My wife and I have always been active and try to make healthy choices. Even so, she is starting to develop knee osteoarthritis. This comes as a surprise to us because of our efforts to avoid such conditions. What else can we do that we aren’t already doing to keep this from getting worse?

Lifestyle, including diet and exercise is still and always the best bet for working with degenerative joint changes that produce this condition we call osteoarthritis. These are things you have some control over — we call them modifiable risk factors.

Being inactive and/or overweight are often the first modifiable risk factors patients are directed to pay attention to and make changes. But it sounds like this is one area you have already focused on as a couple.

That brings us to the issue of knee alignment and muscle function. It’s a well-known fact that uneven load on the knee joint can wear down the cartilage on one side, resulting in osteoarthritis. What causes this kind of problem? Sometimes it is just the way a person is put together. If the bones of the leg don’t line up exactly evenly and in the middle, problems can develop.

Muscle impairments can also contribute to the start or worsening of knee osteoarthritis. What do we mean by “impairments”? Muscle impairment includes problems with muscle activation (muscle fibers contracting), muscle atrophy (wasting away), and force production.

Force production refers to the ability of the nervous system to fully contract all the muscle fibers. A fully activated muscle must have the ability to fire up all the motor units at a rate that produces optimal muscle function. Failure of any of these factors to function with the correct timing and force can result in knee muscle weakness and the progression of OA.

That brings us back to your original question: what can you do now? The best approach is to work with your orthopedic surgeon and a physical therapist to address all the potential issues (alignment, muscle function). There may be some simple surgical interventions to restore good alignment. Early treatment can often prevent (or slow down) worsening of the problem.

Your wife may need a specific exercise program. The therapist will prescribe a program that addresses any particular anatomic or motor function problems she may have that are contributing to the degenerative process. Sticking with the program is important to get the best results. If you are already in the habit of exercising, that’s half the battle for most people!