At AposTherapy® one of the most common conditions we deal with is knee osteoarthritis, we see patients at all stages of the spectrum, in relation to both pain and levels of osteoarthritic changes seen on X-rays. Research has suggested that degenerative changes of the knee will be seen on an X-ray for the majority of the population over 65 years old. It is thought that 80% of the population over 75 years old will show degenerative changes on an X-ray, however only about 60% of people with evidence of knee OA on an X-ray experience symptoms in their knees1. This leads to the question: if 80% of the over 75 population present with degenerative changes on an X-ray why do only 60% experience symptoms?
When reporting on X-rays, osteoarthritis is often categorised from 1-4 on a scale called Kellgren-Lawrence Scale; 1 is considered mild degenerative changes and 4 indicates severe degenerative changes. In the AposTherapy® clinic we often see patients with mild-moderate levels of degeneration (KL 1/2) experiencing high levels of pain whereas some patients present with moderate-severe degeneration on an X-ray (KL 3/4) but report fewer symptoms. This again poses the same question: why don’t the symptoms correlate with the level of degenerative change as reported on an X-ray?
Four main factors are thought to be involved in this equation: mechanical, inflammatory, acquired sensitivity (of the nervous system) and genetic factors. The mechanical factors include accumulative loading with age, Body Mass Index (BMI), repetitive stress/impact and the muscular control patterns being used to support the joint. BMI is a measure of your weight compared to your height, a BMI higher than 25 is considered overweight and over 30 would be considered obese.
There is research to suggest that subjects with higher BMIs are more likely to experience symptoms from degenerative changes. This is a likely link considering the more you weigh, the more load is passing through your knee joints. Even more specifically, the severity of symptoms increases within increasing categories of BMI. Research has shown by losing weight, thus reducing your BMI, you are likely to experience a reduction in the symptoms that result from degenerative changes (OA) in the knee joints. In one study they found that a 5% reduction in weight over an 18 month period resulted in an 18% improvement in function, coupled with dietary changes the functional improvement rises to 24% leading to significantly improved mobility. So losing just 5% of your weight can have more than triple the effect on your ability to function.
In the AposTherapy® clinic, many patients report a vicious cycle between knee pain and BMI; the knee pain reduces activity level, leading to weight-gain which has a negative impact on their knee symptoms, resulting in a further reduction in activity levels. Some patients will then look to surgical options to reduce their pain. However a high BMI is also a risk factor for a poor outcome from surgery as it often results in longer hospital stays, longer functional rehabilitation periods and high risk of complications whilst under general anesthetics, which is related to a higher prevalence of cardiovascular diseases. Due to the increased risks in surgery, in many cases it is advisable to lose weight prior to proceeding with surgery, which leaves the patient in that vicious cycle between pain and weight-gain.
To reduce BMI it is important to focus on both diet and exercise. The exercise must be adjusted to the knee condition so low-impact exercise is preferable. Upper body exercise including the use of weights, hand bicycles can burn a lot of calories. When it comes to introducing lower body exercise swimming (front crawl or back stroke, not breast stroke) and walking in the water is ideal, as well as cycling (ensure the correct bike height) and again appropriate weight training exercises. Exercise that incorporates balance such as, Swiss-ball and gentle cross-fit routines can be helpful for both weight-reduction as well as improving the support for the joint.
Another popular form of exercise is walking, however due to the weight-bearing, repetitive-impact involved it may exacerbate symptoms around the knee. As mentioned above, another mechanical factor affecting the chances of experiencing symptoms from osteoarthritis is the pathological/compensatory pattern in which nerves and muscles are working to control the joints and to cope with pain. This is a factor that can be greatly improved by using AposTherapy®.
Due to the biomechanical adjustments made to the AposTherapy® foot-worn device, pain can be reduced whilst wearing them thus allowing for increased mobility. To gain a benefit through therapy, the patient must be dedicated to performing their treatment regularly; this can be particularly difficult for obese patients who generally tend to lead less active lives. To achieve an improvement through AposTherapy®, the patient only needs to wear the device whilst completing their regular daily routine at home or at work, making it a convenient form of treatment for all patients. By following a personalised AposTherapy® Programme for 2-3 months, patients report a reduction in symptoms in regular shoes as well; this allows them to increase their activity levels and can assist in weight loss.
1 Web resource accessed on 03/06/13
Radiographic Assessment of Osteoarthritis. American Family Physician. Swagerty DL M.D. et al. July 15, 2001