What can you do about Osteoarthritis?

Several studies over the last decade have shown that exercise and physical therapy can have a huge impact on knee joint arthritis pain and function. Several meta-analysis studies demonstrate land based and aquatic strength training, coordination and balance exercises, lower extremity flexibility and aerobic exercises can decrease arthritic knee pain significantly and improve function and quality of life. Recent studies also show that exercise has a beneficial impact on knee articular cartilage health by decreasing pro-inflammatory chemicals while increasing anti-inflammatory ones.

X-ray and imaging studies show that arthritic findings in knees are a fairly common finding. Arthritic changes do not always equate to pain. In 2018, the British Journal of Sports Medicine reported in a systematic review of 5397 asymptomatic knee patients. Patients over the age of 40 had findings of arthritic changes 19-43%, cartilage defects 43%, and meniscus tears 19% in their knees. In patients under the age of 40, 4-14% of subjects had arthritic findings, 11% had cartilage defects, and 4% had meniscal tears. Findings on medical imaging rarely correlate to pain. However, when you cluster exam findings such as poor movement patterns, weakness, loss of ROM, poor joint mobility, heredity, joint alignment, overall health, nervous system sensitivity, views about pain and suffering, and imaging findings, they can be correlated.

Secondly, a recent study found that marathon runners have a lower incidence of knee arthritis. This study suggests that impact and weight bearing exercise can help keep our joints healthy and may actually lead to increased healing of pre-existing arthritic changes. Running was shown to help flush out and decrease concentrations of cytokines and other pro-inflammatory chemicals that can be found in mild to moderate arthritic knee joints. Further, several studies have shown that runners have thicker articular cartilage in their knees compared to sedentary individuals.

How can physical therapy help?

1. A PT can help educate you on your symptoms, beliefs about movement, exercise and pain, and how to start to improve your condition.

2. PTs can provide a strength, range of motion (ROM), balance and coordination assessment of your lower extremities and spine to identity what’s impacting your knee

3. A PT can assess old injuries and their impact on your knee. Do you have an old back injury with some subtle, lingering leg weakness or tightness? Do you have an old severe ankle sprain that you didn’t fully regain all its ROM? Are you lacking adequate hip mobility? Are the muscles in your foot weak?

4. As manual therapists, we can provide gentle mobilizations and soft tissue work to improve joint mobility and decrease pain. We can help train your joint’s awareness and proprioception so it can handle unexpected stresses and strains with more resiliency.

5. Physical therapists can design an individualized program with corrective ROM and strengthening exercises for your trunk, hips, knees and feet. We can design a daily/ weekly maintenance home program for your knee. We can also give you a program for progressive return to activity and progressive loading to facilitate improved tissue strength and tolerance. Further we can help you understand what to avoid and what’s okay to do with your knee.

6. Physical therapists can help you with understanding your step cadence (step rate) while running. Studies show that over striding increases stress to your lower extremities. Increasing your step rate by 5% but keeping speed constant, can decrease the stress on your knees by 20%! Heiderscheit, B et al., 2011 7. We can give you advice on shoe wear and/ or orthotics/ arch inserts and if they are right for you.

References

1. Tanaka R et al.  Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Clininical Rehabilitation. 2013 Dec;27(12):1059-71

2. Uthman OA et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis.  BMJ. 2013 Sep 20;342014 & Nov;48(21):1579

3. Tanaka R et al.  Does exercise therapy improve the health-related quality of life of people with knee osteoarthritis? A systematic review and meta-analysis of randomized controlled trials.  J Phys Ther Sci. 2015 Oct;27(10)

4. Li, Y et al. The effects of resistance exercise in patients with knee osteoarthritis: a systematic review and meta-analysis.  Clinical Rehabilitation. 2016 Oct;30(10):947-959

5. Zacharias A et al.  Efficacy of rehabilitation programs for improving muscle strength in people with hip or knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage. 2014 Nov;22(11):1752-73

6. Fransen, M. Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev. 2003;(3).

7. Goh, SL et al. Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis.  Annals Physical Rehabilitation Medicine. 2019 Sep;62(5):356-365

8. Bartels, EM et al.  Aquatic exercise for the treatment of knee and hip osteoarthritis.  Cochrane Database Syst Rev. 2016 Mar 23;3

9. Allyn M et al. The pain-relieving qualities of exercise in knee osteoarthritis. Open Access Rheumatology: Research and Reviews 2013:5 81–9

10. Horga, LM et al. Can marathon running improve knee damage of middle-aged adults? A prospective cohort study. BMJ Open Sport Exerc Med. 2019; 5(1)

11. Heiderscheit, B et al.  Effects of Step Rate Manipulation on Joint Mechanics during Running.  Med Sci Sports Exercise. 2011; 43(2): 296–302