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 consumption of the cartilage with exposed bone; this is also referred to as a bone 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

Where does the pain from knee osteoarthritis come from

The intensity and frequency of pain in knee osteoarthritis varies greatly from person to person. Often, the intensity and frequency of pain are also very variable in the person suffering from knee osteoarthritis. Many people wrongly assume that only the degraded cartilage causes the pain in knee osteoarthritis. The variability of the pain proves that the degraded cartilage alone cannot be the cause of 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, or 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 and its treatment. As with all structures in the body, cartilage also undergoes a continuous process of build-up and degradation. 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 osteoarthritis can be different. 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)

On the other hand, the causes of pain in knee osteoarthritis also vary, as various internal processes take place 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 musculoskeletal system senses the incorrect and excessive strain on the knee joint and tries to protect the joint and cartilage by tensing the muscles and fasciae, preventing the knee from moving to the maximum possible extent. This tension in the myofascial structures can lead to pain during movement, as the knee is working against this tension.

• Myofascial tension
  As osteoarthritis progresses, bony growths, known as osteophytes, form at 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.

Cause of knee osteoarthritis

The causes of cartilage degeneration and the associated pain in the knee joint are closely linked to modern lifestyles and changing environmental conditions. In the past, our ancestors had to move around a lot more to get food. Hunting, foraging for berries or farming are just a few examples. Over long distances, this movement was carried out barefoot and on natural ground. The surface of the ground and the extent of the movement meant, among other things, that the foot and leg muscles were well developed and naturally strained. Lifestyle has changed considerably over thousands of years. Modern civilisation is often characterised by a lack of exercise and a sedentary lifestyle. However, when we do move, it is on hard, flat floors such as concrete or tarmac and in immobile, supportive shoes due to the changed environmental conditions. Consequently, the altered quantity and quality of movement leads to physical adaptations. The effects of this on the development of knee osteoarthritis are described below.

Lack of exercise and a sedentary lifestyle

Non-specific cause: No exact cause can be identified.

• 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 malpositions
  The weakened musculature can also lead to foot malpositions. The muscles responsible are no longer able to support the longitudinal arch, which leads to flat feet. The collapse of the longitudinal arch deprives the foot of its shock-absorbing function when walking and standing. The force exerted is therefore transmitted directly to the knees and their cartilage via the feet with every step. The increased load can damage the cartilage over time, leading to knee osteoarthritis and knee pain. Furthermore, the knee axis can be shifted inwards or outwards due to a bent foot as well as pronation and supination, which leads to increased stress on the cartilage on the respective side. Prolonged one-sided strain can result in cartilage degradation in the knee joint.

• Restricted blood 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 knee osteoarthritis in the long term.

• Fascia dysfunction
  The fasciae change their original structure and can become brittle if they are subjected to irregular and unphysiological strain. As a result, the fascial network loses its elasticity and leads to increased tension around the knee joint. The increased tension pushes the upper and lower leg bones closer together and brings the kneecap closer to the knee joint. This additional pressure from the closer bones wears down the cartilage layer excessively. Furthermore, the altered fascia structure can also impair the mobility of the joints, causing them to stiffen. More on this in the following point.

• 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.

Hard, flat floors and immobile, supportive shoes

Hard, flat floors and immobile, supportive shoes have a significant impact on the musculoskeletal system and can cause or exacerbate back pain. The following factors play a significant role in the development of back pain.

• Reduced shock absorption and increased force impact
  Due to the firmness of hard floors such as concrete or tiles and the stiffness of conventional shoe soles, the impact forces are reflected instead of absorbed with every step. The lack of shock absorption increases the impact force and the strain on the joints and spine. 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 stabilised, which also leads to incorrect and excessive strain. The muscles around the back and the underlying structures help to protect the spine. In the long term, the lack of cushioning and the resulting increased force can cause wear and tear in the spine and painful overloading.

• 

  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 knee osteoarthritis. Those areas of the cartilage that are not stressed can become brittle and lose their elasticity and therefore 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 over time.

Symptoms of knee osteoarthritis

It is important to note that the following are the most common symptoms of knee osteoarthritis. However, the list of symptoms is not complete and exhaustive. Atypical symptoms are also possible, which 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 localised hyperthermia in the knee.

• If the cartilage is severely degraded, the rubbing of the bones against each other can cause crunching or cracking noises.

• Feeling of instability in the knee

• Lack of stability under load.

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

• Malalignment of the knee with development of knock knees or bow legs due to uneven cartilage degradation.

• Weather-influenced ailments. Pain and stiffness may become more severe in humid or chilly 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

Um Kniearthrose Schmerzen zu behandeln, gibt es mehrere Ansätze. Nachfolgend sollen einige Kniearthrose Therapien aufgezeigt werden. Die Liste dieser Therapien ist nicht abschliessend. Auch können verschiedene Massnahmen kombiniert werden, um die Kniearthrose zu behandeln. Eine ärztliche Konsultation wird empfohlen, um die geeignete Therapie bei Arthrose im Kniegelenk zu ermitteln.

