by ptfadmin | Jan 31, 2023 | Health Tips
by Tyler Tice, PT, DPT, MS, ATC
Introduction:
As life expectancy increases globally as modern medicine becomes more advanced, chronic diseases will affect a larger portion of our population as a result. One of the leading causes of chronic pain and disability worldwide is knee osteoarthritis (OA). Knee OA affects the entire joint and its symptoms are frequently related to physical inactivity. Currently, there are many lines of treatment that a patient with knee OA can undergo. There is substantial research supporting the use of exercise in positively impacting knee OA symptoms, however pharmacological intervention continues to be the primary form of treatment. This purpose of this article was to provide updated information regarding current treatment interventions for knee OA.
Key Treatments – Non-pharmacological
Patient education: Patient education is an essential role in decision-making, disease self-management, and medication adherence of individuals with knee OA. As healthcare providers, it’s essential to develop a clear understanding of the disease to effectively direct patients towards high-quality health information. Some key messages that should be included in your education should be: 1) regular physical activity and individualized exercise programs can reduce pain, prevent worsening, and improve daily function in OA; 2) losing weight for overweight individuals is a benefit, as well as maintaining a healthy weight through appropriate diet and exercise; and 3) OA symptoms can often be significantly reduced without the need for undergoing surgery.
Exercise: The role of physical activity and exercise therapy to reduce symptoms and improve physical function in individuals with knee OA is well-established in the world of research. Current research shows that 150 minutes per week of moderate intensity aerobic exercise or 2 days per week of moderate to vigorous physical activity muscle-strengthening exercises are beneficial for individuals with knee OA. Additionally, more pain reduction was observed when quadriceps-specific exercises were incorporated to exercise routines compared to general lower-limb strengthening exercises and were performed at least 3 times per week. When creating a patient’s exercise program it should focus on patient-centered rehabilitation, consider patient preferences and access to exercise equipment. A key piece that patients should be educated on prior to beginning an exercise program is that pain/discomfort during physical activity does not mean increased structural damage to the joint.
Weight loss: Because of its systemic effects on the body due to inflammatory and metabolic changes, obesity and overweight are considered primary risk factors related to chronic disease, including knee OA. A reduction in weight of approximately 5.1 kilograms (11.22 pounds) decreases the risk of developing knee OA by more than 50% in women with a baseline BMI higher than 25 kg/m2. For individuals with knee OA, a combination of diet and exercise has a moderate effect on relieving pain. After successfully losing weight, maintenance of weight loss remains a substantial challenge. Successful strategies for weight maintenance included creating consecutive weight loss goals, having a regular meal pattern that includes breakfast and healthier eating, having a physically activity lifestyle, and controlling over-eating through self-monitoring behaviors.
Thermal modalities: There is a lack of evidence that supports the use of thermal modalities such as ice packs or moist hot packs in individuals with knee OA.
Laser, therapeutic ultrasound, and electrical stimulation: The Osteoarthritis Research Society International (OARSI) strongly recommends against the use of laser therapy for knee OA. There is currently low-quality evidence that supports the use of therapeutic ultrasound for individuals with knee OA. There is currently very low-quality evidence that supports the use of transcutaneous electrical stimulation in patients with knee OA.
Manual therapy techniques, taping, and acupuncture: There is currently low-level evidence showing that manual therapy techniques provide additional benefit when compared to exercise intervention alone in patients with knee OA. There is very low-level of evidence to support the use of taping for the management of knee OA. When utilizing traditional acupuncture, there is low-level evidence that supports the use of this intervention in patients with knee OA.
Pharmacological strategies
Non-steroidal anti-inflammatory drugs (NSAIDs): Topical NSAIDs are strongly recommended as first-line treatment in both the OARSI and American College of Rheumatology (ACR). OARSI recommends topical NSAIDs for individuals with GI or cardiovascular comorbidities as well as frailty. In addition to topical NSAIDs, the ACR strongly recommends the use of oral NSAIDs and intra-articular glucocorticoid injections.
Opioids: There is high-quality evidence that demonstrates opioids only have small effects on pain and physical function in individuals with knee OA. Additionally, when compared to placebo, patients that used opioids have 3-4 times higher risk of serious adverse effects and/or dropouts due to adverse events.
Nutraceuticals: Nutraceuticals are foods or food supplements that are thought to have health benefits. Glucosamine and chondroitin sulfate are commonly used by patients with knee OA; however, they lack scientific evidence to support their use.
Surgery: Surgery is typically the last resort for knee OA management. There are a wide variety of surgical intervention options available with arthroscopic joint lavage being the most common procedure performed. There are several studies that demonstrate low efficacy of this surgical intervention and the clinical practice guideline published by the Journal of the American Academy of Orthopedic Surgeons strongly recommends against the use of arthroscopy in nearly all patients with degenerative knee disease. Joint replacement surgery is another popular surgery for individuals with end-stage knee OA. Before undergoing this surgery, individuals should trial conservative management for 6 months. If conservative management is unsuccessful in improving symptoms and function, then joint replacement should be considered. However, it is important to note that one in five patients that undergo total knee replacement (TKR) is not satisfied with the outcome. When assessing patients following TKR, it is important for clinicians to measure both self-reported measures and objective measures to comprehensively assess individuals with knee OA.
