Knee Arthritis and Physical Therapy Interventions

knee arthritis, physical therapy, knee pain

Knee Arthritis Background Information

Osteoarthritis (OA) costs have risen to 13.2 billion dollars per year and are the leading cause of disability in adults(1).

Knee OA is the most common area and leads to mild to moderate disability in >10% of adults over age 552. Up to 70% of older adults have OA changes on imaging but remain asymptomatic(3).

The clinical examination has also been shown to help in the ruling out (sensitivity .91) and ruling in (specificity of .86) using the following findings(4). 

Physical Therapy Treatments for Knee Arthritis 

knee manual physical therapy, knee pain, knee arthritis

A multimodal approach is utilized in the management of OA including activity modification, weight reduction, education, manual therapy including joint mobilization/ manipulation and soft tissue treatments, and exercise(7,8).

Grade A Oxford Level of Evidence is found with a manual therapy and exercise approach to knee OA(9).

Exercise is recommended by all clinical guidelines for management of knee OA(5,6). 

Evidence for Physical Therapy Management of Knee OA

knee arthritis, function, pain, boulder physical therapy treatment

Deyle et al. demonstrated improvements in pain, disability, and function following PT including manual therapy and exercise interventions. Some patients reported a 20-40% improvement in 2-3 visits. This program also delayed or prevented a total knee replace- ment in some participants9. See figures at the right.

Authors have reported manual therapy to be more clinically and cost effective compared to usual medical care for the treatment of knee OA with improvements noted up to 1 year(11,12).

In addition, manual therapy and exercise was twice as successful as a home program for the short term improvement of pain and function1(3).

Cochrane Reviews support the utilization of exercise to alleviate symptoms of OA, as well as, improve strength and physical fitness(10). 

knee replacements, knee pain, physical therapy treatments

When to seek Physical Therapy care 

Most patients (>80%) will benefit from a low risk, cost effective program of manual therapy and exercise.

Patients with primary complaints of knee pain/stiffness, difficulty and/or pain with gait, stairs, and ADLs are appropriate for referral to a manual physical therapist. 

References

1. Leigh, J. et al. Estimating the costs of job related arthritis. J Rheumatol. 2001. 28(7):1647-54.

2. Peat, G. et al. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001. 60(2):91-7.

3. Guermazi, A. et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study. BMJ. 2012.

4. Altman, R. et al. Development of criteria for the classifica- tion and reporting of osteoarthritis. Classification of OA of the knee. Arthritis Rheum. 1986. 29(8):1039-49.

5. Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommenda- tions for the non- pharmacological core management of hip and knee osteoar- thritis. Ann Rheum Dis 2013;72:1125–35.

6. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthri- tis Cartilage 2008;16: 137– 62.

7. Larmer, P. et al. Systematic Review of Guidelines for the Physical Management of Osteoarthritis. Arch Phys Med Rehab. 2014. 95:375-389

8. Jamtvedt, G. et al. PT interventions for patients with osteoarthritis of the knee: An overview of systematic reviews. PT. 2008. 88(1).

9. Deyle, G et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A RCT. Ann Int Med. 2000. 132(3):173-81.

10. McConnell, F. et al. Exercise for osteoarthritis of the knee. Cochrane Review. 2015.

11. Abbott, J. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a RCT. Osteoarthritis Cartilage. 2013. 21:525-534.

12. Pinto, D. Manual therapy, exercise therapy, or both in addition to usual care, for OA of the hip or knee. Economic evaluation alongside a RCT. Osteoarthritis and Cartilage. 2013. 21:1504-1513.

13. Deyle, G. et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85:1301–1317.