Definition

What is knee osteoarthritis?

Knee osteoarthritis is a degenerative disease of the knee joint. The knee joint connects the upper and lower leg bones and the kneecap. Wherever the knee joint bones touch, these contact surfaces are covered with a layer of cartilage. Healthy cartilage has a very smooth gliding surface that enables low-friction movement in the joint.
In knee osteoarthritis, the cartilage is partially damaged. Cartilage damage is divided into four stages:

• Stage/grade I: Soft cartilage

• Stage/grade II: Rough surface with cracks

• Stage/grade III: Deep tears in the cartilage that extend to the bone

• Stage/grade IV: Complete wear of the cartilage with exposed bone. This is also referred to as bony baldness.

Healthy knee joint

1. Thigh bone
2. Cartilage
3. Outer meniscus
4. Fibula
5. Inner meniscus
6. Shinbone

Knee joint arthrosis

1. Exposed bone
2. Bone outgrowths
3. Damaged cartilage
4. Damaged meniscus

What is the source of pain in knee osteoarthritis

The intensity and frequency of pain in knee osteoarthritis (gonarthrosis) varies greatly from person to person. Often, the intensity and frequency of pain are also very variable in the person suffering from osteoarthritis of the knee. Many people wrongly assume that only the degraded cartilage causes the pain in osteoarthritis of the knee. The variability of osteoarthritis pain in the knee proves that it is not just the degraded cartilage or cartilage damage in the knee that causes the pain. If this were the case, the pain would be relatively constant over a certain period of time and would be felt with every movement of the knee joint. People suffering from osteoarthritis of the knee often report that they are completely pain-free within a very short period of time, and even experience severe pain around the knee joint. This pain variability proves that cartilage health and thickness should not be the sole basis for deciding on further measures. X-rays and other imaging procedures should therefore have no relevant influence on the assessment of the severity of osteoarthritis in the knee and knee joint osteoarthritis treatment. As with all structures in the body, cartilage also undergoes a continuous build-up and breakdown process. The aim in everyday life must now be to ensure that the degradation processes do not overlap the build-up processes. These processes are discussed in more detail on this page. The variability in the intensity and frequency of pain is partly due to the fact that the areas of knee arthrosis can vary. A distinction is made between the following areas:

• on the inside of the knee joint (medial)

• on the outside of the knee joint (lateral)

• under the kneecap (patellofemoral)

Conversely, the causes of pain in knee osteoarthritis are diverse, as different internal processes occur in the body during knee osteoarthritis. The most common processes are explained below:

• Cartilage degradation
  The articular cartilage acts as a shock absorber between the bones of the knee joint. If the cartilage gradually breaks down, additional pressure can be exerted on the periosteum. The periosteum is equipped with blood vessels and numerous nerves, which react to the pressure with corresponding pain. In contrast to the bone, the periosteum is very sensitive to pain.

• Joint inflammation (synovitis)
  Cartilage wear can trigger inflammatory processes in the synovial membrane (synovium). This inflammation leads to increased production of synovial fluid and can cause swelling, overheating and pain.

• Joint effusions
  The increased formation of joint fluid (effusion) as a reaction to cartilage degradation exerts additional pressure on the joint, which can cause pain and feelings of tension.

• Irritation of the surrounding tissue
  The changes in the joint also irritate surrounding structures such as ligaments, tendons, muscles and fascia. This irritation can also cause pain and increased joint stiffness, especially after long periods of rest or at the start of movements.

• Bone changes (osteophytes)
  As osteoarthritis progresses, bony growths, known as osteophytes, form on the edges of the joint. These bony outgrowths are not painful themselves, but can press on nerves or soft tissue, which leads to additional pain and restricted movement.

• Microcracks in the bone (subchondral changes)
  The increasing loss of cartilage also puts more strain on the underlying bone (subchondral bone). This can lead to small cracks, bone thickening or so-called "boulder cysts", which also cause pain.

• Myofascial tension
  The musculoskeletal system senses the incorrect and excessive strain on the knee joint and tries to protect the joint and the cartilage by tensing the muscles and fasciae so that the knee can no longer be moved to the maximum possible extent. This tension in the myofascial structures can lead to pain during movement, as the muscles are working against this tension.