Take Home Messages:
Knee OA is a degenerative disease that effects a high number of individuals, many of which utilize physical therapy to manage their symptoms and improve their function. It is important for clinicians to stay up to date on evidence-based treatment interventions to provide the best first line care that would most benefit their patients. When it comes to interventions that may not have strong evidence supporting them, if they are interventions that the patient reports pain reduction with, there is little harm in including them into your treatment, however overall treatment should still include evidence-backed intervention like exercise.
Reference:
Dantas, L. O., Salvini, T. F., & McAlindon, T. E. (2021). Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian journal of physical therapy, 25(2), 135–146. https://doi.org/10.1016/j.bjpt.2020.08.004
by urikerbel | Jun 18, 2019 | Health Tips
By Sidney Jones, SPT
Background
Osteoarthritis (OA) is a common degenerative joint disease that is usually associated with pain, limited range of motion, muscle weakness, difficulty with activities of daily living and impaired quality of life. The knee is the most common joint in the body affected by osteoarthritis. Low-level laser therapy has been studied and used for pain control, anti-inflammatory effects and its healing efficacy. The purpose of this study was to determine the effects of adding low-level laser therapy (LLLT) to an exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, knee range of motion, and quality of life in older subjects with knee OA.
Participants
Men and women between 60-72 years old with chronic osteoarthritis according to the American College of Rheumatology (ACR) criteria grades II & III and knee OA according to the Kellgren-Lawrence grade. Participants also had to have the ability to stand independently and willingness to participate in the study.
Methods – laser therapy treatment
Group1: 18 subjects 7 males & 11 females were treated with a laser dose of 6 J/cm² over 8 points around the knee. Each point received energy of 6 J/point for 60 seconds.
Group 2: 18 subjects 6 males & 12 females were treated with a laser dose of 3 J/cm² on 9 points around the knee. Each point received energy of 3 J/point for 50 seconds.
Group 3: 15 subjects 5 males & 10 females participated as the control group. Procedure was identical but without emission of energy.
Exercise Training Program
All participants in each group participated in the same exercise training program for 30 to 45-minute sessions 2 times a week for 8 weeks. The program included stretching the quadriceps, hamstrings, adductors, and calf muscles. Strengthening exercises included knee extension, straight leg raises and quadriceps setting. All participants were instructed to practice these exercises as a home program.
Each participant was evaluated pre and post 8 weeks of physical therapy interventions on:
- Pain intensity with Visual Analogue Scale (VAS)
- Physical function with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
- Knee range of motion, active knee flexion range of motion was measured with long arm universal goniometer.
- Isometric strength of knee flexor and extensor muscles was measured using Handheld Dynamometer
Results
The best improvements in VAS, WOMAC pain, knee range of motion and physical function were seen in patients who were treated with 6 J/cm² then 3 J/cm² and then placebo group. Mean values for WOMAC significantly reduced, which means improved physical function. Isometric strength of the quadriceps and hamstring muscles increased significantly in each group after interventions. The largest increase in isometric strength of the quadriceps and hamstring muscles and knee flexion range of motion was seen in patients who received 6 J/cm² followed by 3 J/cm² and then the placebo group. Mean values of knee flexion range of motion increased significantly after physical therapy interventions in each group with significant differences among the 3 groups.
Discussion about adding laser therapy
The current study suggests that adding LLLT to exercise training program could be an important modality for treating older adults with OA than exercise training alone. The active laser groups either 6 J/cm² or 3 J/cm² had a significant reduction of pain intensity in VAS and WOMAC, increase in physical function, increase in isometric quadriceps and hamstring muscle strength, and increase in range of motion after treatment of knee OA.
Conclusion
Adding LLLT to an exercise training program is more effective than exercise training alone in treatment of patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm² or 3 J/cm².
PTF Approach to adding laser therapy
Here at Physical Therapy First, we perform a complete evaluation and based on those findings we design a treatment plan that best addresses our patient’s needs. Our goal is to provide quality patient care and as this study suggests, multiple interventions can and should be used to treat knee osteoarthritis simultaneously. At Physical Therapy First, laser therapy and strengthening are options along with several other interventions such as soft tissue mobilization, stretching and providing our patients with a home exercise program to maximize outcomes.
Original Article about Laser Therapy
Youssef, E. F., Muaidi, Q. I., & Shanb, A. A. (2016). Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. Journal of Lasers in Medical Sciences,7(2), 112-119. doi:10.15171/jlms.2016.19
by urikerbel | Apr 28, 2019 | Health Tips
By Lillian Wynn PT, DPT
Physical Therapist
Background
40% of American adults (110 million people) report walking or running as part of a regular exercise routine. Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the third of three blog posts designed to look at current medical research regarding running on aging joints.
