Knee Osteoarthritis

Knee pain in the middle to late decades of life is a common complaint amongst patients presenting to osteopathic clinics across the globe. Osteoarthritis (OA) is a common cause of knee pain in this age group of people. Research suggests approximately 654 million people aged 40 years and over were living with knee OA in 2020 around the world. This comes at an incredible cost to healthcare services worldwide, with figures in the billions of dollars!

What is osteoarthritis?

Osteoarthritis is just one of a number of forms of arthritis… Essentially a disease which affects the joints in our body. OA is the most common form of arthritis, with Rheumatoid Arthritis (RA) being the second most common form. This blog will focus on OA, a potentially debilitating disease that most commonly affects the weight-bearing joints of the body (i.e. the knees, hips and lumbar spine), but can affect any joint in the body where the joint surfaces are covered in cartilage.

The characteristics of OA include loss of the cartilage that covers the ends of bones that come together to form joints. The underlying and surrounding bone, as well as other joint structures (including joint capsules and other tissues) are also susceptible to degenerative changes that ultimately lead to poor functioning of a joint. The process usually occurs over a long period of time, often starting early in life (interestingly with little to no symptoms at all) and progressing into the latter years. The severity of the disease varies from person to person with some people only experiencing mild symptoms throughout their life. Other people experience more severe symptoms and may require joint replacement surgery as a last port of call to ensure they can continue to live their life as pain-free as possible.

Osteoarthritis of the knee can affect either of the two main joint components of the knee… The joint between the ends of the thighbone and the shin-bone (called the tibiofemoral joint), and the joint between the thigh-bone and the knee-cap (called the patella-femoral joint).

 

Risk factors

There are certain factors associated with higher rates of knee OA. These include:

  • Age: Rates of knee OA increase in the elderly
  • Obesity: Rates of knee OA increase with higher levels of obesity
  • Gender: Females slightly out-do the males with this one, being approximately 1.5 times more likely to develop it
  • Trauma: A trauma to the knee can increase your likelihood of developing knee OA
  • Smoking: Smoking is associated with higher rates of knee OA

 

Signs and symptoms

The signs and symptoms of knee OA include:

  • Pain
  • Stiffness
  • Swelling
  • Reduced range of motion
  • Difficulty performing functional movements including squatting and kneeling

 

Pain associated with tibiofemoral OA commonly affects the inside region of the knee first, where the two bones meet at the joint line. Patella-femoral related pain is often felt deep behind the kneecap. Pain will vary from one person to another, and the severity of pain does not necessarily relate to the severity of degeneration. Although if you speak to a person who is about to have a joint replacement surgery (i.e. their joint has degenerated to the point of needing a surgical intervention to keep the person functioning well), they will likely tell you that the pain is extremely debilitating.

Pain and stiffness are regularly felt first thing in the morning and late at night. OA tends to respond well to movement of the joints, and so people often find their pain and stiffness improves once they are up and moving, for it to return once their day has finished and they are relaxing at night.

 

Treatment

So, you’ve been diagnosed with knee OA. What to do? Call your osteo… Ta-dah!!!! Given we are experts in how the human body moves (we study human biomechanics at uni), we’re good at picking up how the body should and shouldn’t move. There are no magic pills for treating OA of the knee, and no practitioner can claim to treat the disease itself, as there is unfortunately no cure for OA. It is a progressive, degenerative disease, but there are ways of stunting the progression of this condition if the risk factors leading to its presence are attacked head on.

Poor movement resulting from daily postural repetitive strain, or an old injury that wasn’t treated to resolution is a big factor in the maintenance and development of OA in the knee. Poor movement or dysfunction occurring in the low back, hip or ankle can all lead to excessive load being placed through the knee joints, which can exacerbate the disease process. This is where we come in. We can watch you move during an assessment and work out what is causing the excessive loads through the knee and put a plan in place to improve range of motion and flexibility, strengthen muscles and return you to (hopefully) pain-free daily activities. We will use a combination of soft tissue manipulation, joint mobilization and progressive exercise programs to restore life to your body. Returning to efficient movement patterns after years of neglect, poor movement and a de-conditioned body part will take time, but with determination from both you and your practitioner, it can happen.

 

As previously mentioned, some cases of knee OA can end up requiring surgical intervention to replace either part of or the whole joint. The good news is, if you do have to go through this process, we have your back (well… in this case, your knee) and can help you through rehab and recovery. Many people who have a knee replacement return to full daily activities and live a long and pain-free life.

Knee pain? What are you waiting for? Call us today on (416) 546-4887 or book online to schedule your appointment.

