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My Knee is Bone on Bone!!!

Treatment of arthritic knees is changing, and for the better! Many of us would have heard the term before, "bone on bone". For a long time, people have been told this is the end and the only option is a knee replacement. Not true! You are never truly bone on bone, cartilage still exists and can be improved.

A worn-out knee is not just about your knee. This might sound strange at first but let's try and make some sense of it.

Yes, you are experiencing pain in your knee and no doubt a reduction in mobility or function. But there are a few more factors that contribute than just the knee;

1. Excess weight. Carrying extra weight is probably one of the biggest contributors and/or maintainers of pain from knee arthritis. People will say, "yeah, of course, it's more load on the knee". That's part of it but probably more importantly carrying excess weight (meaning fat), puts the body in a low-grade inflammatory state. Cytokines are small proteins in the body that are important in telling cells what to do. Fat cells produce "adipokines", which are pro-inflammatory cytokines. Inflammation doesn't "activate" free nerve endings, but makes them more sensitive. The nerves are then more sensitive to everything! But this is reversible.

2. Not loading your knee enough! This is a problem as well. Articular cartilage doesn't have a blood supply. However, it contains special cells called chondrocytes. These cells are stimulated by load and pressure. Often when people start to get pain with knee arthritis the one thing they stop is using their knee because of fear of more damage. When that is the one thing they should continue to do.

3. Previous injuries and surgery to your knee can also speed up degeneration

So What Should You Do?

Firstly, rehab and treatment should be individualised to the patient. But some basic principles apply to everyone.

Rehab for an arthritic knee is demanding, there is no way around it. But don't think a knee replacement is an easy option. It is a major operation with all the risks involved and there is probably even more demanding rehab after a total knee replacement which if you don't do you will have a poor outcome from the surgery.

Take a "top-down" approach to treating your knee pain.

This simply means treating your whole system, not just your knee.

Sleep, arthritic knee patients often have impaired sleep, poor sleep is a big contributor to persistent pain. In the early stages of treatment if the knee has some swelling and the patient can tolerate anti-inflammatory medication a course of non-steroidal anti-inflammatories (eg ibuprofen) can get the ball rolling, reduce excess swelling, reduce inflammation and night pain leading to better sleep.

Exercise, a great starting point is stationary cycling. Depending on the individual they might start at 20-30 minutes, every day! There's some good evidence that the lubricant secreting cells in synovial joints respond well to cyclical movements. This increases belief in your knee. Exercise itself has a pain-reducing effect as well. This activity also starts to build some muscular strength.

Rehab/Treatment, specific exercises will be prescribed by your osteopath, particularly the quadriceps muscles on the front of the thigh. Some manual treatments can help decrease pain to allow exercise and often an arthritic knee will lack full extension which doesn't allow it to function properly. Manual therapy can be targeted to increase the extension of the affected knee.

Diet, as we discussed before losing some excess fat can be a big help with your knee pain to reduce inflammation. This is not meant to be nutritional advice and if you want more detailed advice please consult a dietitian. So what diet should I be on?? Well, it might not be that complicated. A balanced diet is best, low GI foods, high fibre, foods that are slow to metabolise. Intermittent fasting? There is some evidence that fasting decreases the inflammatory process but it's still not clear what fasting regime works for each person yet. At the end of the day eating/digestion is a burden on the body so letting it have a break now and then and eating unprocessed foods is the way to go.

We hope this information gives people hope with knee arthritis. How we think has a strong effect on our outcomes. So don't give up if you've been told your knee is worn out. It might just need the right attention and work. If you embark on this sort of program you may delay or avoid a replacement altogether. In 6-12 months you could be at full function again.

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