What knee osteoarthritis is
Osteoarthritis, or gonarthrosis, is a process that involves the whole joint: the cartilage, the bone beneath it, the synovial membrane, the ligaments and the surrounding muscles. It is not just mechanical “wear and tear” of the knee – the joint tissues are constantly remodelling, and their condition depends, among other things, on how they are loaded. The symptoms usually come and go in waves: periods of more pain and swelling alternate with weeks of relative calm.
It is worth knowing that the picture on an X-ray is a poor predictor of how bad the pain will be. People with advanced changes on an X-ray can be active and have few symptoms, while others suffer a great deal with minor changes. In people over 45 with typical symptoms, the diagnosis is usually made on the basis of the history and clinical examination – an X-ray is not needed to start exercising.
Exercise and education as the foundation of treatment
Current guidelines consistently state that the first step in treating knee osteoarthritis is exercise and education and, in people who are overweight, also weight loss. An example of this approach is the GLA:D programme, which combines knowledge about the condition with supervised exercises for strength and movement control. We base our work at the practice on similar principles: we explain what is happening in the joint, how to understand pain during exercise and how to pace your activity, and then run progressive medical training.
Stronger quadriceps and glutes absorb loads better and improve knee stability. Even a moderate reduction in body weight noticeably takes load off the joint when walking and on stairs. Manual therapy and soft tissue work can reduce pain in the short term, but they are an add-on – they will not replace regular exercise.
During flare-ups, when the knee is more swollen and painful, we do not stop activity completely, we just reduce its dose for a while. The first effects of an exercise programme are usually visible after a few weeks, and they last when exercise stays a regular part of your week.
What to avoid and when to see an orthopaedic surgeon
Arthroscopic washing out or “cleaning” of the joint is not recommended in osteoarthritis – it does not give better results than well-conducted conservative treatment. Likewise, with degenerative meniscus tears in people over 40, treatment starts with conservative care, because exercise gives results comparable to arthroscopy; we write more about this on the meniscus tear page. Avoiding movement for fear of “grinding down” the knee does not help either: inactivity weakens the muscles and usually makes the symptoms worse.
An orthopaedic consultation is needed when, despite several months of consistent treatment, pain and limitations clearly get in the way of daily life. It is the orthopaedic surgeon who assesses whether and when surgery is indicated.
How to keep the results day to day
An exercise programme works best when it does not end along with the visits. After a few weeks of work at the practice we agree a set you can carry on with on your own, and a threshold at which it is worth reducing the load for a while. Every few months it is good to check your progress and increase the weight – a knee that has stopped hurting still needs a stimulus so that the muscles do not lose strength.
The goal stays the same: regular activity that suits you – walking, cycling, swimming or exercise in the gym – and a knee you can rely on day to day. We set out the details at the visit.