• Physiotherapy: Special exercises and forms of therapy are used to improve mobility, strengthen the muscles and relieve pressure on the joint.

• Exercise therapy: Gentle exercise (e.g. swimming, cycling or yoga) promotes mobility and muscle tone without overloading. It also promotes blood circulation.

• 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 changes: Anti-inflammatory diet to reduce systemic inflammation around the knee joint

• Acupuncture: Relieving pain by targeting specific points.

• Heat or cold applications: Heat to relax tense structures, cold to relieve inflammation.

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

• Medication Therapy: Painkillers and anti-inflammatory drugs. Cartilage-building supplements.

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

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

• Surgical measures: 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

The kybun range of products aim to eliminate the harmful 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 the musculoskeletal system on the one hand and activate it on the other. The relief ensures that back pain is reduced as a first step. Activation is intended to tackle the causes of current and chronic back pain so that the complaints become a thing of the past in the long term. This makes kybun shoes ideal for back pain, as they help to treat back pain 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 thanks to the cushioning effect
  When the heel strikes the ground in kybun shoes, the elastic, springy material is compressed. This rebound effect of the sole means that some of the forces occurring can be absorbed and released again for the rolling phase. The force-absorbing capacity of the kybun sole leads to cushioning and thus protects the back and surrounding structures from excessive force. The reduced impact of force reduces strain and minimises the risk of back pain.

• 

  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 musculature through elastic-springy properties
  When standing and walking on elastic-springy material, the entire body has to work on the unique surface, so that both the muscles around the feet and the deep muscles of the entire musculoskeletal system are activated and strengthened. This improves muscle function, which has a positive effect on the stabilisation and guidance of the spine and surrounding soft tissue.

• Balance and EMG
  Balance ability was measured using a force plate by moving the body's centre of gravity from front to back (ant-post) and sideways (med-lat) while standing quietly. Muscular activity was recorded in parallel using electromyography (EMG).

  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.

• Promotes circulation through increased movement 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.

• Promoting movement and reducing sedentary behaviour
  The injured structures in and around the back require numerous nutrients to heal. These nutrients are transported to the relevant tissue by the blood and synovial fluid. In addition, anti-inflammatory substances are transported to the back and the surrounding soft tissue via the blood, while harmful and inflammation-promoting messenger substances are transported away. This constant exchange of fluids thus supplies the corresponding structures. The elastic, springy kybun materials promote movement and thus activate the muscles around the spine. This increases blood circulation, which in turn favours the benefits mentioned above.

• Care and protection of the fascia
  Fasciae surround practically the entire body and are interconnected. They hold our body together and give it its shape. Fasciae are responsible for the transmission of force and the degree of stretch in all movements. They keep the muscle fibres lubricated. If the fasciae are tense, sticky or matted, they can no longer fulfil their function or can only do so incompletely. A lack of exercise and unnatural movements on hard, flat floors and in immobile, supportive shoes can lead to a change in the fascia structure and thus affect the way it functions. Tense fascia around the back can increase the tension on sensitive soft tissue (muscles, nerves, intervertebral discs, etc.) and thus lead to pain. Tense fascia can also reduce the natural range of movement of the vertebral bodies and the surrounding soft tissue. This limitation results in increased utilisation of the range of motion that is still possible during any movement. For example, changes in the fascia structure mean that certain muscle groups cannot work to their full range of movement. Similarly, the adhesions of the various fasciae can also involve muscle groups that should not be active for a specific movement. In both cases, this results in incorrect and excessive strain on the individual vertebrae and the surrounding soft tissue. The elastic, springy material promotes movement and ensures natural and physiological strain. This cares for the fasciae and protects them from structural changes.

• 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

Bevor Sie die kybun Schuhe zum ersten Mal tragen, sollten Sie einige Anwendungstipps berücksichtigen. Die korrekte Anwendung kann helfen, um die Kniearthrose Schmerzen zu lindern. Arthrose im Kniegelenk behandeln Sie des Weiteren zusätzlich durch eine gezielte Kniearthrose Therapie, die im nächsten Abschnitt erläutert wird.

• To begin with, only wear kybun shoes for as long as your body allows. Take breaks from wearing them if the pain from the heel spur or plantar fasciitis increases or the musculoskeletal system becomes fatigued. Heel spur treatment and plantar fasciitis treatment take 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 likelihood 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 likelihood 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 knee osteoarthritis to reduce pain and eliminate misalignment and overloading. The kybun shoes thus offer an ideal therapy for knee osteoarthritis.

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 knee osteoarthritis, as the pain 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 knee osteoarthritis.

Calf and hamstring muscles

• Starting position in four-footed stance.

• 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 knee osteoarthritis pain, 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 knee osteoarthritis.

Front thigh muscles

• Start position in 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 you.

• 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.