Knee Osteoarthritis

The Facts:

More disability and clinical symptoms result from osteoarthrtits (OA) of the knee than any other joint.  While the exact cause of knee OA is unclear, its prevalence is known to increase with age and in females.²
 
Clinical symptoms of OA include: ¹
• joint pain (specific to the knee and hip are complaints of "deep, aching pain"³
• tenderness
• decreased movement
• a grating sound and/or sensation in the joint
• occasional swelling, and varying degrees of inflammation.
 
OA is distinguished by a progressive loss of articular cartilage, sclerosis/hardening of the subchondral bone, joint space narrowing, and osteophyte (“bone spur”) development.⁴ All of these changes can lead to:
• pain
• loss of muscle strength
• limitation in activities of daily living
• decreased mobility
• overall reduced quality of life

 

Mythbusters:

 

Myth:

Patients with knee osteoarthritis will should simply follow a "cookbook" approach to exercise, because they will achieve the same benefit from doing a few basic exercises as they would seeing a therapist one-on-one.

 

Fact:

A 2006 study compared home-based PT program (consisting of home exercises, and one follow up clinic visit) versus clinic-based treatment (consisting of 8 treatment sessions of supervised exercise, individualized manual therapy, and a home exercise program). 

• After 4 weeks, both groupd did show improvements based on outcome measures, but...
• Clinic-based group: 52% improvement
• Home-based group: 26% improvement
• Clinic-based group also reported great satisfaction with treatment, and less reliance on pain medications

 

Myth:

Aquatic physical therapy is superior to land-based PT in treatment of patients with knee osteoarthritis.

 

Fact:

Systematic reviews have shown both land-based and aquatic therapy programs are beneficial treatment plans for knee OA. 

• Two of the four studies showed greater pain reduction with aquatic therapy
• The other two studies showed greater strength gains with land-based therapy
• No research exists on the long-term benefit of aquatic therapy

With this in mind, patient tolerance may be a guiding factor in choosing the initial plan, but patients will likely benefit more from eventual progression towards a land-based program.