Cause of knee osteoarthritis

The causes of cartilage degradation and the associated osteoarthritis pain in the knee are closely linked to modern lifestyles and changing environmental conditions. In the past, our ancestors had to move more holistically and significantly more to obtain food. Hunting, gathering berries, or farming are just a few examples. This movement was often done barefoot and on natural ground over long distances. The ground surface and the extent of movement, among other things, led to well-developed and naturally stressed foot and leg muscles.
The lifestyle has changed significantly over millennia. Modern civilization is often characterized by a lack of movement and a sedentary lifestyle. However, when we do move, it is due to the changed environmental conditions on hard, flat surfaces like concrete or asphalt and in rigid, supportive shoes. Consequently, the changed quantity and quality of movement lead to physical adaptations. The following will describe the effects of this on the development of knee osteoarthritis (gonarthrosis).

Lack of exercise and a sedentary lifestyle

The modern way of life, which is characterized by a lack of exercise and a sedentary lifestyle, places incorrect strain on the musculoskeletal system. The lack of exercise and sedentary lifestyle lead to physical adaptations that can cause the knee joint cartilage to break down. The following changes play a significant role in the development of osteoarthritis of the knee joint:

• Weakened muscles
  Lack of exercise and a sedentary lifestyle cause essential muscles to atrophy. The foot and leg muscles play a decisive role in the health of the cartilage in the knee joint. On the one hand, functional foot muscles support the longitudinal arch of the foot, which is the first instance of reducing the force exerted on the knee and thus its cartilage when standing and walking. On the other hand, the foot and leg muscles ensure that the foot rolls naturally and thus protects against uncontrolled foot drop after heel strike. Due to uncontrolled rolling of the foot, the knee is hit with every step instead of being guided physiologically. This incorrect and excessive strain leads to overstressing of the cartilage in the knee joint. The lower leg and thigh muscles stabilise the knee joint and keep it in the correct position. Active and tense muscles around the knee joint also protect the cartilage from the forces exerted during each individual movement. The importance of functioning muscles in the feet and legs is therefore essential for the health of the joint cartilage.

• Foot deformities
  The weakened muscles can additionally lead to foot deformities. The responsible muscles are no longer able to support the longitudinal arch, which leads to a flatfoot or fallen arch. By the collapse of the longitudinal arch, the foot loses its shock-absorbing function when walking and standing. The force exerted is thus directly transferred from the feet to the knees and their cartilage with each step. The increased load can damage the cartilage over time and thus lead to osteoarthritis in the knee and knee pain.
  Furthermore, a pronated or supinated foot can shift the knee axis inward or outward, leading to increased stress on the cartilage on the respective side. Continuous unilateral stress can result in cartilage degradation in the knee joint.

• Restricted supply to the cartilage
  The cartilage in the knee is not supplied directly by blood vessels, but receives its nutrients from the synovial fluid that is pumped into the joint through movement. A lack of movement disrupts this process, which leads to an insufficient supply of nutrients and oxygen to the cartilage. This reduces the elasticity and resilience of the cartilage, increases friction and wear and tear and can lead to osteoarthritis of the knee in the long term.

• Fascia Dysfunction
  The fasciae change their original structure and can become brittle when they are subjected to irregular and unphysiological stress. As a result, the fascial network loses its elastic functionality, leading to increased tension around the knee joint. Due to the increased tension, the thigh and shin bones are pressed closer together, and the kneecap is drawn closer to the knee joint. This additional pressure from the closer bones excessively wears down the cartilage layer. This can lead to osteoarthritis in the knee joint. Furthermore, the altered fascia structure can also impair the mobility of the joints, causing them to stiffen. More on this in the following section.

• Joint stiffness
  Due to a lack of exercise and a sedentary lifestyle, the joints are not moved to the maximum possible range of motion. The result is a natural stiffening of the joints. Immobile joints, especially in and around the foot, prevent a natural rolling movement and thus increase the force exerted on the knee joint. In addition, the knee joint can also stiffen, which also increases the pressure in and around the knee. The cartilage is therefore misloaded and overloaded and can lead to osteoarthritis in the knee joint.

