“Office knee” syndrome

“Office knee” syndrome

 

“Office knee” syndrome is a modern disease, one of a today’s still short list of illnesses typical of office workers. The list also includes a tunnel syndrome, cervical and thoracic spine osteochondrosis, flat feet, “dry eye” syndrome, varicose veins of lower limbs, blood circulation disorders in small pelvis organs, excessive weight.

 

According to a statistics reported by the Academy of Medical Royal Colleges of the UK, nowadays one out of ten office workers suffers from a so-called “office knee” syndrome.

 

“Office knee” syndrome is a variant of early knee osteoarthritis – gonarthrosis. This condition is associated with a durable sitting on the same place, hypodynamic and obesity widespread among office staff. At that, leg joints appear in the less physiologically favorable situation. Relying on preliminary data, for the development of the disease, a worker has to be in an almost similar pose eight hours a day within twenty years (holidays and vacations included). However, this process may accelerate to ten years, if a person has excessive weight and flat feet. Obesity increases the load on knee joints almost twice, and the progression of the gonarthrosis will depend on the extent of overweight. Early pathological changes of knees may occur due to incorrect exercises without warming-up and gradual increase of loadings, incorrect footwear, pathologies of feet, excessive weight, long periods of hypodynamics.

 

Such a situation distorts blood supply – excessive weight accelerates the process of wear of cartilage, and inadequate income of oxygen slows down natural recovery of cells, making the disease to progress constantly and relentlessly.

 

 

“Office knee” syndrome progresses at the account of a constant static strain in a knee. It is accompanied with gradual destruction of the structure of the joint, inflammation and pain. Finally, this could result in disability. Similar syndromes are observed in athletes whose sports include jumping or running with obstacles, in other words – constant excessive dynamic load also leads to a constant destruction of a knee.

 

Scientists consider that the danger of this syndrome is significantly underestimated by the modern medicine. According to experts, by year 2050, almost 50% of office workers will suffer from it. The term “office knee syndrome” appeared about a quarter of an age ago, when offices started to use computers and the internet, and sitting work became popular. Within 2 recent years, restrictions imposed by COVID-19 pandemics and many employees’ change to a remote work enforced the problem of hypodynamics and the associated “office knee syndrome”.

 

According to preliminary calculations, by the age of 50 and after 20 years of sitting work, the “office knee” develops in one out of three people. However, due to obesity, it may occur much early – in 10 years.

 

Today, the generation of mass internet users, bloger, tik-tokers, reviewrs, and office staff has not reached that critical age, when this syndrome expresses itself. That’s why all its dangers are still unknown.

 

What is the “office knee” syndrome?

 

The syndrome of an “office knee” is a knee osteoarthritis (OA) – gonarthrosis, developing in persons of the age untypical for this disorder – 40-45, and not associated with severe physical loads, traumas, or sports. Nowadays, OA of 45-years-old patients occurs in about 2% of all cases of knee osteoarthritis revealed, but this number tends to grow within the recent years.

 

Why early knee osteoarthritis is so dangerous?

 

First, OA as the disease develops stage by stage. Its initial stage, once found in a young patient, will sometimes become a final one. Having this diagnosis, a patient will never ignore the discovered changes, live a habitual way of life, neglect possible consequences.

 

Second, most those who suffer from OA are not aware of their disease. Early stages are typical of a symptomless progression and ignoring the initial pain, psychological underestimation of own health conditions.

 

Third, early stages of OA are curable for conservative prophylactic and treatment methods. They can slow down or even stop progression of the disease, recover primary cartilage defects, completely remove pain and distortions of biomechanics.

 

 

 

Thus, the task of early diagnostics of the “office knee” syndrome is systematization of first symptoms and informing the patient with early OA, that is it necessary to start the treatment immediately and to change the sitting way of life to avoid future need in joint replacement as the only way to recover the function of knee and get rid of pain.

 

Traditional objectives of medicine are etiology, pathogenesis, clinics, diagnostics, treatment, and prevention of OA in young age, using all available methods.

 

Main tasks of a physician who treats an early OA:

    1. Eliminate pain syndrome.

    2. Recovery and preserve biomechanics of the joint.

    3. Prevent OA progression.

    4. Recover damaged cartilage.

 

The treatment must be complex, with a patient’s complete awareness of the necessity of the physician’s prescriptions. The treatment complex must include non-pharmaceutic, pharmaceutic, and in some cases – surgical (arthroscopic and corrective) remedies.

 

The following non-pharmaceutic methods have recommended themselves in clinical practice:

 

  access to information, teaching the patient to live with the disease;
  teaching how to walk to unload the affected extremity;
  therapeutic exercises to strengthen muscles and support the amplitude of motions (resistance training, power exercises), including therapeutic exercises in a swimming pool (swimming, aqua-aerobics);
  encouraging overweight patients to slim – a diet to reduce the body weight and balance the metabolism;
  the use of unloading devices: cane or crutches for a unilateral disease, walker – for a bilateral one; 
  the use of individually selected or customized insteps and lateral edge insoles to balance and recover the correct axis and biomechanics of the extremity while walking;
  in cases of valgus or varus deformities – the use of a knee bandage or orthesis to reduce biomechanical distortion and pain.

 

Among physiotherapeutic methods, the following are evidence-based and recommended for multiple joint disorders: physioprocedures, electrostimulation, acupuncture, balneo- and SPA therapy (thermal bathes with mineral water).

 

Another part of the complex approach to the treatment of early OA includes pharmaceutical means. The main task of these medicines are to remove pain and edema of a joint, eliminate the inflammation, recover blood circulation, ensure metabolism and oxygen supply to stop knee cartilage “starvation”.

 

Besides the mentioned above, pharmaceutical therapy to early OA relies on the complex use of hyaluronates and other choldroprotectors. Such therapy especially distinguishes intra-articular injections of hyaluronic acid (HA), as they promote recovery of the biomechanics of synovial liquid, elimination of pain, improvement of the quality of life, slow down the progression of OA, postpone the need for arthroplasty, ensure fast recovery after arthroscopy. In recent years, HA is more and more frequently replaced with a regenerative therapy using a patient’s own cells – PRP (autologous platelets rich plasma), MFAT (micro fragmented adipose tissue), MSC (mesenchymal stem cells). For more details about these methods, see “Regenerative technologies in orthopedics and trauma care”.

 

In the complex conservative therapy by pharmaceutical and non-pharmaceutical methods appears inefficient for the early OA, surgical treatment must be considered. Indications for surgery at early stages of OA are: functional distortions resulting from the segment’s deformation or instability, blockage at any location, a recurrent chronic inflammation process without improvements at the background of the therapy. In our blog (Corrective osteotomies) we mentioned surgical techniques, alternative to joint replacement.

 

Preventing early osteoarthritis of a knee

 

 

For this category of patients, efficient are constant control of weight and reasonable physical loading after preliminary warm-up exercises for joints. Work and rest schedule is also important, stipulating a pause during a working hours. This pause shall include not only a lunch, but also a warming-up or easy exercises. Even 10-15 minutes a day devoted to the health could have a good result, even if it is not obvious at once. Except for the weight control, patients should refuse from products accelerating the destruction of cartilage and bone tissue and causing system metabolic disorders.