Many patients with arthritis of the knee walk, unknowingly, with a slight limp, as this transfers some load away from the joint and onto the muscles and soft tissues. If this walking pattern persists, the muscles at the front of the thigh (quads) are being underused and therefore get weak and floppy. The muscles in the calf and back of the thigh are being overused and become painful and cramp. The overloaded soft tissues all around the front of the knee become very painful, swollen and stiff. These symptoms are in addition to the pain from the arthritic knee.
Many patients and their medical advisors may be unaware that they are limping and that a substantial component of their symptoms may be due to their walking pattern rather than the arthritis itself. The weak quads will not respond to gym exercises, as these muscles rely on being used to support the patient’s body weight during the 10,000 steps we normally take per day. If the quads muscle is being bypassed in the limping patient, the quads will remain weak.
Detecting and changing the walking pattern of a patient with a subtle limp can be difficult, but if the patient can learn to use their muscles normally, as they do on the other leg, a large proportion of the pain may disappear and their quads muscles automatically build up. This can change an unacceptably painful knee/leg to a situation that is quite manageable to the patient, even though the X-ray appearances remain unchanged.
If this retraining of the patient’s walking pattern is accompanied by significant weight loss, then patients who may have been on the verge of total knee replacement, quickly find they have less pain, stronger muscles and may be able to defer total knee replacement.