Knee Osteoarthritis Osteopathy and Prescriptive Exercise by Osteopaths

Knee Osteoarthritis

Knee Osteoarthritis is a disease that affects your knee joints. The surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. The condition is sometimes called arthrosis, osteoarthrosis, degenerative joint disease or wear and tear. (AR, n.d)

Knee Osteoarthritis

What are the Symptoms of Knee Osteoarthritis

The symptoms of osteoarthritis can include:
• pain
• stiff ness
• a grating or grinding sensation when
the joint moves (crepitus)
• swelling (either hard or soft).
Sometimes the knee may either lock or give way when you put weight on it. (AR, n.d.)

Who gets Knee Osteoarthritis?

Almost anyone can get osteoarthritis,
but it’s most likely if:
• you’re in your late 40s or older
• you’re overweight
• you’re a woman
• your parents, brothers or sisters
have had osteoarthritis
• you’ve previously had a severe
knee injury
• your joints have been damaged by another disease, for example rheumatoid rheumatoid arthritis arthritis or gout (AR, n.d.)

The National Institute of Clinical Excellence Reccomendations

NICE (2014) advises people with osteoarthritis to exercise as a core treatment, irrespective of age, comorbidity, pain severity or disability. Exercise should include:

  • local muscle strengthening and
  • general aerobic fitness.It has not been specified whether exercise should be provided by the NHS or whether the healthcare professional should provide advice and encouragement to the person to obtain and carry out the intervention themselves. Exercise has been found to be beneficial but the clinician needs to make a judgement in each case on how to effectively ensure participation. This will depend upon the person’s individual needs, circumstances and self-motivation, and the availability of local facilities.
  • Manipulation and stretching should be considered as an adjunct to core treatments, particularly for osteoarthritis of the hip. 

Manual Therapy for Knee Osteoarthritis

Manual therapy provided significant, clinically important and sustained improvements in symptoms for patients with OA of hips or knees (Abbott et al. 2013).

Short term effect of Manual Therayp for Knee Osteoarthritis

Manual therapy improves pain and physical function, in the short and long-term, compared with exercise for those with hip OA, and massage therapy providesshort-term benefit in pain and function over no treatment for those with knee OA (French et al. 2011).

Long Term Effect of Manual Therapy for Knee Osteoarthritis

After 3-months an 8-session multi-modal treatment of exercise, OA education, manual-therapy and taping that was targeted to the PFJ and tailored to individual patients resulted in superior outcomes for patient-perceived change and pain compared to OA-education alone in people with predominant PFJ OA (Crossley et al. 2015).

Safety of Manual Therapy for Knee Osteoarthritis

Manual therapy might be effective and safe for improving pain, stiffness, and physical function in KOA patients and could be treated as complementary and alternative options (Xu et al. 2017).

Hip Mobilisation for Knee Osteoarthritis

Patients experienced increases in ROM, decreased pain, and fewer subjects had painful test findings immediately following a single session of hip mobilizations (Currier et al. 2007).

Combining Manual Therapy With Exercise for Knee Osteoarthritis

Manual Therapy appears to be moderately effective for improved function, specifically as an adjunct to another treatment and versus comparators of no treatment or other treatments (Salamh et al. 2016).

Exercise therapy plus manual mobilisation showed a moderate effect size on pain (0.69) compared to the small effect sizes for strength training (0.38) or exercise therapy alone (0.34). Supervised exercise treatment in physiotherapy and manual therapy should in our opinion include at least an active exercise program involving strength training, aerobic activity exercises, and active range of motion exercises. To achieve better pain relief in patients with knee osteoarthritis, physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs (Jansen et al. 2011).

Knee Osteoarthritis Exercise

Among people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2-6 months after cessation of formal treatment (Fransen et al. 2015).

Non-Elastic Tapping for Knee Osteoarthritis

Therapeutic taping seemed to be superior to control taping in pain control for knee osteoarthritis. Non-elastic taping, but not elastic taping, provides benefits in pain reduction and functional performance (Ouyang et al. 2017).

How Many Maintenance Appointments will I need for Knee Osteoarthritis?

Distributing 12 sessions of exercise therapy over a year in the form of booster sessions was more effective than providing 12 consecutive exercise therapy sessions. Providing manual therapy in addition to exercise therapy improved treatment effectiveness compared to providing 12 consecutive exercise therapy sessions alone (Abbott  et al. 2015).

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Reference List

Arthritis Research (AR) UK (n.d.). Osteoarthritis of the Knee

Abbott JH, Chapple CM, Fitzgerald GK, Fritz JM, Childs JD, Harcombe H, Stout K. (2015)The Incremental Effects of Manual Therapy or Booster Sessions in Addition to Exercise Therapy for Knee Osteoarthritis: A Randomized Clinical Trial. J Orthop Sports Phys Ther. Dec;45(12):975-83

Abbott JH, MC Robertson m MC, Chapple, Pinto CD (2013). Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness Osteoarthritis and Cartilage 21 525e534

Crossley KM, Vicenzino B, Lentzos J, Schache AG, Pandy MG, Ozturk H, Hinman RS (2015). Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial. Osteoarthritis Cartilage. Sep;23(9):1457-64

Currier LL, Froehlich PJ, Carow SD, McAndrew RK, Cliborne AV, Boyles RE, Mansfield LT, Wainner RS (2007). Development of a Clinical Prediction Rule to Identify Patients With Knee Pain and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable Short-Term Response to Hip Mobilization. Physical Therapy, Volume 87, Issue 9, 1 September, Pages 1106–1119

Fransen M, McConnell S, Harmer AR ,Van der Esch M, Simic M, Bennell KL. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic reviewBr J Sports Med. Dec;49(24):1554-7

French HP, Brennan A, B White, T Cusack (2011). Manual therapy for osteoarthritis of the hip or knee–a systematic review. Manual therapy

Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJM (2011).  Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review Journal of Physiotherapy Vol. 57 

National Institute of Clinical Excellence (NICE) (2014). Osteoarthritis: care and management

Salamh P, Cook C, Reiman MP, Sheets C (2016) Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis. Musculoskeletal Care. Nov 18.

Ouyang JH, Chang KH, Hsu WY, Cho YT, Liou TH, Lin YN (2017). Non-elastic taping, but not elastic taping, provides benefits for patients with knee osteoarthritis: systemic review and meta-analysis. J Orthop Sports Phys Ther.  Jun;45(6):453-61

Xu Q, Chen B, Wang Y, Wang X, Han D, Ding D, Zheng Y, Cao Y, Zhan H, Zhou Y (2017). The Effectiveness of Manual Therapy for Relieving Pain, Stiffness, and Dysfunction in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Physician. May;20(4):229-243.


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