Osteoarthritis of the knee, or degenerative joint disease, is an arthritic condition in which the protective covering (articular cartilage) which lines the bones on the tibia, femur and/or patella has begun to erode and become soft and frayed.  As the cartilage deteriorates, the bones begin to rub together causing pain, swelling and a decreased ability to tolerate various activities.

In treatment of this condition, we have found a few things in particular to be very helpful in reducing the symptoms associated with this problem.

Activity modification:
Modification of those activities that increase symptoms is essential.  Finding the level of activity that your knee can tolerate with given activities will help in making the time spent performing them more comfortable.  For instance, if you find that 1 - 2 days of doubles tennis a week is tolerable and does not significantly increase pain and swelling, then that is your guideline.  If, however, your knee really bothers you every time you try to play singles or more than a couple of days a week, then it is time to listen to your body. It is helpful to equate your knees to a "bank account".  You will have to budget your knee money in order not to have pain that debilitates (or bankrupts) you. 

Range of Motion and Flexibility:
Many people continue to underestimate the value of maintaining their maximal flexibility level and joint range of motion. Daily stretching is critical joint health flexibly muscles help the joint to function efficiently and with the least amount of strain. The long-term osteoarthitric knee tends to display a decreased amount of knee extension. We have found that mobilizing the knee to restore as much extension as possible will help relieve symptoms and improve gait. Hip and ankle range of motion must also be optimized to provide as much force distribution throughout the lower extremity as possible.  The stretches below should be done daily.  Hold all stretches for 45 seconds.

Hamstring stretch.  Keep knee slightly bent, pulling leg towards chest.		Gluteal stretch.
Quad stretch.  Keep stomach muscles tight and low back flat		Calf stretch.  Cross back leg beyond, keep weight on outside of back foot, heel down.

Shoe wear:
The use of shock absorbing insoles and/or cushioned shoes is also very helpful in reducing the pounding to the joint throughout the day.  Modification of shoe choice to accommodate insoles and preferably wearing a running shoe that has a significant amount of cushion can reduce the ground reaction force onto the joint by up to 20%.  The less often you stress the joint repetitively, the less overall damage in the long run.  Even though you may not a run, a good running shoe will help your knee.  Just think if running shoes are good for people who do marathons, they must be great for just running errands.    Go to a reputable running store and try on at least 3 pairs of running shoes.  Choose the one that feels the best to you.  Keep them fresh by replacing them about every six to nine months.

Example of good athletic shoes and placement of wedges (inside shoe) for lateral OA

Unloading wedges:
If the standing posture of your knees is either bowlegged (varus) or knock-knee (valgus), then this also increases the stress onto the joint.  We have found the use of unloading wedges in your shoes is also helpful in taking that load off the involved side of the joint and distributing it more evenly onto the knee.  The wedges are placed inside the shoe and under the insole if possible. They are placed the medial side of the heel for lateral OA and under the lateral side of the shoe for medial OA. This aids not only in pain relief, but also decreased wear onto the joint.

Unloading knee braces:
Custom-made or off-the-shelf knee braces are another way that equipment may be utilized to reduce the forces onto the joint.  If your physician feels that you are a candidate for an unloading brace, then one can be fit to your leg and used for activities that typically produce pain or symptoms.  Some wear the brace just for activity, while others wear their brace more often throughout the daytime. 

Unloader brace for medial OA

Glucosamine:
Glucosamine is a substance synthesized by the body and naturally present in cartilage.  It stimulates cartilage cells to produce certain compounds that are the building blocks of articular cartilage.  It acts as an antiinflamatory, an inhibitor of degradative cartilage enzymes, and a stimulant of joint lubrication.  We have found that 1500 mg of glucosamine daily to be the most effective dosage.  This can be obtained at most health food stores as a pill or in grocery stores in the form of Joint Juice.  Other information on glucosamine can be found at Glucosamine/Chondroitin Sulfate.           

Body weight:
Maintaining a light weight helps to reduce the extra stress onto the joint.  This is accomplished by one hour of exercise seven days a week, drinking at least six tall glasses of water each day preferably before each meal, avoid eating between meals, and maintaining a healthful lifestyle.  The knee joint cycles approximately 2-3 million times per year at up to five times body weight (depending on the height of the steps).  A weight loss of 10 pounds leads to up to 50 pounds off the knee with each of these few million steps each year.  Optimize your weight!

Pain management:
Pain management techniques such as moist heat packs, warm baths and jacuzzis help to relax sore muscles and relieve the tightness and soreness.  These are also good to use as a warm-up prior to a good stretching and strengthening program.  The use of cold packs for 15 minutes is very effective when the knee feels acutely irritated or inflamed, or any time after prolonged activity.  The use of over-the-counter drugs such as acetaminophen (Tylenol) which is a non-aspirin pain reliever can also prove beneficial.  Glucosamine when used daily helps diminish inflammation and pain in a safe manner.  Always consult your physician before taking any anti-inflammatory medication regularly.

Exercise:
Exercise is a critical component in the treatment of osteoarthritis because it helps strengthen the muscles that surround the joint and the muscles aid in shock absorption. Meaning weak leg musculature leads to increased force through the knee, hip and spine.  All people should be on a muscle strengthening program but especially people with arthritis.  When one join hurts we try to find exercises for the other joints.  Other benefits of exercise include improved stability, increased joint flexibility therefore decreased stress on one part of the joint.  Bicycling and swimming are great exercises for sore joints. Bicycling is one of the best ways to get an intense workout without putting extra stress on the joint surfaces.  Riding a street or stationery bike for at least 30 minutes 3-4 times per week will be beneficial. The key is to keep progressing on the intensity of your rides as you improve.  Pool exercises such as leg lifts, smooth gentle kicking strokes with a kickboard focusing on the hip, and deep water running with the use of a flotation belt are also very effective in increasing strength without increasing symptoms. Keeping flexible through daily stretching exercises is helpful.  Yoga, Pilates, and dance exercises keep the body moving.

The exercises below are more specific for the lower extremities and can be dome with very little equipment in your home. All exercises should be essentially pain free.  Be careful with form and progress gradually, adding only 5-10 repetitions per week.  The following exercises are of a general nature and may not be appropriate for all individuals.  It is best to consult a physical therapist for an individualized program that takes your needs and biomechanics into account.  The best way to protect an osteoarthric joint is to keep the muscles around it strong and flexible in a low impact manner.

For specific strengthening try: