Osteoarthritis is the most common type of knee arthritis. It is a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age (Figure 1). Osteoarthritis usually develops gradually and tends to cause varying degrees of pain and swelling when you stand or walk and before a change in the weather. It can also lead to stiffness, especially in the morning and after you've been active, and to a loss of flexibility in your knee joints.



What factors increase the risk of developing OA knee?
Several factors may increase the risk of developing osteoarthritis of the knee.
• Age: The ability of cartilage to heal itself decreases as people age.
• Subluxation: Subluxation of the spine and lower limbs.
• Weight: Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage.
• Repetitive stress injuries: These are usually associated with certain occupations, particularly those that involve standing, kneeling, squatting, walking upstairs and downstairs frequently.
• Other causes: Trauma, e.g. sprain, contusion or fracture

What are the symptoms?
1. Pain in the affected joint after repetitive use, especially worse later in the day. There can be swelling, warmth, and creaking of the affected joints.
2. Pain and stiffness of the joints occur after long periods of inactivity, e.g. sitting for a long time.
3. In severe case, it causes pain at rest or pain with limited motion.

What are the treatments?
1. To reduce weight and avoid activities that exert excessive stress on the joint cartilage
2. To reduce joint pain and inflammation while improving and maintaining joint function by ice and hot pack, shockwave (Figure 2), interferential (Figure 3), ultrasound, etc.

Figure 2: Shockwave therapy    Figure 3: Interferential therapy

3. To strengthen the muscular support around the knee joint especially on quadriceps. Swimming is particularly suited for patients with osteoarthritis because it allows them to exercise with minimal impact stress to the joints.
4. To correct the misalignment of the spine.
5. To provide support devices, such as braces and walkers for reducing stress on the joints.
6. To assess daily activities and determine additional devices that may help patients at work or home
7. Some studies, but not all, have suggested that the food supplement glucosamine can relieve symptoms of pain and stiffness for some persons with osteoarthritis. Fish oil supplements have been shown to have some anti-inflammation properties and increasing the dietary fish intake and/or fish oil capsules (omega 3 capsules) can sometimes reduce inflammation of arthritis.