Posts in Arthritis
Does Running Cause Knee Osteoarthritis?
running-knee-arthritis

Knee arthritis is a common condition among older adults leading to increased knee pain and decreased participation in recreational and sporting activities.  A incorrect, but commonly held belief is exercise may lead to further arthritis or knee damage due to a "wear and tear" effect.  This outdated line of thought has been disproven by many research studies documenting a beneficial not harmful effect of exercise on both young and old knee joints.  Unfortunately, the myth of exercise causing knee arthritis remains especially in regards to sports including running.

A recent study by Lo and colleagues should finally put this myth to rest (Arthritis Care and Research 2016).  Authors studied over 2500 participants to retrospectively identify risk factors which were associated with the eventual development of knee arthritis.  Among these individuals, 30% had run at some time in their lives.  The authors reported no increased risk of knee arthritis among the running participants compared to their age matched peers.  They concluded that running does not appear to be detrimental to the knees.  

Hyaluronic Acid vs. Corticosteroid for Knee Osteoarthritis

Knee Osteoarthritis is a common condition affecting many middle aged adults which leads to pain, loss of range of motion, and decreased function.  Physical Therapy remains the primary choice for conservative treatment, but often these treatments are combined with injections to the knee joint.  Corticosteroids are an inexpensive injection designed to reduce pain and inflammation in the knee, but Hyaluronic Acid injections such as Synvisc are also on the rise.  These injections claim to cushion and lubricate the knee joint leading to reduced pain and improved function.  One downside of these injections is their cost ($250-$1000 per injection) which is often not covered by insurance.  In addition, the research on these injections has been compared to saline (placebo) injections instead of a head to head comparison with the corticosteroid.

Recently an article in the Journal of Bone and Joint Surgery examined the impact of a single corticosteroid or hyaluronic acid injection on 99 patients with knee osteoarthritis (Tammachote et al. 2016).  Patients were randomized to receive one of the two injections then followed over 6 months.  As you can see from the graph above both groups demonstrated similar outcomes in pain, function, and range of motion at 6 months.  Differences were noted in the short term with decreased pain and improved function noted in the first two weeks in the patients receiving the corticosteroid.  The authors called into question the cost of these expensive injections compared to the less expensive corticosteroid.  

Does Physical Activity Improve after a Total Knee or Hip Replacement?

Total knee and hip replacements are among the fastest growing surgeries in our country.  Physical Therapy remains the first line treatment for patients with knee and hip arthritis, but in patients with severe osteoarthritic pain and loss of function joint replacement remains a good surgical option.  In prior research among patients undergoing these procedures there is often a disconnect between subjective reporting of pain and function and the objective testing of a patient's function.  For example, a patient may report great outcomes and an ability to walk long distances without fatigue or pain, but objective testing in Physical Therapy often reveals residual endurance, strength, and balance impairments.  

In addition to severe pain, one of the most important indications for a total joint procedure is loss of function.   After the surgery patients are expected to increase their activity levels due to reduced pain, but new research is questioning this assumption.  A recent review article in the Journal of Orthopedic and Sports Physical Therapy examined if physical activity levels increased after these procedures (Arnold et al. 2016).  Authors reviewed the available data and found 8 studies of 373 patients who underwent a total joint replacement.  

These studies objectively tracked a patients physical activity levels up to 1 year after the procedure to see if levels had increased compared to pre operative levels.  The authors reported negligible improvements at 6 months and limited evidence to support increases in activity levels at 1 year.  At one year, patients with total joint replacements were significantly less active than their peers.  This study indicates the importance of post operative Physical Therapy to effectively improve strength, endurance, and balance allowing patients to resume an active lifestyle.  

Injections for Knee Osteoarthritis

Knee osteoarthritis is a common condition in aging adults leading to pain and reduced performance of daily and recreational activities.  Manual therapy and exercise remain a hallmark of conservative care for this condition and have been shown to delay or prevent the need for a total knee replacement.  In addition to exercise, corticosteroid injections are often proposed to patients in order to reduce pain and improve patient participation.  A recent study in the Journal of the American Medical Association examined the impact of these injections in patients with knee arthritis.

Henriksen and colleagues studied 100 patients and randomized them to either a corticosteroid injection or a placebo injection prior to undergoing Physical Therapy 3 days a week for 12 weeks.  These patients all had evidence of knee arthritis on x ray and reported pain with daily activities including walking.  All patients improved through the course of the study, but no significant differences were noted at 2, 14, or 26 weeks between the group receiving a corticosteroid injection or a placebo.   The authors concluded there was no additional clinical benefit of a steroid injection and Physical Therapy compared to Physical Therapy alone.  Thus, Physical Therapy was the main reason for the patient's improvement.   

Patients with knee osteoarthritis are encouraged to seek out a local Physical Therapist to implement an effective rehabilitation program.  

Resistance Training the Aging Adult and Injury Prevention

There are few treatments more effective for the prevention and treatment of injuries and musculoskeletal conditions than resistance training.  Unfortunately, many Americans are not performing enough strengthening to prevent the loss of muscle mass (sarcopenia) which begins to occur in the 3rd decade of life.  After age 30 we begin to demonstrate a progressive loss of muscle mass, strength, and endurance due to the aging process.  Thankfully, this loss can be attenuated with strength training, but not solely aerobic and endurance training (Klitgaard et al. 1990).  This loss of strength becomes a risk factor for many health conditions including low back pain and knee osteoarthritis.  

It is important to note age does not seem to influence an individuals ability to perform strength training exercise.  A review article reported an average strength increase of 25-33% in older adults who began a strength training program (Peterson et al. 2010).  Participants performed 2-3 sets of 8-10 repetitions per exercise targeting major muscle groups 2 to 3 days per week.  These programs have also been shown to improve an adult's quality of life and prevent conditions such as osteoporosis, knee osteoarthritis and back pain.  

It is never too late to begin an exercise program and adults are encourage to speak with a local Physical Therapist to design a safe and effective exercise program to improve their quality of life and athletic performance.  

Physical Therapy Reduces Need for Total Hip Replacement

Over 200,000 Americans undergo a total hip replacement often as a result of severe hip osteoarthritis.  Patients who enter the surgery in a weakened, less functional state have worse outcomes up to 2 years post operatively compared to their higher functioning peers (Fortin et al. 1999, 2002).  This is concerning because the most rapid recovery after surgery occurs in the first 3 months with slower recovery up to 1 year.  A patient with more difficulty entering surgery would have limited success in this crucial window in their recovery.  Conversely, pre operative Physical Therapy for patients with limited flexibility, strength, balance, and endurance can improve surgical outcomes, but similar to research in knee osteoarthritis may delay or prevent the need for the surgery.  

A recent study was conducted to determine the long term impact of PT interventions on patients with hip osteoarthritis (Svege et al. Ann Rheum Dis. 2015).  Patients were randomized to either an education or PT group and followed up to 6 years after the treatment.  The authors reported the average time to a total hip replacement was 5 and a half years in the Physical Therapy group compared to 3 and a half years in the education group.  In addition, twice as many patients in the Physical Therapy group did not require surgery reducing the need for surgery by 44%.  

This evidence adds to our knowledge on the beneficial effects of Physical Therapy on patients with hip osteoarthritis.  Patients with hip pain are advised to see a Physical Therapist to postpone or prevent the need for a total hip replacement.