Article summary
PARTICIPANTS:
This paper is a systematic review and meta-analysis, so the authors compiled research on knee osteoarthritis (OA) and running, and summarized the findings in order to provide a concise recommendation based on the general consensus of research. Articles were included if they: were level I-III evidence, written in English, used physician diagnosed OA with clinical and/or radiographic findings, and running was compared to non-running. Articles that compared running to other forms of exercises were not included in this study.
METHODS:
Literature searches were performed, and 1,907 articles were reviewed. Of those, 25 met their inclusion criteria. Statistical analysis was performed on those 25 studies to come to a meta-analysis, which summarizes and confirms the general recommendations based on significant research.
CONCLUSIONS:
The authors concluded that recreational running was in fact associated with lower levels of OA when compared to sedentary individuals. Competitive running was associated with higher levels of OA than recreational runners. Overall, sedentary subject demonstrated the most symptomatic OA. The study also argues that this simply compares runners to non-runners. So the only conclusion that can be drawn is that running is better than being sedentary. More research should be done into seeing if running vs other forms of exercise is the best for of exercise.
PTF approach
Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.
Original Article
Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther, 47(6), 373-390. doi:10.2519/jospt.2017.7137
by urikerbel | Feb 13, 2019 | Health Tips
By Lillian Wynn PT, DPT
Physical Therapist
Background
40% of American adults (110 million people) report walking or running as part of a regular exercise routine. Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the second of three blog posts designed to look at current medical research regarding running on aging joints.
Article summary:
PARTICIPANTS:
Men and women 45-79 years old, were grouped into 3 groups.
1: No symptoms of knee osteoarthritis, and deemed low risk for developing knee osteoarthritis
2: No symptoms of knee osteoarthritis, and deemed high risk
3: Symptoms of knee osteoarthritis
METHODS
Patients were labeled as high volume runners, low volume runners, or non-runners. X-rays and pain questionnaires were provided at the start of the study, again at a 2 year follow up. Pain questionnaires were provided at the final 8 year follow up
RESULTS
Any history of running-low or high volume was associated with lower knee pain. There was slightly lower evidence of knee osteoarthritis on the x-rays of runners, but it was not statistically significant. Statistically the highest predictor of knee pain was BMI.
CONCLUSIONS
Other factors besides running seem to have more of an impact on symptomatic knee osteoarthritis. It is possible that wince runners tend to be more active and have lower BMI, that any potential damage is offset by the benefits of regular exercise.
PTF approach
Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.
Original Article
Lo, G., Driban, J., Kriska, A. McAlindon, T., Souza, R., Petersen, N., Storti, K., Eaton, C., Hochberg, M., Jackson, R., Kwoh, K., Nevitt, M., Suarez-Almazaor, M. (2017). History of Running is Not Associated with Higher Risk of Symptomatic Knee Osteoarthritis: A Cross-Sectional Study form the Osteoarthritis Initiative. Arthritis care res, 69(2), 183-191. doi:10.1002/acr.22939.
by urikerbel | Jan 29, 2019 | Health Tips
By Lillian Wynn PT, DPT
Physical Therapist
Background
40% of American adults (110 million people) report walking or running as part of a regular exercise routine. Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the first of three blog posts designed to look at current medical research regarding running on aging joints.
Article summary
Often of most concern with running is whether the impact is harmful to the knee joint, as the thought is impact could cause and/or worsen osteoarthritis. Osteoarthritis is the term given to changes that occur along a joints surface as we age. The most common way to diagnose osteoarthritis is with an x-ray. A prospective study published in The American Journal for Preventative Medicine investigated whether running as we age increases the severity or frequency of knee arthritis.
PARTICIPANTS
45 long distance runners who were 50 years old or older, and had been running for at least 10 years; and 53 controls who were 50 years or older and did not run for exercise.
METHODS
Initial x-rays were taken of both knees of all participants. Over the next 18 years, 5 follow up x-rays were taken of each patient. These x-rays were graded on a standard scale to quantify the severity of knee arthritis.
RESULTS
Runners did not show higher rates or more severe cases of knee osteoarthritis than non-runners
CONCLUSIONS
Models found that higher BMI, higher initial damage on x-ray, and age to be most strongly correlated with arthritis on x-ray. There was no data to suggest that running, gender, previous knee injury, or total exercise time contributed to osteoarthritis of the knee. In short-go out and go for your run!
PTF approach
Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. Often tight and/or weak muscles, stiff joints, and poor movement patterns can contribute to pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.
Original Article
Chakravarty, E., Hubert, H., Lingala, V., Zatarain, E., Fries, J. (2008). Long Distance Running and Knee Osteoarthritis A Prospective Study. American Journal of Preventative Medicine, 35(2), 133-138. doi:10.1016/j.amepre.2008.03.032.
