Knee Osteoarthritis - Tips
Comprehensive Knee Osteoarthritis (OA) Management: What You Need to Know
Knee osteoarthritis (OA) is one of the most commonly researched forms of osteoarthritis, yet many patients receive overly simplistic advice, such as general suggestions about exercise, pain management, or surgery. As physiotherapists, it’s crucial to provide patients with comprehensive guidance on available treatment options and help them manage their condition effectively. Since knee OA affects patients in multiple ways, a tailored, multi-faceted approach to treatment is often the best strategy.
In this blog, we'll explore expert physiotherapist Allison Ezzat’s approach to knee OA management, covering:
A range of treatment options
Exercise recommendations
Techniques in manual therapy and taping
Treatment Options for Knee OA
First-Line Treatments
Exercise should be the foundation of any knee OA treatment plan. A structured exercise program should focus on improving both strength and power. Here are some general exercise guidelines:
Strength training: 8-12 repetitions for 3 sets
Power training: 4-5 repetitions for 4-5 sets, with emphasis on speed during the concentric phase
Frequency: 2-3 times per week
It's normal for patients to experience some discomfort during exercise, but pain levels should not exceed 5/10 and should return to baseline within 24 hours.
Education is equally important. Patients need to understand what OA is and address common misconceptions, such as the belief that pain during movement always means structural damage. It's also essential to explain how loading the joints through exercise can benefit tissue health. Encourage at least 45 minutes of moderate physical activity each week, aiming to build up to 150 minutes as they progress. Activities can range from swimming to dancing—anything that keeps them moving.
In some cases, weight management may be necessary, especially if excess body weight is exacerbating knee OA symptoms. In such instances, a referral to a physician or dietitian might be appropriate.
Second-Line Treatments
Second-line treatments focus on short-term pain relief, allowing patients to participate in exercise more comfortably. While not essential, they can complement first-line treatments and are often low-risk options, including:
Manual therapy
Taping
Bracing
Orthotics
Acupuncture
Pain medications and cortisone injections may also offer temporary relief, but these come with side effects, such as the potential for cartilage damage with repeated cortisone injections. These treatments should be used cautiously.
Third-Line Treatments
The final option for managing knee OA is joint replacement surgery, which has high success rates (around 80-90%). It’s important to note that pre-surgery exercise can significantly improve post-operative outcomes. Regardless of whether surgery is chosen, exercise remains a key component of managing knee OA, both before and after the procedure.
Exercise Prescription for Knee OA
Therapeutic exercises play a critical role in strengthening the lower limbs. These exercises should be simple enough for patients to perform on their own and should target:
Knee flexion and extension
Hip abduction
Ankle plantarflexion
Hip extension
Functional exercises that mimic everyday movements should also be included in a well-rounded program. Squats, lunges, and step-ups are ideal for building functional strength. Squat variations, such as single-leg squats or box squats, can be adjusted to challenge different levels of ability. Lunge variations (forward, backward, side) and progressive step-ups are also effective, especially for patients who struggle with stairs.
For core training, isometric exercises like planks are recommended. Start with short holds (3 sets of 10 seconds) and gradually build up to longer holds. Variations, such as adding unilateral hip extension to a plank, can further challenge the patient as they progress.
Manual Therapy and Taping Techniques
Manual therapy and taping can be useful for reducing pain and improving range of motion during exercise. Manual therapy techniques, such as posterior tibial glides for improving knee flexion or anterior glides for improving knee extension, can be highly effective.
For taping, using rigid tape to promote a medial glide or superior tilt of the patella can often reduce pain during movement. If taping reduces the patient’s pain by about 25% during a specific activity, it’s a sign that the taping method is working for them.
Conclusion
Effectively managing knee OA requires a well-rounded approach. The primary focus should always be on first-line treatments such as exercise, education, and weight management (when needed). However, second- and third-line treatments can play a supportive role in managing pain and improving the patient’s overall quality of life.
Physiotherapists are in a unique position to educate and guide patients through their journey with knee OA, helping them regain mobility and get back to doing the activities they enjoy.
For more insights on knee OA management from expert physiotherapist Allison Ezzat, be sure to check out her full practical session.
