Conditions We Treat at Prairie Osteopath

🦵 KNEE PAIN: DON’T IGNORE THE WARNING SIGNS Today’s knee pain can become tomorrow’s movement problem — but ageing does not have to mean losing mobility. Knee pain is one of the most common musculoskeletal complaints affecting athletes, desk workers, overweight individuals, older adults and even younger people. Pain may arise from osteoarthritis, ligament or meniscus injuries, patellofemoral problems, muscle weakness, overuse, poor biomechanics, previous injuries or excess body weight. The important message is: Ageing is inevitable. Loss of strength, mobility and independence is not inevitable. With appropriate assessment, progressive strengthening, weight management, mobility training and an active lifestyle, many people can maintain good function well into their 70s, 80s and beyond. 🔍 WHAT ACTUALLY CAUSES KNEE PAIN? Knee pain is not always caused by the knee joint itself. Common contributing factors include: 🦴 Knee osteoarthritis 🏃 Sports injuries and overuse 🦵 Meniscus injuries Ligament sprains or tears Patellofemoral pain Tendinopathy Muscle weakness or imbalance Reduced hip or ankle mobility Poor movement mechanics Previous fractures or surgery Obesity/excess body weight Prolonged sitting and inactivity Sudden increases in exercise or workload A comprehensive assessment should therefore look at the hip, knee, ankle, foot, pelvis and overall movement pattern, rather than simply treating the painful area. 🩺 KNEE PAIN EXAMINATION & CLINICAL TESTING A good physiotherapy/manual osteopathic assessment should begin with a detailed history. 1. History We assess: Where exactly is the pain? When did it start? Was there an injury? Is there swelling? Is there locking or giving way? Is there clicking or grinding? Is pain worse with stairs, squatting or walking? Is there morning stiffness? How far can the patient walk? Previous injuries/surgery? Current medications and medical conditions? Physical activity and occupational demands? 2. Physical examination This may include: Observation Swelling Muscle wasting Knee alignment Gait Posture Palpation Joint line Patella Tendons Ligaments Surrounding muscles Range of motion Knee flexion Knee extension Hip and ankle mobility Strength assessment Quadriceps Hamstrings Gluteal muscles Calf muscles Hip abductors and external rotators 3. Special tests when clinically indicated Depending on the history, a clinician may use: Lachman test Anterior/posterior drawer tests Varus/valgus stress tests McMurray test Thessaly test Patellar apprehension testing Patellar mobility assessment Functional squat/step-down assessment Functional tests such as sit-to-stand, walking, stair assessment, balance and single-leg control can also provide valuable information. Imaging such as X-ray or MRI is not automatically required for every knee pain case; it should be considered according to the clinical presentation and suspected pathology. 💻 HOW DOES A SEDENTARY LIFESTYLE AFFECT YOUR KNEES? One of the biggest misconceptions is: “If my knee hurts, I should stop moving.” In many cases, prolonged inactivity can actually make the problem worse. Sitting for hours can contribute to: Less movement → muscle deconditioning → reduced strength → poorer joint support → reduced exercise tolerance → weight gain → greater mechanical load → more difficulty moving. The quadriceps and gluteal muscles are particularly important for controlling forces around the knee. When people spend most of the day sitting and then suddenly ask weak muscles to climb stairs, squat, run or play sports, the knee may have to tolerate loads that the surrounding tissues are poorly prepared to manage. The WHO recommends that older adults reduce sedentary time and replace sitting with physical activity of any intensity, because even light activity provides health benefits. A simple rule: Don't try to exercise for 30 minutes and then sit for the remaining 10 hours. Instead: Move frequently throughout the day + exercise regularly. 