CHP Magazines CHP Magazines Spring 2019 #16 | Page 68
The one thing that could save your arthritic knee
In 2014-2015 there were 52,039
knee replacement procedures
undertaken in Australia. That
represents 257 procedures per
100,000 people aged 18 years and
over.
Clearly, this represents an extremely
small proportion of people suffering
debilitating osteo-arthritic knee pain, most
of whom never make it to surgery, yet the
reality of living with an osteo-arthritic knee
can have significantly debilitating effects on
quality of life and income earning capacity
[including sport].
The causes of osteo-arthritis of the knee
can be attributed to a multitude of factors.
•
•
Genetic biomechanical anomalies
such as knocked knee [genu
valgum] or bow legged [genu
varum] deformity creates a bias in
the weight bearing distribution of
the knee joint where only a small
portion of the articular surface of
the joint is subjected to most of the
weight - bearing forces.
Repetitive loading will eventually
68 Complete Health
•
lead to gradual deterioration of
the protective articular cartilage
surface until it pierces into the
underlying pain sensitive bone.
Other causes of osteoarthritis often
include poorly managed meniscal
[cartilage] tears which can occur
in a previously healthy knee as the
result of a twisting injury in sports
or activities requiring directional
change such as netball or football
or repetitive thrusting with rotation
such as occurs in breast stroke
swimming.
Understandable confusion exists on the
use of the term “cartilage” which may refer
to two distinctly different knee structures.
The medical term “cartilage” is used to
describe the smooth covering on any joint
surface which serves to protect bone from
erosion. Colloquially, it is commonly [and
incorrectly] used to refer to the meniscus,
the crescent shaped pad[s] located between
the thigh and shin bones that offer further
joint protection.
Tears to a healthy meniscus can occur
creating a sharp edge or a small sliver that
may not lie entirely congruent with the
remaining meniscal body thereby creating a
small “step”.
A meniscal fragment can act to both
impede locking of the knee as well as
shatter the smooth porcelain- like surface of
the joint under excessive loading.
For the most part, peripheral meniscal
tears generally heal within a couple of
months if the split is not being constantly
pulled apart by twisting or pivoting on a bent
knee.
Significant knee trauma and
osteoporosis [de- mineralisation of bones]
are also primary contributors to knee osteo-
arthritis.
Irrespective of whatever the cause
of your osteo-arthritic knee, a common
feature is that miniscule cartilage fragments
or debris may emerge within the joint
obstructing the knee from locking out fully.
The greater the joint obstruction, the greater
the knee bend and the smaller the contact
surface between the femur [thigh bone] and
tibia [shin bone].
Continuing to weight bear under these
circumstances can precipitate very rapid
destruction of a healthy knee leading to
pain, swelling and difficulty activating the
quadriceps muscles.
The single most important objective
should always be to restore full and
un-restricted knee extension. Under no
circumstances should the knee be forced
into a locked or fully straightened position as
this will accelerate joint destruction.
The most useful technique for restoring
knee function to an osteo-arthritic knee is
to gently glide the two bone apart with the
joint in 90 degrees which can be achieved
by placing a webbing belt or folded towel
behind the knee and pulling back on the
shin bone for a minute or so. This painless
technique can immediately restore knee
extension without harming the joint surface.
Swelling can then be managed
through conservative measures such as
electrotherapy and anti- inflammatory
medication and quadriceps function restored
through graduated weight- bearing exercise.
Peter Georgilopoulos
APA Titled Sports
Physiotherapist
Physiotherapist to the
Socceroos 1990-2000
Peter owns
Spine+Body Centre of
Allied Health in Bundall
on the Gold Coast. PH:
07 5531 6422
He has a long standing clinical interest in
muscle flexibility in the sporting population
particularly in relation to neural influences and,
his association with Bond University over the
last few years has enabled him to undertake
research in this area resulting in two studies
to date the first of which was published in
“Manual Therapy”.