T hirty-something Nidhi Arora was constantly on the move. A high profile job and a hectic social life kept her on her toes. But one fine day, her left knee couldn’t take it any more and she fell from the stairs. Though she did not suffer any major injury, the problem with her knee persisted. Consultation with a doctor revealed that she was a victim of knee osteoarthritis (KOA).

Nidhi is not the only case in point. More and more youngsters are turning out to be victims of osteoarthritis of the knee, a disease which was once known to affect those belonging to a much higher age bracket. Koushik Ghosh, orthopaedic surgeon and rheumatologist, points out, “In my 15 years of practice, I have witnessed a dramatic shift in the average age of patients complaining of knee problems. And 50 per cent of all major orthopaedic complaints are related to the knee.”

Such knee problems can often have a debilitating effect and can even make something as natural as walking a tough job. According to experts, it’s difficult to pinpoint the root cause of such problems. It may run in the family or it could be a result of obesity or a trauma (such as a severe fracture). However, it’s been well established that smoking is one of the major risk factors and can aggravate the problem. Ghosh also points an accusing finger at a sedentary lifestyle and modern dietary habits. “Eating junk food, avoiding fresh fruits and vegetables and an insufficient intake of calcium aggravates cartilage damage,” he emphasises.

A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones. Arthritis develops when the cartilage begins to deteriorate or is lost. As this cartilage is lost, the joint space between the bones narrows down. This decreases the ability of the cartilage to work as a shock absorber and reduce the impact of stress on the joints. The remaining cartilage wears down faster and eventually the cartilage in some spots disappears altogether, leaving the bones to grind against one another. One good way to recover such loss is through ample intake of fresh fruits and vegetables, the source of vitamins.

What is dangerous is that the initial onset of KOA doesn’t come with any obvious, external symptoms. However, with time, one tends to experience morning stiffness, pain while engaging in some activity and mild swelling. A dull nagging pain, especially with weather changes, is common in the intermediate stages. In the later stages, progressive disability and moderate pain make things worse. Physiotherapist Namita Das says that in case of acute pain, the use of crepe bandage, rays, and kneecaps can provide relief. But usually painkillers are prescribed and only when the pain subsides, varying levels of exercises based on the symptoms are suggested for patients.

The aim of the treatment is to restore normal functioning. This can be done through the use of anti-inflammatory medication, carefully planned exercise programmes, weight control and occasional steroid injections. Typically, 30 minutes of riding an exercise bike three to four times a week increases leg strength and mobility among patients with KOA. Indrajit Sardar, orthopaedic surgeon attached to the Belle Vue Nursing Home in Calcutta, advises exercises, change in walk patterns and lifestyle, and judicious activity to control this problem. At the same time he warns, “Do not do too much in too little time in the hope of overnight improvement. This will only worsen the condition.”

Patients with KOA are taught quadriceps-strengthening exercises and are usually encouraged to perform them every day. They may also take recourse to aerobic exercise programmes such as fitness walking, or swimming. Many patients with osteoarthritis of the hip and knee are more comfortable wearing shoes with good shock-absorbing properties. Also, the use of an appropriately selected cane can reduce hip loading by 20 to 30 per cent.

Fahmi Rahman, physiotherapist, signs off with a vital tip: “Exercise regularly for half an hour and keep your weight under control. After 40, everyone should take calcium supplements along with vitamin D3 for better absorption of calcium. Women who undergo multiple deliveries must get calcium therapy immediately.”

Exercises that can help

• Knee extension stretching: Sit with your legs stretched as much as possible supported on a rolled towel, placed under the ankle. Press down with the hands against the femur joint just above the patella (knee bone) to cause a sustained force to increase extension. Hold for three to five seconds. Do this five to ten times, thrice daily.

• Knee flexion – stretching: Sit on a chair with the concerned knee flexed to the end of its available range and the foot firmly planted on the floor. Move forward on the chair, not allowing the foot to slide. Hold the position for a comfortable, sustained stretch to the knee extension. Hold for three to five seconds. Do this five to ten times thrice daily.

• Seated thigh extension (quadriceps strengthening exercises): Sit firmly on a chair with your back straight, knees flexed at 90°, foot on the floor. Straighten one leg and hold with toe tucked in. Repeat this for the prescribed number of times. Hold for three to five seconds. Do 10 to 20 times thrice daily for each leg, and then do both legs together. Hold for three to five seconds. Do 10 to 20 times thrice daily.

• Hamstring strengthening exercises: Sit with your knee in extension, slightly flexed over a rolled towel. Isometrically contract the knee flexors just enough to feel tension developing in the muscle group by gently pushing the heel on the floor and holding the contraction. First do one leg at a time, then do both legs together. Hold for three to five seconds. Do this 10 to 20 times thrice daily.