These are the top 7 signs and symptoms of knee arthritis. I’m going to go over each one of these symptoms in detail to help you understand what’s going on inside your knee. I’m also going to give you the one treatment that everyone should be doing to alleviate pain, maintain your independence and ability to perform daily activities, and even slow down the progression of arthritis.
Knee osteoarthritis is characterized by the progressive deterioration and loss of cartilage inside the knee. This can lead to various symptoms, the first of which is pain. Now, some people feel knee pain only when they move a lot, but others feel it even when they're sitting or lying down. For some people, this pain can make it hard to sleep at night, especially if they are tossing and turning in bed.
The really confusing thing about knee arthritis is that sometimes the pain is there all the time, but at other times it comes and goes. This can be rather frustrating because you never know if you can really rely on your knee or if the pain will flare up and then severely limit your day to day activities.
The second symptom of knee arthritis is stiffness. And the stiffness happens because of degenerative changes in the joint. This includes wear and tear of cartilage, inflammation of the synovial membrane, and the emergence of osteophytes or bone spurs. The stiffness is usually worse in the mornings after getting up, but it can also present after extended periods of inactivity such as long drives or sitting in a restaurant.
Everyone experiences knee stiffness in their own way. For some people, it’s just a minor annoyance. But for others, it can make daily activities really difficult. Even simple actions like squatting or walking up stairs can be challenging due to the tightness and stiffness inside the knee.
The third sign and symptom is swelling. And the reason people get swelling is because as the cartilage within the knee joint wears away, things start to rub and grind against each other and that results in inflammation. Inflammation leads to fluid building up, and that makes the knee look and feel swollen. This swelling can make activities that involve bending the knee really uncomfortable. It's also worth noting that the severity and frequency of swelling can vary. Some people experience chronic, persistent swelling, while others only notice it from time to time. This can lead to a lot of frustration as you never really know what’s going to flare up your knee.
Number four is decreased range of motion and mobility. So as the cartilage in the knee wears away, you start to lose the smooth and frictionless motion of the knee. Now if you combine that with the growth of bone spurs and the swelling from inflammation, the knee can get really restricted in movement. This can make a lot of day to day activities like kneeling or getting up from a chair really difficult. Many people also find themselves unable to fully flex or extend the knee. This can significantly affect daily tasks like getting in and out of a car or even putting on shoes.
The bigger concern here is that the joint stiffness, pain, and limited mobility can lead to a cycle of reduced activity. This will then further exacerbate the loss of flexibility and lead to muscle atrophy. In addition, the decreased mobility often impacts a person’s gait, potentially leading to an uneven stride. This leads to compensatory changes and pain in other areas like the hips, the low back, or even the foot and ankle.
So the fifth sign and symptom is mechanical symptoms. And these occur because of the ongoing degeneration inside the knee. One common symptom is called crepitus. This is where people feel or hear a grinding or crunching sound when they move their knees. This happens because the smooth cartilage that once protected the bones is no longer there and now the bones are grinding or scraping against each other.
Another mechanical symptom is the sensation of the knee "locking up" or "catching." This is due to underlying structural issues related to degeneration. Typical culprits are meniscus tears, detached pieces of cartilage, and bone spurs. Any of these can disrupt regular movement, causing catching, or they may become lodged in the joint space, leading to the knee locking up.
Number six is weakness and instability. Pain and inflammation in the knee causes the muscles surrounding the knee to become less active and atrophied. The problem with this is that our muscles are designed to support and provide stability to our joints. And because arthritis can result in significant muscle weakness, many people feel like the knee is not supported. This leads to a sensation that the knee is giving out or buckling. This is much more noticeable during weight bearing activities like walking or standing up from a seated position.
The big downside of all of this is that it results in a lot of hesitancy and fear of movement. Many people intentionally limit their physical activity and avoid situations where their knee might betray them. And overtime, this hesitancy leads to a sedentary lifestyle which then further exacerbates muscle weakness and therefore instability.
The last sign and symptom of knee arthritis is deformity and the gradual loss of the normal definition of the knee. The degenerative process leads to structural changes that distort the normal contours of the knee. Bone spurs develop and can make the joint appear larger or misshapen.
Two of the most common deformities associated with knee arthritis are the bow-legged (varus) deformity or the knock-kneed (valgus) appearance. These altered alignments not only impact the appearance of the knee but also place abnormal stresses on the joint, leading to worse pain and more functional limitation.
So I think it’s important to point out that not everyone with knee arthritis will have all of these signs and symptoms. In fact, the severity of your symptoms do not correlate with the severity of arthritis. Someone who has severe bone on bone arthritis could have very minor symptoms such as a little bit of grinding and catching while someone with mild arthritis could have a significantly swollen knee and have difficulty walking. This is why when it comes to arthritis, we should be treating you and your symptoms NOT your x-rays nor your MRI.
So now that you know the most common signs of arthritis, we can understand why exercise therapy is the foundation of treatment for everyone with knee arthritis. Regular aerobic exercise helps keep the joints moving which reduces stiffness and improves range of motion. This is because aerobic exercise helps stimulate the production of lubrication inside the joint which allows for movement to be smooth. Exercise also improves blood flow which can help decrease inflammation and reduce swelling.
Strength training targeting the quadriceps, glutes and hip muscles, hamstrings, and calves also play a major role in the treatment of knee arthritis. Stronger muscles around the knee can help support and protect the joint. This reduces instability that leads to mechanical symptoms and further wear and tear. More importantly, stronger muscles allow people to be more functional and more independent in performing day to day tasks.
But exercise is only one component of taking a multi modal approach to treating knee osteoarthritis. There are still a lot of other excellent treatments that can not only reduce pain and symptoms, but also potentially slow down the progression of arthritis.
One such treatment is platelet rich plasma injections. PRP is a new and powerful treatment that I have been doing for my patients over the last several years and it has been a complete game changer. Click on the link on my website to learn more about platelet rich plasma.