Jessica Bento, Physical Therapist (Creator DVRT Restoration Certification, Knees Over Toes Course, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)
“My doctor said I have bone on bone in both my knees.”
One of THE most common statements I hear from my patients. What they are really saying is that they were diagnosed with osteoarthritis. We will get to the bone on bone part shortly.
Osteoarthritis is a rather common diagnosis I get a lot of questions on, particularly osteoarthritis of the knee, and it makes sense that I would.
Osteoarthritis of the knee or OA affects almost 60 million Americans. That’s A LOT of people. Osteoarthritis, broadly speaking, is the second leading cause of disability in the US. Guessing you might not have known that stat but when you think about what OA does to a joint you can then see how it would cause an increase in disability.
So you might be thinking, what is OA? You have an idea but really don’t know the difference between arthritis and all the other stuff that affects the knees.
Well, OA is actually a disease that affects the joints primarily from mechanical wear and tear. Aging tends to be the greatest risk factor when it comes to OA but genetics, certain metabolic diseases, individuals that live in larger bodies, joint injuries, and being a woman can all lend to a higher risk.
When the joint starts to lose cartilage which is tissue that covers the surface of joints which acts as a shock absorber and allowing bones to slide nicely over one another. That bone then tries to fix the issue (like our body always does when its injured)…but not always in a good way, it begins to change. The new bone growth may not be so perfect and causes the joint to be unstable, cause increased pain, or causes movement dysfunction at the joint.
This is where the bone on bone comes into play…without the cartilage protecting the joint, the space between the bones decreases and the ends of the bones become closer to each other. When there is little to no cartilage left the ends of the bones can rub against each other causing pain and impaired range of motion as well as a decrease in overall function.
There are several types of arthritis but when you hear arthritis vs OA typically you are talking about joint inflammation not caused by wear and tear. A lot of times more hereditary factors lend to arthritis. Again, I am not going to go into all the different types as today I am primarily addressing OA of the knee.
Keeping in mind people with arthritis tend to feel a bit better with they exercise or when they move the joint that is affected whereas people with OA tend to feel more pain with movement of the affected joint…now that’s not true for every one, just giving some generalizations as we are going to talk about problem solving exercise for the person with knee OA.
So when we are thinking about exercise prescription for individuals with OA what do we need to take into consideration?
Wait a minutę, didn’t I just say people with OA tend to hurt more when they move the affected joint so why are we talking about exercise?
Well, study after study has shown that individuals with OA that participate in and strengthening program have improved symptoms and improved outcomes.
…”exercise is a vital component of the treatment for some of the underlying mechanisms of knee OA, including muscle strength insufficiency, muscle activation imbalance, and aberrant biomechanics and cartilage loading.”(1)
“Based on the contemporary literature, regular light to moderate physical activity has both preventive and therapeutic benefits for individuals with knee OA. “ (2)
Now, before this blog post gets too long winded lets talk about some things we should take into consideration when dealing with OA and a strengthening program. Below are my top three things to consider.
Pain should always be a guide, obviously we do not push through pain we find ways to modify movements so that there is less pain or no pain at all.
Integrated movements, not isolated. We want to teach the body to work more efficiently and the only way to do that is by integrated exercises, isolated exercises are only going to teach dysfunctional movement patterns or feed into ones already there. Remember typically, people with OA already have impaired movement, we need to re teach proper movement and get the kinetic chain working better.
Modify, Modify, Modify. Its ok to modify exercises, changing the range of motion, providing more feedback, and so forth. Know how to regress any exercises that is key.
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So what do I mean?
Well, take a squat, you might think a bodyweight squat is where you would start someone with OA, since load might add more of a challenge. Well, think again, load can offer amazing feedback and allow that individual to move into the squat pattern much better and experience less pain. If we provide core stability through load then our bodies will feeling freer to move into something like a squat. We talk about this all the time, proximal stability for distal mobility. Something like a USB press out squat is where I should start most of my OA patients. 9 times out of 10 they perform a perfect squat. This is where I started one of my clients that had severe OA of the knees and she never though in a million years should would be able to squat again, and she not only did the press out squat, she did so pain free.
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Adding in the core stability from the use of the Ultimate Sandbag will enhance the connection we gain through the entire body.
Meeting people where they are at is so important, and understanding you can’t “fix” everything but you can improve upon it.
Focusing on the areas above and below the joint is going to be key as well, strong feet and strong hips as well as the core make for stronger knees.
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Gallo, P. M. (2020). Resistance exercise and knee osteoarthritis. Journal of Clinical Exercise Physiology, 9(2), 89–90. https://doi.org/10.31189/2165-7629-9.2.89
Esser, S., & Bailey, A. (2011). Effects of exercise and physical activity on knee osteoarthritis. Current Pain and Headache Reports, 15(6), 423–430. https://doi.org/10.1007/s11916-011-0225-z
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