👵 WHY DO MULTIPLE HEALTH PROBLEMS BECOME MORE COMMON AFTER 65? Age itself does not automatically cause disease. However, as we grow older, the body accumulates the effects of genetics, previous injuries, metabolic health, inactivity, excess weight, smoking, nutrition, sleep, stress and environmental exposures. Consequently, several chronic conditions may coexist. This is called multimorbidity. It can include combinations such as: Hypertension Diabetes Cardiovascular disease Arthritis Osteoporosis Obesity Chronic respiratory disease Kidney disease Previous stroke Reduced muscle strength Balance impairment A large systematic review published in The Lancet Healthy Longevity examined 87 studies and found that multimorbidity is very common in adults aged ≥65, although prevalence varied substantially depending on the population and definition used. An earlier analysis of almost 31 million Medicare beneficiaries found multimorbidity in 62% of people aged 65–74 and 81.5% of those aged ≥85. This is why rehabilitation of an older adult should not simply focus on the painful knee. We should ask: How strong is the person? How well do they walk? Can they get up from a chair? Can they climb stairs? How is their balance? Are they maintaining muscle mass? Are cardiovascular and metabolic conditions being appropriately managed? 🌎 BUT WHY ARE SOME PEOPLE STILL ACTIVE AT 85, 90 OR 100? This is one of the most fascinating areas of ageing research. The Newcastle 85+ Study in the UK followed more than 1,000 people who were 85 years old, specifically examining why some people maintain health and independence while others develop disability and frailty. The Leiden 85-plus Study in the Netherlands followed people beginning at age 85 and demonstrated substantial differences in disability and health trajectories between individuals. Multimorbidity was associated with greater disability and, in some groups, faster functional decline. Research on exceptional longevity also provides an important lesson. The New England Centenarian Study, based in the United States and involving thousands of centenarians and their families, investigates why some people maintain remarkably good health into very advanced age. Researchers have observed that many centenarians tend to delay or avoid several major age-related diseases, resulting in a longer healthspan, not simply a longer lifespan. The lesson isn't: “Everyone can live to 100 if they exercise.” Genetics, socioeconomic factors, medical care and chance all matter. The lesson is: We should aim not merely to add years to life, but to add functional years to life. 💆 THERAPEUTIC MASSAGE & MANUAL OSTEOPATHIC TREATMENT For selected patients, hands-on treatment can be useful as part of a broader rehabilitation program. Therapeutic massage may help address: Quadriceps tightness Hamstring tension Calf tightness Myofascial restrictions Soft-tissue sensitivity Muscle guarding Perceived pain and stiffness A randomized controlled trial involving people with knee osteoarthritis reported improvements in pain, stiffness, physical function and some functional measures following a course of Swedish massage. A 2022 systematic review/meta-analysis involving 12 studies and 737 participants found short-term improvements in pain and stiffness with massage, although the authors noted limitations in the evidence and lack of clear long-term benefit. Manual osteopathic/ manual therapy approaches may include: Soft-tissue techniques Myofascial techniques Joint mobilization Patellar mobilization Muscle Energy Techniques where appropriate Hip and ankle mobility work Fascial/soft-tissue assessment Movement and postural assessment However, hands-on treatment should not be presented as a replacement for active rehabilitation. Current OA guidelines emphasize exercise, weight management and self-management as core components of care. The American College of Rheumatology/Arthritis Foundation guideline does not recommend massage or manual therapy as superior to exercise for knee OA, highlighting that manual treatment should not displace active rehabilitation. Our philosophy should therefore be: Hands-on treatment to improve comfort and movement → followed by strengthening and functional retraining. 🏋️ WHY MUSCLE STRENGTH IS SO IMPORTANT A strong knee is not simply about the knee joint. We need strength throughout the kinetic chain: Hip Gluteus maximus Gluteus medius Hip external rotators Knee Quadriceps Hamstrings Ankle Gastrocnemius Soleus Tibialis muscles Good strength helps the body control walking, stairs, squatting, balance and everyday activities. For older adults, maintaining strength is particularly important because age-related muscle loss and reduced physical activity can contribute to frailty, falls and loss of independence. 