How loss of Proprioception can affect Knee osteoarthritis?

by Gayatri_Barnwal
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You may have a known person with Knee osteoarthritis. It is a common joint disease that can cause major functional restrictions. And mainly targets people above 50 years of age and grows gradually from a little discomfort to serious disability. It becomes painful to do common day-to-day activities like walking or climbing stairs. Recent researches have linked knee osteoarthritis to proprioception accuracy. Impaired proprioception can significantly damage the knee osteoarthritis of an aging person. 

KNEE PROPRIOCEPTION

Proprioception is the ability with which you sense the position and movement of your body parts. When you move, there is a stretch in muscle and a change in joint position. The sensory receptors in your muscles and joints transfer this information to the nervous system and help you to sense how your body is moving. For example, you can touch your ears with closed eyes without any conscious thought. It is this ability that puts your feet in the right position while walking without looking at it. But, what is Knee proprioception? It is called so when we talk about movement and position of knee joints. As a person ages, the proprioception in osteoarthritis knee joint reduces. Also read, Risk factors for falls in adults with knee osteoarthritis: a systematic review

proprioception knee osteoarthritis
#proprioception knee osteoarthritis

ANATOMY REASON OF OSTEOARTHRITIS

Let us first see how osteoarthritis occurs. So, you can understand how this process effect knee proprioception.

The knee joint is a union point of three important bones. In the meeting point, the bones are covered with a smooth-slippery substance called cartilage. Its role is to protect joints from friction when you bend or straighten or simply move the knee. Due to the regular wear-and-tear, the cartilage surface gets rough & thinner and causes the direct rubbing of bones. Though the body produces new cells, the new ones grow in irregular structures and are not smooth enough to fulfill the purpose. It leads to difficulty in smooth knee movements and produces pain. Also read, Everything You Need To Know About Aneurysm Osteoarthritis Syndrome

EFFECTS OF AGE & OSTEOARTHRITIS ON KNEE PROPRIOCEPTION

Many studies have concluded proprioceptive accuracy to be impaired in osteoarthritis patients and old-age people. Let’s see how the joints start losing sensing power as an effect of age and osteoarthritis on knee proprioception.

  1. The narrowing of the cartilage layer also loosens the surrounding structures, making it difficult to sense the stretch in the knee.
  2. Muscle spindle transfers information of change in muscle stretch to the nervous system and GTO transfers information about the amount of muscle tension (e.g. GTO can sense and alert you of extra weight lifted by the body and thus protect you from any injury). Due to osteoarthritis pain, a person stops using the muscles which leads them to sleep mode. So,  he stops sensing any stretch and tension in muscles.
  3. Cartilage damage leads to the abnormal loading of the joint during any weight-bearing activity.
  4.  Loss of mechanoreceptors due to ageing causes proprioception loss.
  5. The size of sensory and nerve fibres keeps reducing with age, again leading to proprioception loss.

PROPRIOCEPTIVE EXERCISES FOR KNEE OSTEOARTHRITIS

 Researchers have proved that exercises can be effective in pain relief. You can improve strength, balance, and coordination resulting in better functional abilities of the knee. It also prevents the worsening of symptoms associated with osteoarthritis.

You should do these exercises 3-4 times per week for 30-40 minutes per session. 

1. Quadriceps exercises

There can be an effect of quadriceps strength and proprioception on risk for knee osteoarthritis patients. The Quadriceps (muscles at the front of thighs) has an important role in maintaining the stability of joints during movement. Thus, you can reduce the risk of osteoarthritis by making your quadriceps stronger.

Isometric quadriceps setting:

  • Take a sleeping position (on your back) with your legs straight.
  •  Keep a rolled towel under the affected knee.
  • Now, tighten the quadriceps pushing knee into the towel.
  • Wait for 5 seconds. Repeat (after few sec break).
  • Switch the leg.                                                                                             
  • Do 10 repetitions thrice a day

Quadriceps stretch:

  • Stand with the left hand holding the wall.
  • Bend the right leg behind you and hold onto the foot with your right hand.
  • Hold for 10-20 sec.
  • Switch legs and repeat.