Hard, flat floors and immobile, supportive shoes

Hard, flat floors and immobile, supportive shoes have a significant impact on the knee joints and can cause or exacerbate osteoarthritis of the knee. The following factors play a significant role in the development of osteoarthritis of the knee.

• Reduced shock absorption and increased force impact
  When walking on hard, flat floors and in immobile, supportive shoes, higher forces act on the musculoskeletal system, especially during heel strike. Due to the firmness of industrial floors and the stiffness of conventional shoe soles, the forces that occur cannot be absorbed, which leads to increased strain on the body. This increased force hits the feet first and is then transferred to the knees. The less able the feet are to absorb the forces, the more strain is placed on the next joint up, the knee. The cartilage in the knee joint is therefore increasingly affected with every single step. Furthermore, the increased and early application of force shortens the possible reaction time of the responsible muscles. If the muscles cannot tense up in time, the joint in question is insufficiently stabilized, which also leads to incorrect and excessive strain. Insufficient muscular tension in the feet results in uncontrolled folding of the midfoot after heel strike. This results in the so-called "hinged foot" and leads to an additional impact on the knee joint, which further damages the cartilage. The lower leg and thigh muscles that stabilize the knee are also unable to react quickly enough due to the early and increased application of force. The reduced muscular tension leads to an unstable knee joint, which increases the load on the cartilage and can therefore lead to osteoarthritis in the knee joint in the long term.

• 

  1. Maximum load after time 1 during heel strike in conventional shoes
  2. Maximum load after time 2 during heel strike in kybun shoes
  3. Force in Newton
  4. Time in seconds
  5. Walking on flat, hard ground in kybun shoes
  6. Walking on flat, hard ground in other shoes

• Restricted foot function and muscle weakening
  Shoes with rigid soles or thicker supports prevent the feet from utilising their natural mobility. As a result, the foot muscles are less activated, which leads to a weakening of the arch and stabilisers. A weak arch has a negative effect on the entire body statics and can promote poor posture, which causes back pain. Furthermore, a weakened arch changes the load distribution in the legs and spine.
  
  In addition, altered body statics often lead to compensatory movement patterns. For example, a pronated foot position can cause the pelvis to tilt and the spine to curve unnaturally. This increases the strain on certain vertebral segments and muscles, which can promote back pain (e.g. low back pain or lumbar spine pain) in the long term. Poor foot function also affects the deep muscles and postural control of the entire body. As the feet form the basis of posture, imbalances in the foot area can significantly impair the body's ability to keep the spine stable.

• Unnatural sequence of movements
  Natural movement sequences are designed to react dynamically to changing surfaces. Hard, flat floors and immobile, supportive shoes make a physiological sequence of movements much more difficult. On the one hand, the lack of muscle activation during heel strike causes the foot to fold downwards in an uncontrolled manner. The folding foot and its consequences for the knee joint were described in the previous section. On the other hand, the hardness and inflexibility of industrial floors and the stiffness of conventional shoe soles prevent the foot from rolling naturally. Due to the lack of rolling, the knee joint is not moved through its maximum range of motion, but is loaded in the same area with every step. On the one hand, this leads to certain structures being overloaded and others underloaded. In the case of articular cartilage, the overstressed areas lead to excessive degradation and thus accelerate osteoarthritis in the knee joint. Those areas of the cartilage that are not stressed can become brittle and lose their elasticity and thus their cushioning function. Furthermore, immobile, supportive shoes reduce the sensory feedback from the foot, which leads to a reduction in the exchange of information and therefore a reduction in adaptability. This results in a monotonous load, which is particularly harmful to the knee joint. The lack of variation and constant pressure on certain parts of the knee can cause microtraumas in the joint, which can develop into osteoarthritis of the knee over time.

Symptoms of knee osteoarthritis

It is important to note that the following are the most common symptoms of knee osteoarthritis (gonarthrosis). However, the list of knee osteoarthritis symptoms is not complete and exhaustive. Atypical knee osteoarthritis symptoms are also possible and are not listed here. Knee osteoarthritis symptoms often depend on various factors such as pain perception, cause of the injury, degree of injury, physical constitution, etc. A doctor should be consulted in order to obtain a clear diagnosis.

• Pain in the knee joint, which is initially load-dependent (e.g. when walking, climbing stairs) and later also occurs at rest or at night.

