by Janet Leung, RPT

Introduction
Osteoarthritis (OA) or degenerative arthritis is the most common type of arthritis. According to the Arthritis Society of Canada, 1 in 10 Canadians is affected by OA. The cartilage which rests between bones and protects joints is worn down and becomes thin in OA; this in turn causes joint pain and swelling. Chronic OA leads to problems with joint alignment, muscle wasting and decreased function.

Degenerative arthritis of the knee is a condition which is often seen by family physicians and physiotherapists alike. Patients complain of stiffness, pain with movement and sometimes even at rest, and difficulty performing day-to-day activities such as climbing stairs or going for a walk. Some patients with knee OA elect to undergo arthroscopic surgery which is minimally invasive and involves inserting an arthroscope through a small hole to perform the procedure. The goal is to remove bony fragments and particulate material from the knee, and to debride the roughened joint surfaces.

Landmark Study
BikingA large-scale Canadian study done by researchers at the University of Western Ontario and published in September 2008 in the New England Journal of Medicine provides evidence that physiotherapy combined with medical therapy is just as effective for treatment of knee OA as arthroscopic surgery.

In a study conducted between 1999 and 2007, patients with moderate to severe knee OA were randomly assigned to receive either optimized physiotherapy and medical therapy alone, or arthroscopic surgery in addition to physiotherapy and medical therapy. The physiotherapy treatment given was identical in both groups, at a frequency of one hour per week for 12 consecutive weeks. The medical therapy to both groups included the stepwise use of acetaminophen (such as Tylenol) and non-steroidal anti-inflammatory drugs (such as Ibuprofen); in addition, injection of hyaluronic acid into the joint and oral glucosamine were made available to patients.

The findings of the study showed that patients who underwent athroscopic surgery for knee OA were no better off and did not have longer lasting pain relief than patients who only received physiotherapy and medical therapy, as measured by validated outcome measures on arthritis disability (pain, stiffness and physical function) and quality of life. Patients with knee OA in the absence of other findings (such as meniscal tears) can likely avoid arthroscopic surgery because conservative (non-invasive) treatment is just as effective.

Physiotherapy Treatment
How can physiotherapy help knee OA?

At Cross Roads, our physiotherapists have the goals of:
1) helping to ease your knee pain,
2) teaching you how to control your symptoms of pain and stiffness, and
3) optimizing the strength of muscles around your knee which protect the joint.

Ultimately, you will learn an exercise program to do at home to maintain the gains made in therapy.

Pain relief techniques may involve the application of physical modalities including the use of ice or heat, electrical therapy such as TENS, acupuncture, and gentle manual mobilization of the joint or soft tissues surrounding the knee.

Once pain is better controlled, the therapist will teach you range of motion and stretching exercises to improve your knee movement. Later on strengthening exercises for the knee and hip are added because strong muscles provide joint protection, absorb shock and slow the degenerative process.

The therapist will give you detailed advice on how to protect your knee joint. The concepts of activity pacing and minimizing impact are introduced. Suggestions may be made to modify your activities, e.g. doing lower-impact exercise such as stationary cycling or swimming instead of running, or reducing the length of time spent walking at one time but go for more frequent walks. For patients with severe knee OA, the therapist may prescribe the use of a cane or other aids to ease the pain during walking. Footwear is also evaluated and suggestions made to help reduce the load on your knees.

At discharge, we want you to feel more confident about how to manage your knee OA symptoms and to continue a maintenance exercise program at home.


Reference:
Kirkley A. et al. N Engl J Med. 2008;359:1097-1107.

Physiotherapy and Medical Therapy As Effective As Arthroscopic Surgery For Arthritic Knees