Physical Therapy for Knee Osteoarthritis (OA)
What is Osteoarthritis
Osteoarthritis is a major cause of disability in the ageing population with its prevalence increasing and consequences significantly impacting society.1About one tenth of the world’s population aged over 60 years is estimated to have symptomatic problems that could be attributed to osteoarthritis.2 It affects 27 million people in the U.S.3 Osteoarthritis is a progressive disease. Knee joint is one of the most common areas of the body affected by osteoarthritis. Within a joint, there is a smooth fibrous connective tissue known as articular cartilage. This cartilage surrounds the bone where it comes into contact with another bone. In a normal joint, the cartilage acts as a shock absorber as well as allowing for even movement of the joint without pain. When cartilage degrades, it becomes thinner and may even disappear altogether leading to joint pain and difficulty in movement such as in the knee known as Osteoarthritis (OA). OA is characterized by a repetitive inflammatory response of the articular cartilage due to focal loss or erosion of the articular cartilage and a hypertrophy of osteoblastic activity or a reparative bone response known as osteophytosis.4 Both of these defining characteristics result in joint space narrowing or subchondral sclerosis.5 The cause of primary OA is unknown, however the secondary OA is generally related to trauma or an underlying medical condition, such as diabetes and obesity.6
Knee OA Symptoms:
Individuals who develop knee osteoarthritis may experience various symptoms and these symptoms may develop gradually over time. The main symptoms of knee osteoarthritis are pain and stiffness after sitting with bent or straightened knee for a prolonged period of time, worsening pain following walking, transfer from sitting to standing position, and/or climbing stairs, joint swelling and limited range of motion. These symptoms of knee osteoarthritis can result in a disability, creating a functional limitation, restriction of social activity and reduced quality of life.
Physical Therapy Treatment
Physical therapy intervention includes various techniques that can assist in treatment of knee OA. Therapeutic exercises are used to strengthen the muscles around knee and increase knee joint stability, strengthening the hip muscles also can help balance the force load on the knee joint during walking or running. Manual therapy can improve muscle flexibility and decrease knee joint stiffness. Therapeutic modalities like ultrasound, electrical stimulation, ice and heat are used to aid in control inflammation and pain management. Neuromuscular reeducation exercise help patient improves balance, coordination and posture awareness.
The goal of PT treatment is to decrease pain, increase overall functional strength, increase the range of motion, improve functional mobility, educate patient for proper posture and gait, and improve quality of lift.
1. Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications. Curr Opin Rheumatol 2002; 14: 573_77.
2. Symmons D, Mathers C, Pfleger B. Global burden of osteoarthritis in the year 2000. World Health Organization, Geneva 2003.
3. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–35
4. Esser S, Bailey A. Effects of exercise and physical activity on knee OA. Cure Pain Headache Rep.2011; 15:423–30.
5. Ringdahl E, Pandit S. Treatment of knee osteoarthritis. Am Fam Physician.2011;83:1287–92.
6. Adler PA. The effects of tai chi on pain and function in older adults with osteoarthritis. PhD dissertation. Frances Payne Bolton School of Nursing, Case Western Reserve University, Ohio. 2007