• Joint stiffness, which is particularly pronounced after long periods of rest (e.g. in the morning, so-called "start-up pain").

• Restricted mobility with difficulty bending or extending the knee. Restrictions in everyday movements, e.g. squatting or kneeling.

• Swelling and inflammation in the knee joint. Inflammation can be accompanied by localized overheating in the knee.

• With substantial cartilage wear, the bones rubbing against each other can result in crackling or popping sounds.

• Feeling of instability in the knee

• Lack of stability under load.

• Muscle weakness in the surrounding thigh muscles that stabilise the knee.

• Misalignment of the knee with development of knock knees or bow legs due to uneven

• Weather-dependent knee pain in osteoarthritis. Pain and stiffness can increase in damp or cold weather.

• Varying sensation of pain: From no pain to extreme pain, the pain can vary accordingly in the same person within one day. This is a strong indication that it is not the degenerated cartilage but the myofascial structures that are causing the pain. Reason: Cartilage damage is consistent, but tension and blockages are not.

What helps with knee osteoarthritis? Conventional therapy

There are several approaches to treating knee osteoarthritis pain. Some knee osteoarthritis therapies are listed below. The list of these therapies is not exhaustive. Various measures can also be combined to treat knee osteoarthritis. A medical consultation is recommended to determine the appropriate therapy for osteoarthritis of the knee.

• Physiotherapy: With special knee osteoarthritis exercises and forms of therapy, the aim is to improve mobility, strengthen the muscles and relieve the joint.

• Exercise therapy: Gentle exercise (e.g. swimming, cycling or yoga) promotes mobility and musculature without overloading. It also promotes blood circulation, which is useful when treating osteoarthritis of the knee.

• Weight reduction: Relief for the knee joints by reducing body weight and thus reducing pressure on the joints, less pain and slower cartilage degradation.

• Orthopaedic aids: Supports or orthoses to support and stabilise the knee joint. Shoe insoles to correct misalignments and relieve pressure on certain joint areas.

• Dietary Change: Anti-inflammatory diet to reduce systemic inflammation around the knee joint as an appropriate knee osteoarthritis treatment.

• Acupuncture: Relieving pain by targeting specific points.

• Heat or Cold Applications: Heat for relaxing tense structures, cold for alleviating inflammation. The appropriate temperature must be tested in the treatment of knee osteoarthritis.

• Magnetic field or electrotherapy: Promotes blood circulation and pain relief.

• Drug therapy: Painkillers and anti-inflammatory medication. Cartilage-building medication for cartilage damage.

• Joint injections: Hyaluronic acid to improve joint lubrication and relieve pain. Cortisone to reduce inflammation in acute flare-ups and relieve pain in knee osteoarthritis.

• Autologous blood therapy: This method uses the healing properties of the body's own blood to regenerate joint cartilage and relieve knee osteoarthritis pain.

• Knee joint arthrosis surgery: Arthroscopy with minimally invasive cleaning of the joint, e.g. removal of cartilage remnants. Osteotomy to correct misalignments through bone cuts. Knee prosthesis (partial or full prosthesis) with replacement of the knee joint in cases of very advanced osteoarthritis.

What helps with knee osteoarthritis? kybun mode of action

Kybun products aim to eliminate the health-damaging effects of hard, flat floors and immobile, supportive shoes and actively tackle the lack of exercise and sedentary lifestyle. The elastic, springy properties of kybun products relieve and activate the musculoskeletal system. The relief ensures that the load on the knee joint cartilage is reduced as a first step. Activation is intended to tackle the causes of osteoarthritis of the knee so that knee pain caused by osteoarthritis becomes a thing of the past in the long term. This makes kybun shoes ideal for knee osteoarthritis, as they help treat knee osteoarthritis through the following modes of action:

• Muscle activation and stabilisation of the knee joint
  When walking in kybun shoes, the heels can sink deep into the elastic, springy material thanks to the compression capacity of the soles. By sinking in, the load is built up slowly and in a controlled manner, which gives the body more time to tense the relevant muscles. The tensed leg muscles stabilise the knee joint and the cartilage is naturally stressed. When walking on hard, flat floors and in immobile, supportive shoes, the load is applied to the feet without cushioning. Due to the associated increased force and reduced reaction time, the muscles responsible cannot tense up in time. The lack of muscle tension results in inadequate stabilisation of the knee joint and therefore incorrect and excessive strain on the cartilage.

