What is Osteoarthritis?

Osteoarthritis, is is often referred to as ‘wear-and-tear’ or ‘degenerative joint disease’, is a condition in which the surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. The natural cushioning between the joints called ‘cartilage’ wears away and therefore the bones of the joints rub more closely against one another.

The rubbing can result in pain, swelling, stiffness, reduced mobility and sometimes the bone at the edge of the joint may grow outwards, forming bony spurs called osteophytes.

This can happen over the main surface of your knee joint and behind the kneecap.

Symptoms:

• Pain. Knee pain that tends to get worse when moving the joint and towards the end of the day. Certain movements that are commonly affected are going up and downstairs.
• Stiffness. Sometimes, you may feel stiffness in the knee at certain times, often in the morning or after a period of rest.
• Creaking or grinding sensation when the joint moves.
• Swelling. You may notice hard swelling (caused by osteophytes) or soft swelling (caused by extra fluid in the joint).

What causes it?

As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body repairs itself and you do not experience any symptoms. Almost everyone will eventually develop some degree of osteoarthritis. One common myth is that exercise like running will “wear out your knees”. In actual fact research shows that people who run are less likely to develop arthritis in the knee!

However, several factors increase the risk of developing significant arthritis at an earlier age:

Risk factors include:

• Age. Osteoarthritis usually starts from late 40s onwards. This could be due to the weakening of the muscles, the body being less able to heal itself and the gradual wearing out of the joint with time.
• Obesity. Weight increases the pressure in all the joints. One pound of body weight results in 4 pounds of pressure on the knee joint.
• Gender. Osteoarthritis in the knee is twice as likely in women than men.
• Genetics. If your parents or siblings have had osteoarthritis, you are more likely to develop osteoarthritis.
• Joint Injury.  Injuries to the knee such as a torn meniscus or ligament injury can increase the risk in later life.
• Joint Disease. If the knee has been previously damaged by another joint disease, such as rheumatoid arthritis or gout.

Treatment

There is no cure for osteoarthritis, however, there are a lot of things you can do to improve your pain and symptoms.

Weight Management

Being overweight increases your risk of developing osteoarthritis and also makes it more likely the arthritis will get worse over time. When you walk, run or go up and down stairs the knee can take up to five to six times your body weight. Therefore, even losing a small amount of weight can have a big difference to the strain on your knees. If you need to lose weight, you should follow a balanced, reduced-calorie diet combined with regular exercise.

Other ways you can reduce the strain on your knees

• Pace activities.
• Wear low-heeled shoes with soft, thick soles (such as trainers).
• Avoid keeping your knee still in a bent position for too long.

Physiotherapy

The muscles surrounding your knee joint is like scaffolding. Strengthening the muscles around your knee can help stabilise and protect the joint. It’s also been shown to reduce pain and will prevent your knee giving way and therefore reducing the tendency to fall.

Aerobic exercise can reduce pain by stimulating the release of pain-relieving hormones called endorphins. It can also help you sleep easier, which is important for general health and well-being.

Our physiotherapists can advise on the best exercises to help build strength and fitness, whilst addressing each individual’s needs. It is important to have the right balance between rest and exercise, as too much activity can increase pain, whilst too little can cause the joints to stiffen up and deteriorate further.

Steroid Injections

A Knee steroid injection given directly into the painful knee joint can start to work within a day or so. This has a strong anti-inflammatory effect and can help very painful swollen knees. For further information on steroid injections, please click here

Hyaluronic acid Injections

Hyaluronic acid is injected into the space in the joint that contains synovial fluid (joint fluid) and works by restoring the normal balance between the breakdown and production of hyaluronic acid. This can help improve lubrication and shock absorption of the knee joint as well as reducing pain and inflammation. For further information on Hyaluronic acid injections, please click here

Ultrasound guided baker’s cyst aspiration

Osteoarthritis can cause baker’s cysts in the knee, which are often painless, but you may be able to feel a soft-to-firm lump at the back of your knee. The cysts can cause aching or tenderness when you exercise. A cyst may not need treatment, but if it does, it can be treated by drawing off the extra fluid from your knee using a syringe (known as aspiration). For further information on aspirations, please click here

If you would like to book an appointment for a physiotherapy assessment and treatment or to discuss your painful knee or another joint, please click the button below.

