Osteoarthritis (OA) is the most common form of arthritis and affects roughly 30-40 million Americans. The condition is due to a metabolic disorder of cartilage, the gristle that caps the ends of long bones. Cartilage functions to cushion the joint against impact and also to allow gliding of the joint with movement.
Cartilage consists of cells called chondrocytes that sit inside a matrix- much like grapes inside of gelatin. Normally, chondrocytes produce substances that build up and nourish the matrix. When osteoarthritis develops, the chondrocytes begin to function abnormally and no longer elaborate normal matrix.
Instead, chondrocytes begin to produce destructive enzymes that weaken the matrix. Small cracks in cartilage develop. At the same time, the lining of the joint (synovial capsule) is stimulated to produce inflammatory enzymes that further weaken cartilage. The end result is loss of cartilage. As cartilage wears away, the joint begins to become mechanically unbalanced leading to more damage.
Conventional treatment for osteoarthritis of the knee consists of patient education, maintenance of ideal weight, supplements such as good quality forms of glucosamine/chondroitin, bracing, lateral wedge insoles, non-steroidal anti-inflammatory drugs, injections of glucocorticoids (steroids), injections of viscosupplements, and sometimes surgery. (All of these have been described in previous articles by me).
One often neglected but critical component of treatment is exercise. A recent review discussed the importance of exercise and reached some interesting conclusions. (Bennell K, Hinman R. Current Opin Rheumatol. 2005; 17: 634-40)
Benefits of exercise appear to be additive when exercise is delivered with other interventions such as weight loss.
Types of exercise include strengthening, stretching, and non impact aerobic exercise, all of which are important and which work synergistically.
It appears that supervised exercise sessions are superior to home exercises for pain reduction. The challenge is to convince patient so the importance of exercise. One interesting question is whether exercise can prevent disease or slow its progression.
Also it is apparent that certain patient subgroups that may respond differently to treatment. It has been substantiated that one major risk factor for the development and progression of knee OA is weak quadriceps muscles. This is especially true for women. As a result, if strength training is administered to this high risk group, it may be able to prevent knee osteoarthritis.
According to the authors, novel exercise programs that strengthen hip muscles or alter impairments in knee neuromuscular control may also influence disease progression.
They conclude that "Future studies must identify cost-effective exercise modes, strategies to maximize exercise compliance and optimal treatment combinations. The role of muscle strength and altered neuromuscular control in the prevention and development of osteoarthritis must be evaluated with the view to devising and testing novel exercise interventions."
As a rheumatologist who sees many many patients with OA of the knee, I encourage a comprehensive exercise program along with many of the other treatments described above. No one treatment will work for a patient. However, the right combination of treatments will work for almost all patients. Exercise is an oft-neglected but important component of a comprehensive knee care program with OA.
Related Articles
Can Exercise Prevent Me From Getting Arthritis In My Knees?
By: Nathan Wei | 10/10/2007 | Medicine
Arthritis is the most common chronic disease and affects almost 70 million Americans.
There are more than 100 different types of arthritis and each is treated somewhat differently from the others. The most common form of arthritis is osteoarthritis (OA).
Osteoarthritis (OA) is a major cause of disability among adults over the...
Arthritis Pain Relief- What your Doctors Forgot to Tell you About Arthritis Treatment
By: Joe Barton | 07/11/2007 | Alternative Medicine
What 4 things are essential for arthritis pain relief? Nutrition, Exercise, Oxygen and ??? Discover 8 tips for pain relief and discover what supplement will regenerate cartilage between arthritic joints.
Adverse Effects of Arthritis Painkillers and How to Minimize Them
By: Suman | 15/04/2007 | Medicine
Millions of people are dependent on NSAID drugs to reduce arthritic pain and inflammation. Habitual use of these drugs can lead to dependence on drugs and complications. It is important for arthritis sufferers to learn how to minimize these side effects and to reduce their dependence on drugs.