• Reduction of the force exerted by hard, flat floors due to damping effect
  When the heel strikes the ground in kybun shoes, the elastic-spring material is compressed. The compression capacity of the kybun sole allows the rear foot to sink deep into the elastic-spring material when the heel strikes the ground. This slow and controlled sinking reduces the force and therefore the load on the knee joint and its cartilage. Similar to an airbag in a car, the cushioning effect of the kybun sole helps to minimize the impact of force.

• 

  1. Force effect 1 during heel strike in conventional shoes
  2. Force effect 2 during heel strike in kybun shoes
  3. Force in Newton
  4. Time in seconds
  5. Walking on flat, hard ground in kybun shoes
  6. Walking on flat, hard ground in other shoes

• Furthermore, as the heel slowly sinks into the elastic, springy material, the body has more time to tense the relevant muscle groups. The improved basic tension in the muscles stabilises the individual joints and thus reduces the force exerted on the spine and surrounding structures.

• Activation and strengthening of the muscles thanks to elastic-spring properties
  When walking and standing on the elastic-springy kybun surface, the body must constantly make small compensatory movements to maintain balance. The deliberate instability of kybun products challenges the balance system and specifically activates the stabilizing deep muscles, which are responsible for stability and posture. This leads to the knee joint being better stabilized and thus protected by the surrounding muscles. At the same time, coordination skills are trained as the interaction between the nervous system and muscles is improved. This leads to an improvement in body awareness and the precision of each individual movement.

• Balance and EMG
  The ability to balance was measured with a force plate by moving the body's center of gravity from front to back (ant-post) and sideways (med-lat) while standing. In parallel, electromyography (EMG) recorded muscular activity.

  With ordinary shoes

  1. Reduced muscular activity
  2. Reduced range of movement of the body's centre of gravity

  With kybun shoes

  1. Increased muscular activity
  2. Increased range of movement of the body's centre of gravity

• By activating and strengthening the foot muscles, foot misalignments such as splayfoot, flat foot or fallen arches, which are often caused by muscular deficits, can be counteracted. As an intact longitudinal arch reduces the forces generated during heel strike, the individual vertebrae and soft tissue are also relieved. As the foot is also prevented from bending inwards or outwards, the leg axis remains in its physiological position and the back and adjacent structures are protected from additional incorrect and excessive strain. The slow and controlled sinking of the heel into the elastic, springy material creates myofascial pretension in the muscles involved. This pretension and the improved muscular activity allow the spine to be stabilised and guided at an early stage, which also reduces the force exerted on the back and the surrounding soft tissue.

• Natural foot rolling and increased range of motion thanks to the rebound effect
  
  Thanks to the elastic, springy kybun shoes with the rebound effect and the associated muscular pre-tensioning and reduced acceleration, the foot can be set down in a controlled manner at heel strike. This prevents the cartilage-degrading folding foot, which hits the knee joint with every step. In addition, active rolling on the elastic, springy kybun material utilises the entire range of movement of the foot. The movement sequence begins with the heel touching the ground and ends with the toes pushing off. By utilising the full range of movement in the feet, more movement is automatically generated in the knee joints. This means that the knee joint is not always moved in the same range, which promotes cartilage degradation, but is utilised over the entire range of motion. The result is a reduction in the punctual load intensity. Furthermore, several studies have shown that cartilage can be rebuilt through natural and physiological loading. By utilising the full range of motion, the knee joint becomes or remains mobile and is protected from tension and blockages. This additional movement with a natural and physiological gait can activate and strengthen the muscles and promote blood circulation, which also has a positive effect on osteoarthritis of the knee.

• Promoting blood circulation through increased movement activity
  The knee joint also requires numerous nutrients to nourish, maintain and regenerate the cartilage. These nutrients are transported to the corresponding tissue via the blood and synovial fluid. In addition, anti-inflammatory substances are transported to the knee joint via the blood, while harmful and inflammation-promoting messenger substances are transported away. This constant exchange of fluids thus supplies the cartilage and keeps it elastic and resistant. The elastic, springy kybun materials promote movement and thus activate the muscles around the knee joint. This increases blood circulation, which in turn promotes the benefits mentioned above.

