Osteoarthritis (OA) of the knee is a degeneration of joint cartilage. Cartilage is a smooth protective layer present at the end of the joints. It usually affects males and females above 45-50 years. Developing knee OA in the early '20s and '30s can be secondary Osteoarthritis. Secondary Osteoarthritis is generally due to an underlying condition like a history of severe infection on the knee joint leading to severe cartilage damage. Anterior Cruciate Ligament (ACL) injury, meniscus tear, repetitive stress due to occupation like frequent kneeling or standing for long hours. With a history of ACL injury, there is 4-6 times more likely to develop knee OA. Senior Physiotherapist Lalchawimawi Sanate (PT, LCCE ), Cloudnine Group of Hospitals, Sahakarnagar Branch Bangalore, suggests some knee osteoarthritis exercises during pregnancy.
Common symptoms are:
A pregnant woman with Osteoarthritis of the knee has to proactively seek help from the experts and start strengthening the lower limb muscles. They can continue their:
150 min per week of moderate aerobic exercise for a healthy pregnant woman without complications
Exercise intensity and repetition can be modified accordingly for pregnant women with OA according to the condition of their present pregnancy.
The exercise plan should combine light aerobic exercise, strengthening and stretching exercises, and sensorimotor training with functional training targeting the lower limb muscles.
Pool base exercise:Pool base exercise is one of the best exercise forms for women with OA of the knee. The water buoyancy takes the weight away from your joints. Allowing you to do more repetitions without worrying about the pressure exerted on your knee joint.
Benefits Of Pool Base Exercise
The resistance provided by water helps you gain more strength in your muscles.
Decrease aches and pain in the muscles.
The ideal temperature of the pool should be 28-33 degrees Celsius. However, it should not be higher than the above-recommended temperature as it can increase your core body temperature if the pool water is above 33 degrees. Start with shallow water and progress to deeper water. If you don't know swimming, you can start with walking, squats, and lunges. Water shoes, designed for water-based exercises, can be worn to prevent you from falling due to slipping.
Walking has multiple benefits. Normal walking to brisk walking help improve knee joint range of motion, improve joint integrity, and strengthens muscles. It also helps check healthy weight gain and improve your cardiovascular function.
Start with 10-15 min of walking. If you find your knees painting after 15 min of walking, reduce the walk time to 10 min 2-3 times a day.
Investing in good walking shoes and using a knee brace when walking is wise as it will reduce the pressure on your knees.
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Lower Limb Strengthening Exercise
The priority is strengthening lower limb muscles like the Quadriceps, hamstring, and hip muscles. These muscles stabilize and help absorb shock on the joint during movement. Everyday activities like sitting up and standing up from the chair, climbing up and down the stairs, walking, and lifting an object from down can happen at ease with the Quadriceps, hamstrings, and hip muscles. Strengthening this group of muscles is essential as impairment with this group of muscles can cause functional limitations, increasing joint pain and stiffness.
Hip muscle weakness with OA knee might also lead to increased medial compartment loading of the knee joint leading to pain and discomfort. In addition, decreased strength in the quadriceps muscle is also related to pain and mobility impairments in people with knee OA.
Isometric knee strengthening: Long sitting on the bed or the floor. Placing a rolled towel or a foam roll under your knee and press downward, holding the press for 10 sec
Exercise without weights and with weights: Free weight exercise in standing like Hamstring curls, leg rotation, Side leg raise, and sitting one leg raise will also help achieve stronger lower limb muscles. Exercise using weights like ankle weights, resistance bands, and own body weights like squatting and other exercises can be added according to the progression of an individual.
Stretching exercise helps increase muscle length, relax the muscle fibre, promote the exchange of nutrients in the cartilage, increase blood circulation around the tissues, relieve pain, and improve flexibility. Unfortunately, the quadriceps muscles are found to be the least flexible in the patient with OA of the knee.
Standing Quadriceps Stretching
Stand and take support of a chair or table for balance, bend one knee back and hold your ankle with one hand.
Bend your knee as far as possible.
Maintain the stretch for 10-20 sec.
Repeat each leg 2-3 repetitions.
Standing Hamstring Stretching: Place your right leg on a stable chair with toes facing towards the ceiling. Bend forward at the waist level with your hand, trying to reach your toes until you feel the stretch on your hamstring. Do this on both legs.
Sitting Calf stretching: Sit in a chair, and around your right feet, place a resistance band or towel below the toes. Pull the cloth or resistance band until you feel the stretch on your calf muscles. Repeat on both legs. All stretching should be held for 10-30 sec to reap the benefits.
The physiotherapist's plan of treatment goals will be:
Alleviate pain and discomfort
Improving the strength and flexibility of the lower limbs
Monitor healthy weight gain
Posture assessment and correction
Addressing any pregnancy-related musculoskeletal complaints like low back pain, rib alignment issues, SI joint dysfunction, plantar fasciitis, etc.
Planned exercise is always suggested to gain overall benefits during pregnancy. Let exercise be part of your pregnancy as it benefits both mother and baby.