The Knee
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• The knee is designed for mobility and stability
• Along with the hip and ankle, it supports the body when standing, walking, climbing and during sports activities.
• The knee consists of two joints, the knee cap joint or patellofemoral joint and the joint between the long bones or tibiofemoral joint.
• These joints are interposed by articular cartilage and menisci, and further supported by soft tissues such as the synovium, ligaments, capsules, bursa, fat pads and muscles.

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Osteoarthritis (OA) of the Knee
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• OA is a chronic degenerative disorder primarily affecting the articular cartilage of the knee joints, with eventual soft tissue thickening, bony overgrowth at the margins of the joints (bone spurs or lipping) and muscle atrophy.
• The causes of OA knee may be due to injury, from either a major stress or repeated minor stresses.
• Destruction of the joint cartilage occurs when compressive stresses are imposed on the joint surfaces.
• The cartilage loses its ability to withstand stress; it thins out and the bone may become exposed to stresses.
• Crepitation or loose bodies may occur within the knee joint.
• Stiffness occurs with inactivity, but increased pain occurs with certain activities such as stair climbing, getting up from sitting and prolonged walking or standing.
• As the disease progress, motion becomes more limited, hence a vicious cycle of disability, pain, swelling, stiffness and muscle weakness ensue.

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Physiotherapy Management of OA Knee
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• Physiotherapy is extremely useful in the management of OA knee.
• At Pain Relief Practice, our physiotherapists will carry out thorough examination to discover your signs and symptoms of the OA knee and to analyze the biomechanical (activities) stresses that predispose your knee to compressive stresses.
• We have a range of modalities such as the radio-frequency, electrophysical and deep heat modalities to decrease symptoms such as joint pain, swelling and stiffness.
• Our physiotherapists will incorporate manual therapy and exercise program to increase your joint range of motion, strengthen targeted muscles and prevent deformities of the knee joint.
• The physiotherapist will also advise and educate you on the appropriate activities level, either with modification or moderation of your activities in order to prevent and retard the OA progression.
• OA knee can be treated with good outcome if you sought treatment early and you do not need to suffer from OA knee disease or be disable by it.

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Rheumatoid Arthritis (RA) of the Knee
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• RA is a connective tissue disease with inflammatory changes in the synovial membrane, articular cartilage, subchondral bone and often also involves the tendon sheaths.
• With progression of the disease, granulation tissue covers and erodes the articular cartilage, adhesions of scar tissues form and restrict joint mobility, and bone ankyloses causing deformity as well as disability.

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• The onset and progression vary from mild joint symptoms with aching and stiffness to abrupt swelling, stiffness and progressive deformity.
• There are usually periods of exacerbation (flare) and remission.
• During acute RA, there is joint effusion, swelling and a slight increase in temperature over the joint.
• There is pain at rest and increased with motion. The knee joint is tender and warmth and the muscles are guarded or spasm. The person fatigues easily and requires additional rest during periods of flare up.
• During the remission period, pain in the knee when stress or during certain activities. There is limited range of motion and knee joint stiffness, secondary muscle weakness and/or joint deformities.
• Such restriction may cause the person to self-immobilize the knee joint possibly resulting in more secondary changes to the knee joint and affect the overall health as well as the quality of life of the person.

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Physiotherapy Management
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• A detailed evaluation of the RA knee is important to determine whether the tissues are in the acute or chronic stage of recovery as well as to identify the secondary changes of the knee.
• Most physiotherapeutic interventions and exercise cannot positively alter the pathologic process of RA.
• However if physiotherapy is administered correctly based on the stage of the RA disease, it can help prevent, retard and correct the signs and symptoms as well as the secondary changes from RA knee limitations.
• Evaluation of the RA knee is an important prerequisite for identifying the anatomic structure or structures that are causing pain limiting function and also for determining whether the tissue is in the acute or chronic stage of recovery.

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