• Promoting movement and reducing sedentary activity
  The elastic-springy kybun products promote the joy of movement, as walking and standing on the unique material relieves pressure on the knee joints. The movement activates and strengthens the muscles and promotes blood circulation. The benefits of these two processes have already been described in the previous sections. As the use of kybun products can also reduce the duration of sedentary activity, harmful shortening and blockages of the myofascial structures can be avoided. Increased walking and standing stretches and lengthens the often shortened hip flexor muscles and the posterior chain of calf and thigh muscles, which has a positive effect on the angular position of the knee joint and the pressure on the knee joint cartilage.

• Care and protection of the fasciae
  The fasciae stabilize the knee joint and distribute the load evenly with every single step, which protects against cartilage wear. Healthy and functional fasciae are elastic and therefore free from adhesions and tension. Elastic fascia promotes the mobility of the knee joint and supports good blood circulation, which is important for the nutrient supply and regeneration of the cartilage. Thanks to the kybun shoes, a natural sequence of movements is made possible, which keeps the fasciae elastic.

• Optimised pressure distribution thanks to the reduction of pressure points
  The entire sole of the foot is surrounded by this unique elastic, springy material. This leads to optimised pressure distribution in the feet. As a result, the punctual load on the back (e.g. intervertebral discs) and the surrounding soft tissue can be reduced. In addition, the constant slight movement on the kybun products increases the load-bearing surface, which can also reduce individual pressure points. This can protect the back from overloading and injuries.

Application tips for knee osteoarthritis

Before you wear kybun shoes for the first time, you should consider a few tips on how to use them. Correct use can help to alleviate knee osteoarthritis pain. Osteoarthritis in the knee joint can also be treated with targeted knee osteoarthritis therapy, which is explained in the next section.

• To begin with, only wear the kybun shoes for as long as your body allows. Take breaks from wearing them if the knee pain caused by osteoarthritis increases or the musculoskeletal system becomes tired. Knee joint arthrosis treatment takes time. The activating properties of kybun products train the muscles, which can lead to so-called initial reactions, especially at the beginning.

• Press your heel slowly and in a controlled manner into the elastic, springy material so that the knee joint is relieved. Try to find a load point at which the pain in the knee joint is reduced or does not occur. At the beginning, make sure that you do not roll too much over your heels.

• Start by taking small, controlled steps, reducing the amount of rolling over the forefoot so that less movement is generated in the knee joint. Increase the range of motion of the feet over time, if possible.

• Try the following exercises to boost the effectiveness of kybun shoes and increase the chances of recovery. These are intended as a complementary therapy for back pain and should form part of the treatment for back pain.

What to do for knee osteoarthritis? Helpful exercises

To enhance the effectiveness of kybun shoes and increase the chances of recovery from knee pain, we recommend performing the following exercises for knee osteoarthritis. The selection of exercises is not exhaustive and can be supplemented with additional exercises. The basic rule for all exercises is that the pain in the knee joint must not increase. If any of the exercises intensify the pain, they must be discontinued. Soothing and relieving "pain" outside the pain point in the knee joint (e.g., in the thigh) is desirable. The exercises are divided into the following areas: "Proper Walking in kybun Shoes," "Muscle Length Training," "Fascia Rolling," and "Strengthening." Ideally, the different areas are used complementarily as therapy for knee osteoarthritis.

Walking the right way in kybun shoes

The quality of each individual step is crucial in the treatment of osteoarthritis of the knee in order to reduce knee pain caused by osteoarthritis and to eliminate incorrect and excessive strain. The kybun shoes therefore offer ideal therapy for osteoarthritis of the knee.

Controlled heel strike

• Press the heel carefully and in a controlled manner into the elastic, springy material to determine the load strength and load point without causing pain in the knee joint.

• Controlled foot position so that the foot does not tilt inwards or outwards. This keeps the knee joint in a straight position.

• Lower the midfoot and forefoot slowly and in a controlled manner so that the knee joint is not hit.

• Slow exercises help to rebuild the stabilising muscles around the knee joint.

