Written by Oliver Quick
Knee Osteoarthritis (KOA)
KOA is a leading cause of disability worldwide with it being referred to as a degenerative, wear-and-tear, age and weight related condition that is expected to increase with age and obesity of articular cartilage. KOA has shown to have a prevalence of 33.6% in adults aged 65 and older, with women having a greater prevalence (42.1%) than men (31.2%). Decreased range of motion, grinding or popping sounds and muscle weakness are some of the symptoms that individuals may experience with KOA. These associated factors will have an effect on walking, climbing stairs, performing household chores, sitting upright and a negative psychological impact, that all contribute to a decreased quality in life).
(Chu et al., 2014; Heidari, 2011; Lawrence et al., 2008; Lespasio et al.,2017; Mahir et al., 2016; Roos and Arden, 2016)
Surgical vs Medication vs Injections
NOT the go to form of intervention - conservative treatment including exercise and manual therapy are favoured above pharmacological and surgery interventions
Lack of evidence and increasing number of studies being questioned of the efficacy of pharmacological interventions due to their senior adverse events
Lack of research to support the efficacy and safety for injections
Lack of evidence evaluating the indication, efficacy, cost effectiveness and safety of surgical procedures for KOA
Concerns around the quality, safety and risk profile of the medications
No long term benefits found
Increasing rates of revision surgery
No evidence or support for the long term use of various medication for the management of KOA
Some methods require the individual to have weekly appointments for injections
Do not provide more benefits than conservative interventions
(Fibel et al., 2015; Lim et al., 2014; Lohmander and Roos, 2015; Wehling et al., 2016)
Exercise and Non-Pharmaceutical Interventions for KOA
At the top of the hierarchy outlined by Wehling et al. (2016), was patient education, social support, exercise and manual therapies for the management of KOA.
Exercise and manual therapy have been suggested to facilitate improvements in pain, function and other symptoms displayed in individuals with KOA.
With exercise individuals have displayed other improvements to increasing their physical activity with aerobic exercise and strength training, such as aerobic capacity, muscle strength and endurance.
Exercise can facilitate weight loss that has been reported to reduce the risk of developing symptomatic KOA, improvements in pain and improving disability, improvements in function.
There have been reports of the potential of herbal medicines, dietary supplements and acupuncture that could provide some benefits to alleviate pain in pain.
(Christensen et al., 2015; Egwu et al., 2018; Wehling et al., 2016)
Exercise for KOA (The Top 3)
In a study by Vårbakken et al. (2019) it was reported that individuals who had KOA, displayed differences of muscle strength in the quadriceps of the affected leg. It has been suggested that due to these strength imbalances that when exercising, strength training of the muscles of the knee extensors (quadricep) and the surrounding muscles of the hip (specifically glutes (hip abductors) and hamstrings that can help improve lateral posture sway). Research suggested that a progressive strengthening programme of these muscle groups (knee extensors, hinge and hip abduction progressions) should be incorporated into the rehabilitation of KOA. Some of the benefits to this will include increased knee extensor strength, strength deficits in muscles surrounding the hip, decreased pain, decreased fluid in the knee and improvement in the biochemical makeup of the fluid around the knee. Other forms of exercise such as progressive walk programme, squat progression and calf complex strengthening have shown to have benefits in improving overall pain and function of KOA. Below are the top 3 exercises fo you to start incorporating into your strength training:
1. Knee Extension Progression
Exercise = Isometric Straight Leg Raise
2. Hinge Progression
Exercise = Glute Bridge
3. Hip Abduction Progression
Exercise = Side-lying Hip Abduction
(Alshami and Alhasseny, 2020; Egwu et al., 2018; Miyaguchi et al., 2003; Talbort et al., 2003; Varbakken et al., 2019)
What we can offer at The Tuning Room:
Alongside providing the education and support surrounding pain management of KOA, we can offer rehabilitation and personal training sessions that can facilitate increased physical activity, muscle strengthening, weight loss and improvements in function.
Also, our muscle therapy sessions target improvements in soft tissue mobilisation, restoring length and relieving tension within the muscles to ensure the muscular system is functionally optimally
Alshami, A.M. and Alhassany, H.A., (2020). Girth, strength, and flexibility of the calf muscle in patients with knee osteoarthritis: A case–control study. Journal of Taibah University Medical Sciences, 15(3), pp.197-202.
Christensen, R., Henriksen, M., Leeds, A.R., Gudbergsen, H., Christensen, P., Sørensen, T.J., Bartels, E.M., Riecke, B.F., Aaboe, J., Frederiksen, R. and Boesen, M., (2015). Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve‐month randomized controlled trial. Arthritis care & research, 67(5), pp.640-650.
Chu, C.R., Millis, M.B. and Olson, S.A., (2014). Osteoarthritis: from palliation to prevention: AOA critical issues. The Journal of bone and joint surgery. American volume, 96(15).
Egwu, O.R., Ayanniyi, O.O., Adegoke, B.D.O., Olagbegi, O.M., Ogwumike, O.O. and Odole, A.C., (2018). Effect of self-management education versus quadriceps strengthening exercises on pain and function in patients with knee osteoarthritis. Human Movement, 19(3), pp.64-74.
Fibel, K.H., Hillstrom, H.J. and Halpern, B.C., (2015). State-of-the-Art management of knee osteoarthritis. World Journal of Clinical Cases: WJCC, 3(2), p.89.
Heidari, B., (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian journal of internal medicine, 2(2), p.205.
Lawrence, R.C., Felson, D.T., Helmick, C.G., Arnold, L.M., Choi, H., Deyo, R.A., Gabriel, S., Hirsch, R., Hochberg, M.C., Hunder, G.G. and Jordan, J.M., (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis & Rheumatism, 58(1), pp.26-35.
Lespasio, M.J., Piuzzi, N.S., Husni, M.E., Muschler, G.F., Guarino, A.J. and Mont, M.A., (2017). Knee osteoarthritis: a primer. The Permanente Journal, 21.
Lim, H.C., Adie, S., Naylor, J.M. and Harris, I.A., (2014). Randomised trial support for orthopaedic surgical procedures. PLoS One, 9(6), p.e96745.
Lohmander, L.S. and Roos, E.M., (2015). The evidence base for orthopaedics and sports medicine. Bmj, 350.
Mahir, L., Belhaj, K., Zahi, S., Azanmasso, H., Lmidmani, F. and El Fatimi, A., (2016). Impact of knee osteoarthritis on the quality of life. Annals of physical and rehabilitation medicine, 59, p.e159.
Miyaguchi, M., Kobayashi, A., Kadoya, Y., Ohashi, H., Yamano, Y. and Takaoka, K., (2003). Biochemical change in joint fluid after isometric quadriceps exercise for patients with osteoarthritis of the knee. Osteoarthritis and cartilage, 11(4), pp.252-259.
Roos, E.M. and Arden, N.K., (2016). Strategies for the prevention of knee osteoarthritis. Nature Reviews Rheumatology, 12(2), pp.92-101.
Talbot, L.A., Gaines, J.M., Huynh, T.N. and Metter, E.J., (2003). A home based pedometer driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Journal of the American Geriatrics Society, 51(3), pp.387-392.
Vårbakken, K., Lorås, H., Nilsson, K.G., Engdal, M. and Stensdotter, A.K., (2019). Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: an exploratory cross-sectional study. BMC Musculoskeletal Disorders, 20(1), pp.1-13.
Wehling, P., Moser, C. and Maixner, W., (2016). How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts. Therapeutic advances in musculoskeletal disease, 8(3), pp.72-85.