Coping with degenerative joint disease of the knee |

Coping with degenerative joint disease of the knee

Mara Pacyga MSPT, Pilates InstructorAlpine Physical Therapy & Wellness Center, PCFraser, Colorado

You are not alone if you suffer from degenerative joint disease (DJD) of your knee. Forty-three million Americans suffer with you, with costs of $51 billion per year to care for these painful, functionally limited knees. DJD, or osteoarthritis, of the knee is a process of wear and tear of the joint surfaces of the knee. It can be considered a disease for the reason that once you have it, you must live with it. Yet, you can choose to let pain limit your life; or you can choose to be proactive at lifestyle changes, exercise, and nutrition to promote getting the most function and fun out of your knee as possible. DJD of the knee is a process of damage to and degeneration of joint surface cartilage. The surface cartilage is called hyaline cartilage, which is approximately 2-4mm thick, covering both the joint surface of the femur and that of the tibia. Hyaline cartilage is a matrix made up of 60-80 percent water and 20 percent type II collagen. Cellular type II collagen provides tensile strength to the cartilage surface. Another part of the matrix, made up of chondroitin sulfate and hyaluronic acid, provides compressive strength to the joint surface. This hyaline cartilage does not have any blood supply. Thus, it relies on diffusion of the joint’s synovial fluid through mechanical forces for absorption of healthy nutrients. Without a blood supply, this cartilage cannot heal. Injury to joint cartilage happens from trauma, shear and torsional forces. Have you ever fallen, or landed a basketball jump incorrectly, or tweaked your knee? We all have. As we age, it is a natural process that we also dehydrate, thus losing water as an important substance to the integrity of our joint cartilage. You can argue that we all have a certain stage of knee DJD.Partial thickness loss to the joint cartilage leads to weakened cartilage, irregular joint contact, and aberrant force distribution. A full thickness loss of the joint cartilage can then lead to bone involvement. The bone has blood supply; therefore, an inflammatory response could be created, leading to cells in the blood supply differentiating into either bone or weaker cartilage. This weaker cartilage is type 1 cartilage is called fibrocartilage. Therefore, you end up with either bone spurring, a weaker cartilage band-aid, or possibly a condition in which you are bone on bone. Prevention and early conservative management of knee DJD can prolong the functional lifespan of your knee. The risk factors for knee DJD that we can control include obesity, poor nutrition, joint malalignment and mechanical stress. Those that we can’t control include age, injury, and a previous knee surgery. The components to a preventative/maintenance therapy program for knee DJD include the following: Mobility flexibility of the hip, knee, and ankle Strength functional strength of the hip, knee and ankle as well as core strength Dynamic stability/mobility ability to maintain good alignment of the lower extremity with static and dynamic balance and performance challenges, thus allowing for appropriate shock absorption and decrease harmful joint loading Biomechanical counseling posture and movement strategies to decrease knee pain and preserve your jointsYour physical therapist can help guide you with your exercise program and lifestyle changes as well as help you set appropriate activity limits to slow down the degenerative process. Speak with your doctor about the various supplements available for joint health. You can make a significant impact on the health of your knees, just ask for help.

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