Can Rooster Comb Injections Prevent Knee Replacement?
By: Nathan Wei | 24/10/2007 | Medicine
Osteoarthritis (OA) of the knee is one of the most common problems seen by both rheumatologists as well as orthopedists in the office. The standard forms of therapy include maintenance of proper weight, exercise, application of cold, bracing, analgesics (pain killers), anti-inflammatory medicines, steroid injections, and viscosupplementation. This latter type...
By: | 31/12/1969 |
What Is Hyaluronic Acid And How Does It Work For Arthritis?
By: Nathan Wei | 28/10/2007 | Medicine
Hyaluronic acid (HA) - also known as hyaluronan- is found in all tissues and body fluids. What this article will describe is what HA does in the joints, particularly the knee.
HA is a major component of synovial fluid. Synovial fluid is the naturally-occurring lubricant found in joints.
HA has a variety...
Physical Therapy and Exercise for Arthritis
By: Igor S | 07/08/2008 | Diseases and Conditions
Arthritis treatment often includes physical therapy and exercise. Physical therapy and exercise for arthritis focuses on pain relief, and in restoring function and movement. Increasing the range of motion of a joint is the primary focus of physical therapy.
I Have Osteoarthritis Of The Knee... What Does The Future Hold For Me?
By: Nathan Wei | 09/12/2007 | Medicine
One of the most common afflictions of the baby boomer generation is osteoarthritis of the knee (OAK). Up to 20 million Americans may suffer from this condition.
OAK develops as a result of degradation of the articular cartilage. Articular cartilage is the smooth lining or gristle that covers the ends of...
Got a Question? Ask.
Ask the community a question about this article:
Q&A Powered by:
Latest Medicine Articles
How Women Can Decrease Their Blood Pressure
By: Marci Lall | 16/10/2008
It's a no brainer that regular exercise can help lower high blood pressure. To help you throw your sedentary (inactive) lifestyle out the window and decrease your BP values, incorporate some of these exercises into your daily routine and watch your BP amazingly decrease.
If you do have blood pressure keep...
Buy Ultram Online- Pain! Forget This Word
By: Article Manager | 16/10/2008
Buy Ultram online is beneficial in the treatment of moderate or severe pain. When the treatment is required in order to treat moderate to severe pain, your doctor may recommend you a comprehensive release Ultram. Buy Ultram online from any online store because it is time and money saving way.
Buy Soma- Enjoy a Pain Free Life
By: Article Manager | 16/10/2008
In any kind of muscle pain, use Soma and say good bye to your pain. Soma is very valuable drug in relaxing and relieving the muscle pain. Patients who are suffering from strains, sprains, spasms and many other muscle injuries usually buy Soma. This medication is quite effective particularly with musculoskeletal pain.
Natural And Organic Alternatives To Cosmetic Surgery
By: Hannah Walker | 15/10/2008
It seems that in today's society people will go to greater and more dramatic lengths to pursue their physical ideal and many do not bat an eyelid at the idea of going under the knife. However no one should be fooled by the glamorised, celebrity endorsed culture of cosmetic surgery;...
Is LASIK the Right Thing For You to Do?
By: Lizzie J | 15/10/2008
Most people know a little something about LASIK surgery, but few people under enough detail to make a decision on having the surgery. Here are some basic facts about LASIK that you may need to know before you have this surgery.
When you are considering LASIK surgery to correct your vision...
What to Consider When Choosing Skin Mole Removal
By: Justin DiMateo | 15/10/2008
Procedures to remove a mole are often fairly non-invasive and can usually be done in a doctor's office using local anesthetic. Whether you are choosing to remove a mole for skin cancer suspicion, irritation or cosmetic reasons, there are a couple of methods that you can discuss with your doctor....
What Are Headaches?
By: Annette Badowski | 15/10/2008
In short, a headache is not a disease, but it may indicate that something is wrong. While most headaches are common and not life threatening, some may have an underlying cause that requires medical attention. The most common headaches are "tension", "stress' and "migraine" headaches. Tension and stress type headaches...
