Knee osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage.
Treatment for knee osteoarthritis begins with conservative methods and progresses to surgical treatment options when conservative treatment fails. While medications can help slow the progression of RA and other inflammatory conditions, no proven disease-modifying agents for the treatment of knee osteoarthritis currently.
Physiotherapy should be started with all patients with a diagnosis of OA
Pain is a common symptom that occurs at different intensities depending on the individual, it is not necessarily related to severity of OA progression
Exercise has been proven to be effective as pain management and also improves physical functioning in the short term. Exercises have to take place under the supervision of a physiotherapist initially and when properly instructed these exercises can be performed at home, though research has shown that group exercise combined with home exercise is more effective.[
Role of Physiotherapy
Education
Understanding what OA is
Explaining pain
Explain long term management of OA
Educate regarding activity modification
Role of weight loss
Promote active, healthy lifestyle
Exercise
Reduce knee pain and inflammation.
Normalise knee joint range of motion.
Strengthen lower kinetic chain
Cardio-vascular exercise
Improve proprioception, agility and balance.
Improve function
Use of walking aids as needed
Land-based exercises are ideal for most people and are strongly recommended.
Exercise has also been found to be beneficial for other co-morbidities and overall health. Walking, resistance training, cycling, yoga and Tai Chi are examples of such exercises. An individualised exercise program should be set by a physiotherapist initially, taking into account the patient’s goals and hobbies to ensure long term exercise compliance.
Other Interventions
There are various forms of therapeutic interventions that may or may not be helpful for patients with various degrees of evidence to support them:
Hydrotherapy – this may be particularly helpful if pain is very high and analgesia is not tolerated. It can be useful to build up strength and reduce stiffness around the knee joint in a non-weight bearing position.
Taping – works to offload the joint similar to bracing, this is useful in the short term.
Manual therapy – effective to improve ROM
Massage – may be useful to control pain in some subjects, but this has low evidence to show its effectiveness
Bracing
Electrotherapy – such as TENS and muscle stimulation may be used to improve quadricep strength and has some evidence to show it can help with pain reduction.
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