Controlled rolling

• Slight rolling motion in the forefoot without actively pushing off with a lot of force via the big toes. The stronger the rolling movement, the greater the range of motion in the knee joint. If the knee joint is tight and locked, increasing the range of motion can lead to an increase in pain. In this case, the tension and blockages must first be released.

• Test the possible range of movement of the feet without causing pain. Increase the range of movement if possible.

Muscle length training

Muscle length training is of crucial importance in the treatment of osteoarthritis of the knee, as knee pain in osteoarthritis is often caused by shortening, tension and blockages in the myofascial structures. Targeted stretching exercises can actively tackle the shortening, tension and blockages and are therefore an ideal therapy for osteoarthritis of the knee.

Front thigh muscles

• From a standing position, grab the back of your left foot with your left hand. To check your balance, you can hold on to a stable object with your right hand.

• Left thigh is parallel to the supporting leg.

• Straight back.

• Push your pelvis slightly forwards to increase the stretch in your thigh.

• Pull the heel of the foot towards the buttocks so that the knee is pointing downwards. The closer the heel is pulled towards the buttocks, the greater the stretch.

• Perform 1-2 times daily.

• Hold the exercise for 3 x 30 seconds.

Calf and hamstring muscles

• Begin in an all-fours position.

• Stretch your buttocks upwards into the air.

• If possible, push your heels towards the floor to increase the stretch.

• 3 x 30 seconds per side.

• 1-2 times a day.

Fascia roller

Fascia training with the fascia roller is important in the treatment of osteoarthritis of the knee joint, as this is often caused by shortening, tension and blockages in the myofascial structures. By regularly rolling out the shortened and tense myofascial chains, the fascia roller is suitable as an active therapy for osteoarthritis of the knee joint.

Front thigh muscles

• Commence in a prone position.

• Place the large roller under the thigh of the outstretched leg. Place the other leg at an angle to control the movement.

• Actively roll out the front thigh from the hip to above the knee joint.

• Perform exercises slowly and in a controlled manner. Adjust the pressure to your personal sensation, but go to the tolerable pain threshold.

• Roll out any localised adhesions or hold the position at this point.

• 3 minutes each side.

• Perform 1-2 times daily.

Lateral thigh muscles

• Place a large roller between the outer thigh area and the floor.

• Position the upper leg at a right angle for stabilisation and to guide the movement.

• Actively roll out the lateral thigh from the hip to above the knee joint.

• Perform exercises slowly and controlled.

• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.

• Roll out any localised adhesions or hold the position at this point.

• Exercise can be strengthened by straightening the upper leg.

• 3 minutes each side.

• Carry out 1 - 2 × daily.

Strengthening

Targeted strength training helps to strengthen the leg muscles and thus relieve the knee joints and their cartilage. Strengthened muscles can better absorb the forces acting on the knee joints with every movement. Furthermore, the muscles stabilise the knee joints and thus protect them from incorrect and excessive strain. Strengthening exercises are an effective therapy for knee osteoarthritis and help to alleviate pain in the long term.

Squats

• Starting position: standing, feet slightly wider than hip width and slightly rotated outwards.

• Squat down slowly and in a controlled manner. Push your buttocks back and shift your weight onto your heels.

• Ensure that strength comes from the buttocks. Stabilise your knees so that they do not bend inwards or outwards.

• Slowly straighten up again in a controlled manner.

• If you have balance problems, you can hold on to a stable object with your hands.

• 3 sets of 8 - 12 repetitions.

• Perform 2 - 3 × weekly.

Side-lying leg raise

• Starting position: Lateral position.

• Feet, knees, hips and head are in a straight line. An object can be placed under the head for support.

• Actively lift the upper leg and then actively brake and move it down again.

• At the lowest point, do not put the leg down completely, but move it back up again so that the muscles are always active. If this is not possible, the leg can be put down briefly.

• Make sure your torso is stable during the exercise and perform the movements slowly and in a controlled manner. The upper body should not move with the exercise.

• To make the exercise more challenging, place a resistance band (fitness band) around the knees. The band should be placed just above the knee joint.

• 3 sets of 8 - 12 repetitions.

• Perform 2 - 3 × weekly.