What is knee osteoarthritis?
Osteoarthritis of the knee is a degenerative joint disease that is experienced by many dancers over the course of their lives. It is a progressive disorder of the knee joint, caused by a gradual loss of the joint cartilage and bony deformation. The main symptoms of knee OA are pain, swelling and progressive disability due to limited joint movement.
How can it occur?
Osteoarthritis occurs when the cartilage that covers the surfaces of the bones in your joints gradually deteriorates. Cartilage is a flexible connective tissue that allows almost frictionless joint motion. However, in osteoarthritis, the slick surface of the cartilage becomes rough and diminishes over time.
Intensive dance training over many years is an important risk factor for the development of osteoarthritis of the knee, and the risk will be even higher if you have had severe injuries or operations on the meniscus or cruciate ligaments. Dancers should therefore take all possible precautions to avoid injury.
Repetitive overuse issues on the lower extremities, such as shin splints or stress fractures of the feet, are often related to complex functional problems that involve chronic muscle dysfunction and sometimes severe muscle dysbalance. These significantly increase the risk of developing knee osteoarthritis and therefore must be addressed as soon as possible. Other factors that might contribute to osteoarthritis in dancers include: faulty dance technique, chronic malnutrition, hormonal dysbalance and anatomical abnormality.
What are the typical symptoms of knee osteoarthritis?
Typical symptoms of knee osteoarthritis are pain and stiffness. Pain may occur particularly when you overexert your knee. It usually gets better when you reduce activity and take a break. Stiffness occurs especially after resting, but will get better after you start moving again. Your knee might also produce strange crunching noises called crepitations. They may vary in their intensity and usually arise from the back of the kneecap. A crepitation alone, however, does not implicate that you have osteoarthritis. Many dancers and athletes have crepitation of their knees for different reasons.
Swelling of the joint may also occur after physical activity and can be quite severe. In acute inflammation of an osteoarthritic joint, you may not be able to bare weight on your knee. You’ll probably find that your pain will vary and that you have good days and bad days, sometimes depending on how active you’ve been but sometimes for no apparent reason.
Some people find that changes in the weather especially damp weather and low pressure make their pain and stiffness worse. With progressing osteoarthritis your knee may show significant deformation and become bent or bowed. Bony spurs called osteophytes may form along joint margins and typically limit joint movement.
This X-ray shows an overview of the knee. The joint space between femur and tibia is fully collapsed on the inside part of the knee (right half of the picture) There are osteophytes starting to grow on the edge of the tibial plateau.
How can knee osteoarthritis be diagnosed?
Your doctor will examine your knee and review your symptoms as well as your current daily life activities. He will especially check for pain and swelling of your knee. He will also put a focus on joint range of motion, leg alignment and knee stability. X-rays are the most useful tests to confirm an osteoarthritis. They may show present bone deformation such as osteophytes and narrowing of the space between bones. X-rays aren’t a good indicator of how much pain or disability you have. Some people have a lot of pain from minor joint damage but others only have little pain from severe damage. Your doctor may suggest to have an MRI-scan of your knee, which will show the soft tissues (e.g. cartilage and meniscus) and changes in the bone (e.g. stress reactions) that can’t be seen on standard X-rays.
What are the treatment options?
Different treatment options exist depending on the level of pain and damage suffered by a patient. Non-operative treatment is often limited by structural deformation of the joint due to the ongoing degenerative process. However, muscle dysfunction and dysbalance are important factors, influencing the function of an arthritic knee and can be addressed specifically to improve pain and function.
Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the treatment process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with these functional problems.
If pain is the limiting factor to an active rehabilitation approach, the use of anti-inflammatory drugs and steroid injections to the knee may be recommended. Also, aquatic training can be a good way to start training the knee in these situations. Manual medicine and especially deep myofascial release treatment can be used to address present joint and myofascial dysfunction. Dysfunction of the fascia plays an important role with pain in osteoarthritis and can be addressed effectively with myofascial release techniques.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
Surgery may be recommended if you have severe pain or mobility problems and non-operative treatment has failed to improve the situation.
There are several kinds of replacement knee joints as well as different surgical methods. Your doctor and orthopedic surgeon should help you to choose the best option for you, taking into account the condition of your knee and your general health.
Do you think that you might have knee osteoarthritis and want to have it sorted out? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Find a specialist in manual medicine
Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.
- Start working on your problem
There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.