 

References
1. Cui, A. et al. 2020. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 100587. 29-30. Available from: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2820%2930331-X

  1. Arthritis Australia. 2016. Counting the cost. [Online]. Available from: https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final-Counting-the-Costs_Part1_MAY2016.pdf. [Accessed 09 February 2021]
  2. Centres for Disease Control and Prevention. 2020. Cost statistics: The cost of arthritis in US adults. [Online]. Available from: https://www.cdc.gov/arthritis/data_statistics/cost.htm. [Accessed 09 February 2021]

Vertigo

Vertigo: symptoms and treatment

Benign Paroxysmal Positional Vertigo (BPPV). In simple terms, a non-serious sudden attack of
dizziness brought on by a change in head position.

What is vertigo?
Vertigo is a type of dizziness where a person experiences the sensation of whirling, spinning or swaying. A person will usually feel that they, or objects around them are moving when they are not. There are several causes of vertigo, with the most common cause being BPPV. Other common causes include Ménière’s disease (vertigo with hearing loss and ringing in the ears) and labyrinthitis (inflammation of the inner ear). The ear is made up of an outer, middle and inner section. The outer ear is the ear that we see on the head and the opening that leads into the head itself. This connects to the middle ear — a small area inside the head which houses the ear bones, connects to the inner mouth and also the inner ear. The inner ear is the section which houses our hearing and balance organs — the cochlea and the vestibular system. It is this most inner section which is involved with BPPV.

What causes BPPV?
The structure of the inner ear is quite complicated. It is a maze of hollow chambers and canals
all connected together and filled with fluid. There are three semi-circular canals which are
expertly positioned to detect movement in the 3 planes that our head can move (nodding up and
down, tilting left and right, and looking left and right). Inside the chambers live tiny crystals
which, when movement of the head occurs, move and send important information to the brain
about what type of movement is occurring. Sometimes these crystals become detached from
the chamber and move into the canals where they can play havoc.
Basically, the crystals move through the fluid which stimulates nerve endings in the canal. The
nerves then send a message to the brain which the brain perceives as movement, even though
the head isn’t actually moving. Because this information doesn’t match with what the eyes are

seeing and the ears are detecting, we experience vertigo. It is one big mismatch of information
which is tricking the brain. And the effect is quite unpleasant!
An attack of BPPV can be brought on by a quick change in head position, when rolling over in
bed, sitting up from lying down, or when looking up to the sky. A recent head injury or
degeneration of the inner ear system can precede episodes of BPPV.

Signs and symptoms
The main symptoms as discussed include a sensation of spinning or swaying. People may also
experience feelings of light-headedness, imbalance and nausea. Attacks will usually only last a
period of a few minutes and may come and go. It is not unusual for a person to have a period of
symptoms followed by a period of no symptoms for months at a time. If symptoms persist for
longer than a few minutes at a time, then it is likely the vertigo is from a different cause.
Some conditions that cause vertigo can also give symptoms of headache, hearing loss,
numbness, pins and needles, difficulty speaking, and difficulty coordinating movements.
Episodes of vertigo may also be much longer or constant. If you experience any of these
symptoms they should be reported immediately as they could be signs of more serious issues,
which will need to be investigated.

Can it be treated?
BPPV is very treatable. Many people with dizziness end up seeing their GP first, but it is
common for a GP to refer these cases to us here at Beachealth for ongoing
management. After a thorough session of questioning and assessment, if we are happy with our
diagnosis of BPPV, then we can get to work right away.
BPPV can affect any of the semi-circular canals mentioned above. For treatment, we need to
first bring on the symptoms. It sounds sadistic, but it is necessary to ensure we resolve the
symptoms for you. Treatment for BPPV consists of a series of head and body movements
where you start seated, move into a lying down position and end sitting upright again. This
series of movements is known as the Epley Manoeuvre and is used to treat the most common
form of BPPV. If the source of the problem is coming from a different canal, then the treatment
will be slightly different.
We then send you away with some general do’s and don’ts. You may have to keep your head
relatively still for the rest of the day (sorry, heavy exercise is not recommended at this stage)
and to sleep propped up for the first night after treatment. We will then organise for you to come
back in within a few days to reassess and if necessary continue with another treatment.

Final comments…

Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other
structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so
important that we have a thorough consultation, to ensure we develop the right treatment plan
for you. If you think you are experiencing vertigo, please come in and speak to us. Osteopaths
are highly trained medical practitioners who can help treat more than you think. Call us today on
(416) 546-4887 to book your consultation.

References:
Vestibular Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV).
Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-
disorders/benign-paroxysmal-positional-vertigo.
Healthline. 2018. Benign Positional Vertigo (BPV). Available from:
https://www.healthline.com/health/benign-positional-vertigo.
HANDI project team. 2013. The Epley Manoeuvre. Australian Family Physician. 42 (1). 36-37.
Available from: https://www.racgp.org.au/afp/2013/januaryfebruary/the-epley-manoeuvre/