Knee osteoarthritis

Osteoarthritis is a leading cause of pain and disability, worldwide. Cartilage breakdown partly explains the degenerative nature of knee osteoarthritis, but a major part of the process is due to muscular weakness and loss of control. An effective therapy must then reduce stress on the knee and prevent muscular imbalances that occur as the joint bends and rotates. AposTherapy redistributes the forces acting on the affected area by re-aligning the body and restoring neuromuscular control. Patients report a significant reduction in pain and improvement in their joint function and quality of life.

Osteoarthritis is the most common type of arthritis and describes the degeneration of the joints. The body is constantly repairing the daily wear and tear on our joints; however, osteoarthritis develops when the body can’t maintain this repair process. Knee osteoarthritis is the most common form of osteoarthritis affecting 50% of people aged 65 and above. Whilst most experience relatively mild symptoms, for one in ten people, their knee pain and joint stiffness are debilitating.

Over the last two decades research has shown that the muscles that stabilise and move the joint play a key role in the development and the deterioration of knee osteoarthritis. Weakness and loss of neuromuscular control of the quadriceps, as well as other muscles around the knee and the hip, is thought to be a precursor to the degenerative process. The first apparent change is usually cartilage damage, which increases over time, eventually causing the underlying bony surface to become exposed with growth on the edges of the joint, visible by X-ray.  

Symptoms are often worse on waking up in the morning, after over-activity, as well as sitting or standing for a prolonged period of time. As the tissues around the joints become inflamed and painful, the simplest of actions like climbing stairs or bending to tie a shoe-lace can suddenly seem very difficult, which naturally has a detrimental effect on a person’s quality of life. Symptoms can also worsen when a degenerative tear in the meniscus or bone necrosis occur, as part of the natural history of this pathology.

Various elements can predispose people to developing the condition and increase the rate of degeneration. These include obesity, genetics, gender (women being more likely to develop OA than men), the onset of old age, overuse of the joint in physically demanding occupations, or in professional athletes and previous joint trauma.

An osteoarthritis diagnosis can be made using various methods including clinical criteria and radiographic findings (X-rays and scans). The American College of Rheumatology recommends a combination of history, physical examination and laboratory tests to help diagnose knee osteoarthritis.

The symptoms of knee osteoarthritis emerge as a result of a number of processes occurring in the knee. These processes include aggravation of joint surfaces, bone thickening and spurs, muscle bracing causing fatigue with increased joint compression, as well as inflammation of the joint capsule and the surrounding structures.

People with knee osteoarthritis have been shown to have weaker and less responsive quadriceps muscle. In addition, overactive hamstrings and inner-thigh muscles cause muscular imbalances around the joint and contribute to the progression of the condition. This is because the muscles are increasing the load on the damaged part of the joint and disrupting the knee’s normal movement. Over time it becomes harder for patients to straighten the knee. The over-active muscles can also increase the bowlegged posture, typical of many patients with osteoarthritis. By and large, these muscular imbalances exacerbate the symptoms of osteoarthritis as well as playing a role in further joint damage.

Experts agree that symptom relief can be achieved if muscular imbalances can be addressed, and the muscles are trained to work more efficiently. At the initial onset of osteoarthritis, doctors often advise regular light exercise along with painkillers and/or anti-inflammatory drugs to manage symptoms. If inflammation of the joint is persistent an injection of cortico-steroid is sometimes given, as well as another type of injection containing hyaluronic acid, which is thought to encourage cartilage repair. However, these treatment options are often short-lived and do not address the root of the problem.

Once therapeutic exercise has been introduced and adjustments in lifestyle made, if the osteoarthritis continues to limit normal functioning in daily life, then a surgical intervention is often considered. The surgical path is usually initiated with an arthroscopic (key-hole) operation to clear-out the joint space and trim any damaged cartilage. Ultimately, the last resort is to replace the symptomatic joint with an artificial joint, which is a procedure known as total knee replacement.

The National Institute for Health and Clinical Excellence, UK advises physiotherapy and therapeutic exercises as the most effective and highly-proven treatment for reducing symptoms and slowing down the degenerative process. AposTherapy addresses the muscle bracing found around osteoarthritis joints and works to maintain the range of movement and improve the coordination of those muscles that protect the knee from damage. AposTherapy also enhances  how these muscles function during regular daily life, with the treatment goal being to provide the joints with optimal control and stability.

Based on the latest evidence regarding the central role biomechanics plays in osteoarthritis, AposTherapy offers a novel approach for the treatment and management of the disease. AposTherapy readjusts the distribution of your body's weight away from the damaged area of the knee joint, with the aim of reducing the compressive forces and therefore, the pain. By simulating minutely uneven walking surfaces and altering the nature of the foot's point of contact with the ground, therapy retrains the body's neuromuscular system, instilling optimal patterns of motion. AposTherapy is clinically proven to significantly reduce pain, improve patients’ walking patterns and contribute to a better quality of life.