What is Lumbago?
By: Annette Badowski | 15/10/2008
The medical industry defines lumbago as mild to severe pain or discomfort in the region of the lower back. There are two specific types of lumbago pain, specifically, acute (pain can be sudden and severe and comes and goes) or chronic, lasting over three months. Lumbago can strike anyone, but...
More from Nathan Wei
Tarsal Tunnel Syndrome: Carpal Tunnel Syndrome of the Foot?
By: Nathan Wei | 10/10/2008 | Medicine
Tarsal tunnel syndrome is condition where the posterior tibial nerve in the ankle is compressed. In many ways, this condition is analogous to carpal tunnel syndrome in the hand where the median nerve is compressed.
With tarsal tunnel syndrome, compression of the tibial nerve occurs within a tunnel created by a...
The Ultimate Betrayal Of The Knee Arthritis Lambs
By: Nathan Wei | 29/09/2008 | Medicine
About 20% of the 900,000 arthroscopic knee surgeries performed annually in North America are done as treatment for osteoarthritis (Time, 2008). A knee arthroscopy is a procedure where a small telescope is inserted into a joint and debris is removed. The vast majority are done by orthopedic surgeons.
It turns out...
Stem Cell Therapy For Arthritis: Is It Possible To Wind The Aging Clocks Of The Cartilage Cells In Your Joints Backwards?
By: Nathan Wei | 24/09/2008 | Medicine
Research on stem cells is leading scientists to investigate the possibility of cell-based therapies to treat disease, which is often referred to as regenerative medicine.
Stem cells have two important characteristics that distinguish them from other types of cells. First, they are unspecialized cells that renew themselves for long periods of...
Doctor, When Should Muscle Relaxants be Used For Arthritis?
By: Nathan Wei | 12/09/2008 | Medicine
One question that comes up repeatedly is, "Where do muscle relaxants fall into the treatment approach for different musculoskeletal conditions"?
Patients will sometimes ask about them and physicians who see these patients sometimes wonder if these drugs should be considered.
Skeletal muscle relaxants are the most widely prescribed drug class in the...
Knee Replacement Surgery May Be A Thing Of The Past For Many Baby Boomers
By: Nathan Wei | 12/09/2008 | Medicine
Today, Baby Boomers (defined as those people born between the years 1946 to 1964) are living longer, staying more active, and very interested in continuing to maintain a vigorous lifestyle.
Multiple research studies have demonstrated the benefit of regular exercise in forestalling the complications related to such degenerative conditions as diabetes...
Doctor... Tell me About How I Can Get Into a Research Trial For my Arthritis?
By: Nathan Wei | 11/09/2008 | Medicine
Research trials are conducted for all pharmaceutical drugs for arthritis that eventually reach the market.
A clinical research trial may be the only way you can get early access to a breakthrough arthritis treatment; however, there are pluses and minuses so it's important to understand the questions that need to be...
A New Test to Detect Osteoarthritis Early... Will it Help?
By: Nathan Wei | 10/09/2008 | Medicine
Osteoarthritis is the most common form of arthritis. It affects more than 20 million Americans according to some estimates. Because osteoarthritis (OA) is primarily a degenerative process, the incidence and prevalence of this disorder is expected to rise with the surge in Baby Boomers.
OA affects weight-bearing joints such as the...
Actemra, The New Rheumatoid Arthritis Drug... What Makes it so Special?
By: Nathan Wei | 09/09/2008 | Medicine
Biological response modifiers (BRMS) are drugs that target inflammatory pathways in rheumatoid arthritis (RA) and represent a relatively new approach to the treatment of RA.
Medications that block tumor necrosis factor alpha (TNF-a), a pro-inflammatory cytokine important in the pathogenesis of RA, were among the first to be developed and approved...
Health 
