Knee osteoarthritis (gonarthrosis) is wear of the knee joint: the cartilage that covers the bones in the joint becomes thinner and wears away. It is the most common joint disease in people over 50, more often in women and in people who are overweight. It develops slowly and goes through periods of worse pain and calmer spells. The X-ray doesn’t always match the pain: some people with severe changes walk well, while others with mild ones have a lot of pain.
Symptoms
- Knee pain when walking, on stairs and when getting up from a chair.
- Stiffness in the morning or after sitting, which eases once you get moving.
- Clicking and grinding in the joint when you move.
- Pain at the start of a movement that eases as you warm up and comes back after long walks.
- Swelling after more effort than usual.
- The knee doesn’t straighten or bend fully.
- In advanced cases, the legs bow outwards (bow legs).
Most people describe periods: weeks when the knee is quiet and weeks when it hurts more, usually after effort or when the weather changes. Going down stairs is usually harder than going up.
Why it happens
- Age and wear of the cartilage.
- Being overweight: when you walk, the knee takes several times your body weight.
- Old injuries to the meniscus or ligaments.
- Weak thigh muscles.
- Osteoarthritis in your parents, and bowed legs.
Osteoarthritis isn’t only thinning of the cartilage. The whole joint is affected: the bone under the cartilage, the joint capsule and the muscles around it. That is why movement and strength matter so much.
How we treat it
Bring your latest X-ray. Kaloyan examines your knee, the way you walk and the strength of your thigh. For pain and stiffness he often starts with TECAR therapy, which warms the joint deeply and makes the exercises easier to bear. If the tendons around the knee are irritated, he adds ultrasound therapy. When the thigh muscle is very weak, Kaloyan uses electrical muscle stimulation to activate it until the exercises become easier.
The core of treatment for knee osteoarthritis is exercises: stronger thigh muscles take part of the load off the joint. A course is usually 4–8 sessions, 2–3 a week, and then the exercises continue at home. Cartilage doesn’t grow back, but many people walk for longer and with less pain when they exercise regularly. If the pain gets in the way of daily life despite treatment, Kaloyan will refer you to an orthopaedic doctor to talk about other options.
During a flare-up with swelling, Kaloyan reduces the load and works more on the swelling and pain. When the knee settles, he brings back the strengthening exercises. If you wish, he can see you again after a few months to check your exercises and change them.
What you can do yourself
- Move every day, but spread the load: several short walks instead of one long one.
- Cycle, even on an exercise bike: it is gentle on the knee.
- Wear comfortable shoes with a soft sole.
- If you are overweight, every kilogram you lose reduces the load.
- On days with severe pain, use a walking stick in the hand on your good side.
- On stairs, step up with your good leg first and down with your painful leg first.
- Don’t kneel or squat for long, for example when gardening.
When to see a doctor first
See a doctor first if:
- your knee suddenly swells up and becomes warm and red;
- you have a fever together with the pain;
- your lower leg is swollen and painful;
- you can’t put weight on your leg after a fall;
- the pain is severe at night, at rest.
