual therapy, and weight management, is key to symptom control and maintaining independence. If you or someone you know suffers from persistent knee pain, consider seeing an osteopath as part of a comprehensive care plan.

References (APA 7th Edition)

• Abbott, J. H., Robertson, M. C., Chapple, C., et al. (2013). Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: A randomized controlled trial. Osteoarthritis and Cartilage, 21(4), 525–534. https://doi.org/10.1016/j.joca.2013.01.013
• Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
• Blagojevic, M., Jinks, C., Jeffery, A., & Jordan, K. P. (2010). Risk factors for onset of osteoarthritis of the knee in older adults. Osteoarthritis and Cartilage, 18(1), 24–33. https://doi.org/10.1016/j.joca.2009.07.013
• Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet, 393(10182), 1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9
• O’Neill, T. W., & Felson, D. T. (2018). Mechanisms of osteoarthritis (OA) pain. Current Osteoporosis Reports, 16(6), 611–616. https://doi.org/10.1007/s11914-018-0477-1