🏠 SIMPLE HOME KNEE HEALTH PROGRAM A general program may include the following, but exercises should be individualized when significant pain, injury, surgery or medical conditions are present. DAILY MOBILITY 1. Heel slides 10–15 repetitions 2. Knee extension/heel prop Gentle sustained position 30–60 seconds 3. Ankle pumps 20 repetitions STRENGTH — 3 DAYS/WEEK 4. Sit-to-stand 2–3 sets × 8–12 5. Straight-leg raise 2–3 sets × 8–12 6. Glute bridge 2–3 sets × 10–15 7. Supported mini-squat 2–3 sets × 8–12 8. Calf raises 2–3 sets × 10–15 9. Side-stepping with resistance band 2–3 rounds STRETCHING Gentle stretching may include: Quadriceps Hamstrings Calf Hip flexors Hold approximately 20–30 seconds, without forcing painful range. 🚶 THE 30–30–30 RULE FOR DESK WORKERS If you sit for prolonged periods: Every 30 minutes → get up. Move for 1–3 minutes. Perform several mini movement breaks throughout the working day. Then aim for a structured exercise session according to your fitness and medical status. This is consistent with the broader WHO message: reduce sedentary behaviour and replace it with movement whenever possible. ⚖️ WEIGHT MANAGEMENT MATTERS Every additional kilogram of body mass increases the mechanical demand placed on the lower limbs during everyday movement. For people with knee OA who are overweight or obese, weight reduction combined with exercise is strongly supported by clinical guidelines. The ACR/Arthritis Foundation guideline notes that benefits increase with greater weight loss, while OARSI identifies exercise and dietary weight management combined with exercise as core treatments for knee OA. The goal shouldn't be simply: “Lose weight.” It should be: Lose excess fat while preserving or building muscle. 🛡️ KNEE PAIN PREVENTION Start early. ✔ Maintain healthy body weight ✔ Strengthen the quadriceps and gluteal muscles ✔ Maintain hip and ankle mobility ✔ Avoid prolonged sitting ✔ Increase exercise gradually ✔ Wear appropriate footwear for your activity ✔ Train balance as you age ✔ Recover adequately after sports ✔ Don't repeatedly exercise through significant pain or swelling ✔ Treat previous injuries properly ✔ Maintain cardiovascular fitness ✔ Eat adequate protein and a nutrient-dense diet ✔ Keep socially and physically active 🚨 WHEN SHOULD YOU SEEK PROFESSIONAL ASSESSMENT? Don't ignore knee pain accompanied by: 🔴 Significant swelling 🔴 Inability to bear weight 🔴 Knee locking 🔴 Repeated giving way 🔴 Major trauma 🔴 Sudden severe pain 🔴 Fever/redness/warmth 🔴 Rapidly increasing swelling 🔴 Significant loss of movement 🔴 Persistent pain that isn't improving These symptoms may require medical assessment rather than simply self-treatment. 🌱 THE BIGGER MESSAGE Your knee does not need to be perfect for you to be active. What matters is maintaining: Mobility + Strength + Balance + Cardiovascular Fitness + Healthy Weight + Consistent Movement. The research on people living into their 80s, 90s and beyond gives us an important perspective: chronological age and functional age are not the same thing. Some 85-year-olds struggle to stand from a chair, while others continue walking, exercising, working, travelling and participating in their communities. The goal of rehabilitation should therefore not simply be: “How do we reduce today's knee pain?” It should be: “How do we keep this person moving independently for the next 10, 20 or even 30 years?” 📚 Selected research & literature WHO Guidelines on Physical Activity and Sedentary Behaviour (2020) — recommendations for adults and older adults and evidence regarding sedentary behaviour. Kolasinski et al., ACR/Arthritis Foundation Guideline (2019/2020) — exercise, weight management and non-pharmacological management of knee OA. OARSI Guidelines for Non-Surgical Management of Knee, Hip and Polyarticular OA — structured exercise and weight management as core treatments. Perlman et al. — randomized controlled trial of massage therapy for knee OA. Wu et al., 2022 — systematic review/meta-analysis of massage therapy for knee OA. Nicholson et al., Lancet Healthy Longevity, 2024 — systematic review of multimorbidity and polypharmacy in older adults. Salive, Epidemiologic Reviews, 2013 — multimorbidity among older adults and increasing prevalence with age. Newcastle 85+ Study — longitudinal investigation of health and independence in people aged 85+. Leiden 85-plus Study — prospective research examining multimorbidity, disability and health trajectories in very old adults. New England Centenarian Study — research into exceptional longevity, delayed disease and healthspan.