subject: Knee problems [print this page] Knee problems Knee problems
Arthritis of the knee, according to Felson (1), is the most prevalent joint problem world wide, affecting more than 27 percent of the population at some point in their lives. The likelihood of suffering from knee problems increases with age. There is a slight tendency for men to have more right-sided knee problems, while women show no such predominance (2, 3). As prevention is better than cure, a number of studies have examined the trigger factors for knee arthritis.
Recent studies have shown there are a number of easily identifiable risk factors for future arthritis in the knee. They have been divided into
non work related,
sport related and
work related factors.
Non work related factors include being overweight, which has a significant impact on the likelihood of developing knee arthritis in later life (4). Genetic factors also play a part (5), which explains why it seems to run in families. No single specific gene is responsible however. For women it has been identified any oval varus like shape of the legs causing uneven use of the knee joint has also shown an increased risk of arthritis.
Participants in team sports and combat or contact sports tend to develop more knee arthritis in later life. This is thought to be due to accumulation of minor injuries which are overlooked, and which cause accelerated deterioration of the knee's articular surface in later life. Deterioration of the knee has not been identified in participants in water sports or other individual sports. They therefore appear to be fairly neutral in respect of the risk of developing knee arthritis. Specific training of the back appears to show a beneficial effect and seems protective regarding the development of knee arthritis. This is thought to relate to encouraging a better gait and therefore a more even use of both knee joints.
With regards to work it has been demonstrated excessive strain is one of the main trigger factors of knee arthritis, but this needs to be prolonged and sustained over many years. Mining workers have a double the rate of knee problems compared to the average population (6), although this is only in those who have worked many years in the industry. This is thought to be mainly due to working in a stooped position as it places increased pressure on parts of the knee joint rather than evenly distributing weight through the knee. Knee arthritis in miners and some other professions has now been included in the list of prescribed diseases which may attract compensation in the UK. Floor layers have a significantly higher likelihood of suffering knee problems due to spending significantly more time than average on their knees (7). This effect has been shown in men and women.
Climbing stairs or ladders, or jumping does not appear to be a risk factor for the development of knee arthritis.
Preventive action can be taken in the workplace to minimise the need for and impact of bending and kneeling. For example, using a long tong for litter picking reduces the need for frequent bending in people carrying out street cleansing.
People spending significant time on their knees benefit from pads. Currently there are a wide variety on the market ranging form trousers with pockets at the knee to insert a pad, to pads with a Velcro to attach when needed. The choice of appropriate equipment depends on a variety of factors and can be specific to the job and individual. Occupational health specialists (8) with experience in both the medical factors and workplace demands are best placed to provide appropriate advice. They are able to visit workplaces assessing the specific requirements to advise on the appropriate choice to reduce the risk of long-term problems developing.
References:
1 Felson.Epidemiology of knee and hip osteoarthritis. Epidemiol Rev 1988; 10: 128
2 Andrianakos AA, et al.: Prevalence of symptomatic knee, hand and hip osteoarthritis in Greece. The ESORDIG study. J Rheumatology 2006; 33: 250713
3 D'Ambrosia RD: Epidemiology of osteoarthritis. Orthopedics 2005; 28 (Suppl. 2): p. 201205
4 Grotle M, Hagen KB, Natvig B, Dahl FA, Kvien TK: Obesity and osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord. 2008; 9: 132.
5 Spector TD, Cicuttini J, Baker J, et al.: Genetic influences on osteoarthritis in women: a twin study. BMJ 1996; 312: 94044
6 Michael J W-P, et al. The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee. Dtsch Aztebl Int 2010; 10799): 152-62
7 Kirkesov Jensen L, Milckelsen S, Loft IP, et al.: Radiographic knee osteoarthritis in floorlayers and carpenters. Scand J Work Environ 2000; 26: 25762
8 Business and Health Consultancy, www.BusinessAndHealth.co.uk
