Knee Osteoarthritis: What Works?

Knee Osteoarthritis: What Works?

Osteoarthritis is Not Just for Seniors

Arthritis is often thought of as a problem that only affects a more mature population. In fact, one form of arthritis, osteoarthritis of the knee, is a problem for younger, more active people as well. The typical age of onset of osteoarthritis of the knee is 40 to 45. Even athletes in their twenties and thirties are more susceptible if they’ve suffered a knee injury or are performing improperly exercises that are demanding on the knees, such as lunges. However, it is true that the prevalence and severity of knee osteoarthritis progresses with age. Fortunately, many have the option to reverse the progression of osteoarthritis.

Osteoarthritis as a Preventable Impending Endemic

Australians are living longer, yet the growing burden of chronic disease means society is living longer but in poorer health. Osteoarthritis of the knee is a primary contributor to this situation. Due to an aging population and increasing obesity, the prevalence more than doubled over ten years, pointing to an impending endemic state.^1,2 As the world’s tenth largest contributor to years lived with disabilities, surgeries and hospitalisations for knee osteoarthritis cost world healthcare systems billions of dollars yearly.^3,4 This scenario heightens the importance of focusing on the most effective treatments.

What Works for Osteoarthritis of the Knee?

Lucas Ogura Dantas of the Federal University of San Carlos, Brazil, recently published a review of studies and guidelines.⁵

Exercise Therapy

While more research is needed to refine detailed issues such as frequency and duration, the research showing the efficacy of exercise therapy for knee osteoarthritis is definitive. Physiotherapy ameliorates osteoarthritis progression while quickly reducing pain and improving function with effects comparable to surgery.^6-8

Weight Loss

Adults with knee osteoarthritis and a body mass index higher than 25kg/m2, report improved pain, ability, and quality of life from weight reductions as modest as 5% to 10%.⁹

Patient Education

Misleading beliefs that osteoarthritis is an incurable, progressive disease have been associated with reduced physical activity, self-restrictions on healthy lifestyles, reduced spontaneity, and even feelings of loss and isolation.¹⁰ Consensus opinion recommends educating patients toward more productive behaviours.

Physiotherapy Modalities (Largely Not Recommended)

Physiotherapists attempt multiple modalities in the treatment of knee osteoarthritis, sometimes to the exclusion of evidence-based, guideline-recommended treatments. These include thermal modalities, therapeutic ultrasound, electrical stimulation, manual therapy, taping, nutraceuticals (glucosamine, chondroitin sulphate), and various forms of needling or acupuncture. Generally, these modalities are conditionally recommended or recommended against in the guidelines. Some guidelines recommend against taping that is not Kinesio Taping, laser therapy, TENS, and manual therapies. Some guidelines conditionally recommend in favour of Kinesio Taping and traditional acupuncture. Generally speaking, therapeutic benefits tend to be small, and the research tends to evaluate them against placebo rather than evaluating whether they add to the effectiveness of gold-standard exercise, patient education, and weight loss.

If you are ready to reverse the progression of osteoarthritis, call Advanced Physiotherapy now: (02) 4954 5330

 

Additional Resources

• MOST PEOPLE WITH ARTHRITIS ARE UNDER 65. EARLY INTERVENTION IS BETTER.
• FREE Manual from Advanced Physiotherapy & Injury Prevention: GUIDE TO KNEE PAIN

References

1. Englund M, Turkiewicz A. Osteoarthritis increasingly common public disease. Lakartidningen. 2014;111(21):930.
2. Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018 Nov 10;392(10159):1859-922.
3. Hawker GA. Osteoarthritis is a serious disease. Clin Exp Rheumatol. 2019 Sep 1;37(Suppl 120):3-6.
4. Hinman RS, et al. Efficacy of knee taping in the management of osteoarthritis of the knee: blinded randomized controlled trial. BMJ July 19, 2003; 327: 135-8.
5. Dantas LO, de Fátima Salvini T, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian Journal of Physical Therapy. 2021 Mar 1;25(2):135-46.
6. Katz J, Brophy R, Chaisson C, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. NEJM. Mar 19 2013; DOI: 10.1056/NEJMoa1301408.
7. Pinto D, Robertson M, Abbott J, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee. 2: economic evaluation alongside a randomized controlled trial. Osteoarthritis and Cartilage. 2013; joca.2013.06.014.
8. Fransen M, McConnell S, Harmer A, et al. Exercise for osteoarthritis of the knee. Br J Sports Med. 2015; 49 (24): 1554-1557.
9. Chu IJ, Lim AY, Ng CL. Effects of meaningful weight loss beyond symptomatic relief in adults with knee osteoarthritis and obesity: a systematic review and meta‐analysis. Obesity Reviews. 2018 Nov;19(11):1597-607.
10. Dantas LO, de Fátima Salvini T, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian Journal of Physical Therapy. 2021 Mar 1;25(2):135-46.