BOOK AN APPOINTMENT

What is Tennis Elbow?

Lateral epicondylalgia or lateral epicondyle tendinopathy, formerly and commonly referred to as tennis elbow, is a condition which causes dysfunction within the origin of the tendons on the outside of the elbow.

This is caused by overuse and repetitive loading of the wrist extensor muscles, usually during manual labour, housework and hobbies (For example: racquet sports, typing and playing an instrument). It can come on acutely as a result of a strenuous activity that you do not normally do.

Repetitive use of the forearm muscles can lead to microscopic tears within the tendon origin,  collagen disruption and an in growth of blood vessels. It also leads to muscle dysfunction and changes in the pain systems.

Risk Factors:

• Smoking
• Obesity
• Repetitive wrist extension which is carried out for more than 2 hours per day
• Vigorous activity (managing loads of over 20kg at least x10 a day)
• Handling tools heavier than 1kg.

Common symptoms include:

• Pain on the outside of your elbow.
• Pain from your elbow down into the forearm.
• Difficulty with gripping activities due to pain.
• Difficulty with twisting movements such as opening jars.

What you can do to help yourself

Avoiding aggravating activities and activity modification

• Turning palm up while lifting
• Racquet sports – avoidusing a heavy racquet or with a too small grip size
• Using lighter tools at work
• Counter force brace – some people get relief from using a counterforce brace to offload the tendon when using their arm.

Address ergonomics

• Mouse – ensure your mouse is within close reach. It should be positioned at your side with your arm close to your body and a straight line between your hand and your forearm. The mouse should fit your hand, as if it is too small then this can cause your finger, hand and wrist muscles to remain tense.
• Keyboard – your wrists should be straight and not bent up or down. Do not raise the back of your keyboard as this can increase the strain on your wrists. If your hands are not level with the keyboard you can use a wrist pad.
• Maintain a 90 degree angle between forearms and upper arm. If your forearms are too high or too low, adjust the height of your chair.
• Ambidextrous vertical mouse – reduces exaggerated movements at the wrist joint to reduce stress on muscles and tendons. It can be used in the left and right hand to share the workload.
• Split Keyboard – can help keep your hands in a more neutral position.

Reduce / Quit Smoking

Smoking has been found to reduce circulation. If circulation is poor, tendons may take longer to heal and therefore will increase the risk of injury.  Previous smokers are also at increased risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system. You can find help to reduce or quit smoking here – here

Weight Loss

Being overweight can increase the inflammatory molecules in the body which can lead to local and systemic inflammation within the body and therefore poorer healing and resolution of pain. You can calculate your BMI here to find out if you are a healthy weight.

Physiotherapy

The majority of patients (80-95%) with this condition will resolve with conservative treatment.

For lateral epicondylalgia there is no quick fix. There is no substitute for a thorough examination to allow for a specifically tailored treatment approach.

Physiotherapy will include:

• Specialise strengthening program and load management.
• Manual therapy – which may include joint mobilisations, soft tissue release and acupuncture to settle pain.

ESWT 

Extracorporeal Shock-Wave Therapy (ESWT) is a treatment method which sends sound waves into the tissue which initiates a pro inflammatory response to the affected tissue. This increases blood circulation and metabolism in the affected area to accelerate the body’s own healing process.

For further information about ESWT – please click here

Ultrasound Guided Dry Needling

If conservative treatment is failing then “dry needling” of the tendon may help stimulate an inflammatory reaction within the tendon to kick start the healing process. We do this using ultrasound guidance to ensure we target the exact tissue. If you would like to read more information on this then please click here.