Knee Arthritis

The knee is the most common joint affected by arthritis in the body. It is more common in older patients and can occur without any apparent underlying cause or as a result of previous trauma or in cases of abnormal articular cartilage, such as rheumatoid arthritis.

Common symptoms include knee pain that is gradual in onset, increased pain with activity, knee stiffness, swelling, pain with prolonged sitting or resting, crepitus (a cracking sound with joint movement), less range of motion compared to non-effected side and morning stiffness.

X-rays are the most used method of medical imaging for diagnosing knee osteoarthritis, although the diagnosis can be made clinically (based on the patient’s presenting signs and symptoms) without an X-ray.

Treatment knee osteoarthritis begins with conservative methods and only progresses to surgical treatment when conservative approaches fail.

Treatment should be tailored to address the specific impairments and limitations of the patient and may include the following:

• Manual therapy including soft tissue mobilization of areas of muscular restrictions, joint mobilizations to improve the flexibility/mobility of the knee joint and dry needling to reduce muscle stiffness.
• Flexibility exercises to address impairments in range of motion and muscle flexibility.
• Strengthening exercises to address specific muscle weaknesses.
• Functional exercises to prepare the patient for his or her specific goals (i.e., sitting on the ground, hiking, walking up curbs, kneeling, etc.).
• Gait and balance training to improve walking/stairs quality and to reduce the risk of a fall
• Modalities to reduce pain.

Patients with severe symptoms may warrant a knee replacement.

References:

1. Bartholdy, Cecilie et al. “A Standardized “Rescue” Exercise Program for Symptomatic Flare-Up of Knee Osteoarthritis: Description And Safety Considerations.” Journal of Orthopaedic & Sports Physical Therapy, Vol. 46, No. 11, 2016, pp. 942-946. Journal of Orthopaedic & Sports Physical Therapy (JOSPT), https://doi.org/10.2519/jospt.2016.6908.
2. Lin, Da-Hon et al. “Efficacy Of 2 Non-Weight-Bearing Interventions, Proprioception Training Versus Strength Training, For Patients with Knee Osteoarthritis: A Randomized Clinical Trial.” Journal of Orthopaedic & Sports Physical Therapy, Vol. 39, No. 6, 2009, pp. 450-457. Journal of Orthopaedic & Sports Physical Therapy (JOSPT), https://doi.org/10.2519/jospt.2009.2923.
3. Teo, Pek Ling et al. “Identifying and Prioritizing Clinical Guideline Recommendations Most Relevant to Physical Therapy Practice For Hip and/or Knee Osteoarthritis.” Journal of Orthopaedic & Sports Physical Therapy, Vol. 49, No. 7, 2019, pp. 501-512. Journal of Orthopaedic & Sports Physical Therapy (JOSPT), https://doi.org/10.2519/jospt.2019.8676.
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