2. Calf Stretch

  • This exercise improves the balance of the legs. Stand facing a wall and hold it with both hands for support.
  • Keep a leg one step behind and the other in front.
  • Now, bend the front knee and make sure that heels are on the floor throughout.
  • Pause for 30 seconds and switch the leg.
  • Repeat 3 times.

3. Knee-flexion and -extension exercise

  • Sit in a chair.
  • Bring your leg with affected knees back as far as you can go and wait for 10 sec.
  • Now, slowly straighten it and wait for 10 seconds.
  • Switch the leg and repeat

4. Half squats

  • Stand with both hands (straight) holding a chair.
  • Bend your legs to 45 degrees as if you are sitting on a chair.
  • Wait for a second.
  • Stand again
  • Repeat
  • Ensure your heels are stuck on the floor throughout

Other Exercises:

1.   Standing on one leg for few seconds (eyes open and closed)

2.   Walking on heel and toes for 20m

3.   Balancing exercises on unstable surfaces (e.g.instability dome, balance board)

4.   Seated leg presses

5.   Knee terminal extension

6.   Step-ups

7.   Hamstring stretch

8.   Stationary cycling

Frequently Asked Questions (FAQs)

Q. HOW TO TELL IF YOU HAVE OSTEOARTHRITIS IN YOUR KNEE?

Ans. You can identify osteoarthritis by noticing the following symptoms:
1. Painful, stiff, and swollen joints
2. Feeling of locked knee & creaky sound during walking. (Occasionally)
3. More pain in the morning or after resting and heavy activity.
4. Difficulty in climbing stairs, weight lifting, or bending
5. Thinner legs

Q. HOW TO MANAGE OSTEOARTHRITIS IN THE KNEE?

Ans. 1. Maintain a good body weight
2. Use braces (a belt-like assistive device to support the knee)
3. Regular Knee Exercises
4. Take prescribed medicines for pain relief
5. Doctors’ recommended injections and surgery.

Q. HOW CAN I IMPROVE MY KNEE PROPRIOCEPTION?

Ans. You can improve it by doing regular physical activity and proprioceptive exercises for knee osteoarthritis. (discussed above)

Q. HOW DO YOU TEST FOR KNEE PROPRIOCEPTION?

Ans.  You can test it by a small sensing activity: 
1. Explain what you are going to do, to the patient with open eyes and perform the test with closed eyes.
2. Move his knee into a specific position and maintain it.
3. Tell the patient to copy the position with the opposite knee (with closed eyes).
4. Repeat it at least 5 times.
5. If the patient is unable to detect the position correctly, there is a possibility of proprioception loss.

Q. HOW CAN I MAKE MY KNEES WITH OSTEOARTHRITIS HEALTHY AND STRONGER?

Ans. Osteoarthritis knees can be strengthened by regular strengthening and stretching exercises.

Q. WHAT DOES KNEE OSTEOARTHRITIS NOS MEAN?

Ans. The term NOS (Not otherwise specified) is used when the symptoms of the patient are enough for a general diagnosis but do not match the criteria list of that specific illness. It is generally used for the early stages of Knee Osteoarthritis when all extreme symptoms are not visible.

Q. WHAT HAPPENS IF PROPRIOCEPTION DOESN’T WORK?

Ans.  A narrative review on proprioception in knee osteoarthritis by ScienceDirect has mentioned three possible functions of knee proprioception:
~ Prevent excessive movements which can cause injury
~ Support the static posture of the knee.
~ Maintain coordination between your movements and brain.
Thus, if proprioception doesn’t work, there can be balance issues, lack of coordination, and reduced knee protection while movement.

Q. HOW LONG DOES IT TAKE TO IMPROVE PROPRIOCEPTION?

Ans.  It can take 4-6 weeks of regular exercises to improve proprioception.

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