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WHAT ARE THE BEST TREATMENT OPTIONS FOR KNEE OSTEOARTHRITIS?
by Guy Rogers, Lead Physiotherapist and Running Injury Expert
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Osteoarthritis (OA) is the most common form of arthritis, with the knee being one of the most commonly affected areas. OA of the knee is the thinning of knee cartilage, and anyone can suffer from it, with the most common risks being aged over 50 and obesity.
Anatomy
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The knee is a hinge joint where the thigh and the shin meet.
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The joint consists of muscles, tendons, ligaments, synovial fluid and cartilage.
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Cartilage is a slippery and smooth surface that allows the bones in the joint to move against each other without friction, protecting the joint from stress.
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Cartilage covers both ends of the knees, underneath the kneecap and in the midline of the joint in the form of two rings called the meniscus.
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OA is the thinning of cartilage, making the joint surface rougher which makes movement at the knee more painful and less fluid.  
Causes of Knee Osteoarthritis
It can never be pinned down to one cause but there are multiple reasons for the onset of OA at the knee, such as:
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Age
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Sex – females are at more risk
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Obesity
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Previous knee injuries
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Medical conditions
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Joint instability or hypermobility
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Loss of mobility and genetic history
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Symptoms
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Joint pain worsening after exercise or movement
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Stiffness, especially in the morning or after rest
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Swelling
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Thigh weakness
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Knee giving way when weight bearing or walking
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Cracking (with pain)
Treatment
What is Focused Shockwave Therapy?
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Focused Shockwave Therapy (FSWT) is an alternative treatment method to radial shockwave. They both accelerate the healing process by causing micro-traumas to an area of the body. However, they are used differently depending on the condition.
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FSWT are generated electromagnetically through a cylindrical coil and can treat to depths of up to 12cm, making it ideal to treat knee, hip and back conditions.
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Shockwaves are more focused, as the waves don’t dissipate. This allows us to treat the root cause of pain with more precision compared to radial shockwave.
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How can FSWT help knee OA
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It has been found in clinical research that F-SWT can accelerate meniscal degeneration healing and plays a chondroprotective role in OA (helps to delay the joint space narrowing, improving the biomechanics by protecting chondrocytes- cells responsible for cartilage formation). (Cheng et al., 2019).
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This chondroprotective effect is consistent and beneficial in both the early and late stage of OA (Wang et al., 2012).
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F-SWT has been shown to have beneficial effects on cartilage, subchondral bone and surrounding tissues, as well as providing relief from chronic OA pain (Senbo et al., 2020)
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Exercise
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It’s very important to keep moving if you have osteoarthritis of the knee. Whatever your fitness level, exercise helps condition the knee to cope with day-to-day activities more effectively.
Balance - Too much activity may increase an individual’s pain while too little makes their joints stiffen up, so a balance of both will be most effective.
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Strength - Exercise can strengthen the muscles around your knee, improve your posture and help you to lose weight, all of which can reduce the symptoms and pain of osteoarthritis.
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Improvement - It’s important to carry on with your exercises even if you start to feel better, as stopping or reducing the amount of exercise you do could cause your symptoms to come back again.
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How can we help?
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A Physiotherapist or Sports Rehabilitator can advise you on the most suitable exercises to do.
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Create an individualised plan specific to a person’s fitness level, time availability, condition, age, etc
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Advice on the best sports/ activities to take up such as, swimming which puts less stress on the joint
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Supporting a person both physically and emotionally during the rehabilitation period
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Achieving goals, here we can support your goal. Whether that is being able to walk the dog pain free or be able to run a half-marathon.
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Evidence
A recent systematic review showed that physiotherapy is an effective treatment for reducing pain and increasing joint range of motion in patients with OA (Shamsi et al, 2020).
A 12 month study conducted on patients with knee OA showed that those who received physiotherapy treatment had significant improvement in pain levels and joint range of motion (Nejati et al, 2015).
Ostenil® injection - How does it work?
Ostenil® injection increases the viscosity of the synovial fluid inside your knee joint, this helps with lubrication as well as acting as a shock absorber. It also promotes a protective coating of hyaluronate over the inside of the joint membrane.
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Who is this injection appropriate for?
It is most appropriate for people with mild to moderate osteoarthritis (OA) – especially in the knee. It is especially useful for those who have OA but are still very active as well as those attempting to delay having a total knee replacement.
Can I have more than one injection?
Yes, many patients get benefit for up to 12 months and will often have a repeat injection when their symptoms start to return.
Research has demonstrated that single-dose HA preparations were effective in terms of improving pain and function for individuals suffering from knee (Dernek et al, 2016).
Effects of Shockwave Therapy combined with Hyaluronic Acid Injections on Knee Osteoarthritis
Recent research has shown that SWT when combined with Hyaluronic Acid injections gave a greater treatment outcome. ​
It was concluded that both treatments combined are superior to Hyaluronic Acid Injections as a stand-alone treatment.​
Leading to a greater result in decreasing pain and improving joint function (Liu et al, 2019​).
References
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Cheng L., Chang S., Qian L., Wang Y.. Yang M.. Extracorporeal shock wave therapy for isokinetic muscle strength around the knee joint in athletes with patellar tendinopathy. Journal of Sports Medicine and Physical Fitness. 2019;59(5):822–827.
Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012 Mar 20;7:11. doi: 10.1186/1749-799X-7-11. PMID: 22433113; PMCID: PMC3342893.
An S, Li J, Xie W, Yin N, Li Y, Hu Y. Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism. Biosci Rep. 2020 Nov 27;40(11):BSR20200926. doi: 10.1042/BSR20200926. PMID: 33074309; PMCID: PMC7670564.
Liu, S. C., Qiao, X. F., Tang, Q. X., Li, X. G., Yang, J. H., Wang, T. Q., ... & Qiao, J. M. (2019). Therapeutic efficacy of extracorporeal shock wave combined with hyaluronic acid on knee osteoarthritis. Medicine, 98(8).​ ​
Shamsi, S., Al-Shehri, A., Al Amoudi, K. O., & Khan, S. (2020). Effectiveness of physiotherapy management in knee osteoarthritis: A systematic review. Indian Journal of Medical Specialities, 11(4), 185-191.​
Dernek B, Duymus TM, Koseoglu PK, Aydin T, Kesiktas FN, Aksoy C, Mutlu S. Efficacy of single-dose hyaluronic acid products with two different structures in patients with early-stage knee osteoarthritis. J Phys Ther Sci. 2016 Nov;28(11):3036-3040. doi: 10.1589/jpts.28.3036. Epub 2016 Nov 29. PMID: 27942115; PMCID: PMC5140795.
