Blogs from October, 2022

Knee Osteoarthritis (OA) in Younger People – Part 1

Osteoarthritis (OA) used to be considered a degenerative disease of “wear and tear” affecting older individuals. However, there is steady growth of OA in younger individuals (less than age 50). This is a significant health problem since these people will likely live with OA for a much longer time than previous generations.

Risk factors for developing early OA:

1. Joint injury – such as anterior cruciate ligament (ACL) tear, meniscal tear
2. Obesity – increases risk of OA by 2 mechanisms: excess body fat releases inflammatory mediators which contribute to the joint damage in OA; the excess body weight increases the load on the joint contributing to early wear and tear

Reference:

Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. J Orthop Sports Phys Ther 2017; 47(2):67-79.

Knee Osteoarthritis (OA) in Younger People – Part 2

Physical therapy assessment of knee OA includes:

1. Detailed history including description of pain, stiffness, activity limitations, comorbidities, and patient goals
2. Physical examination – including examination of posture and alignment of the whole lower extremity, range of motion, strength, sensation, balance and performance of functional tasks (such as stairs, squatting, hopping as appropriate)

Physical therapy treatment approach includes:

1. Education about OA – the disease and management
2. Individualized exercise program
3. Manual therapy to soft tissues and joint as appropriate
4. Possible use of a brace either to unload the arthritic part of the joint or for support
5. Discussion of modification of tasks at home and work
6. Discussion of weight control or weight loss, including possible referral to dietician

Reference:

Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. J Orthop Sports Phys Ther 2017; 47(2):67-79.

Knee Osteoarthritis (OA) in Younger People – Part 3

This blog will discuss further the role of an exercise program in knee osteoarthritis (OA). Research has shown that exercise can reduce pain and improve physical function in knee OA. Key components of the exercise program include:

1. Muscle strengthening:

• Strong muscles are important for shock absorption to dampen the load on the knee joint and for proper joint function.
• Key muscles are the quadriceps and hip abductors, but exercise may include strengthening for the core and whole lower extremity
• Strengthening after injury may help prevent early OA. Remember that one of the risk factors for developing early knee OA is injury such as ACL or meniscus tear. Often, insurance companies discontinue payment for physical therapy before the patient has completed their rehabilitation program and patients may have to do their late stage rehabilitation on their own. Without professional advice and support, the injured lower extremity may not regain 100% strength predisposing the patient to higher risk of OA.

2. Neuromuscular retraining:

• These exercises aim to retrain functional stability and control of the entire lower extremity.
• Key exercises are balance and perturbation exercises, agility exercises, possibly plyometrics

3. Flexibility:

• These exercises aim to optimize range of motion of the knee joint and muscles of the lower extremity

Reference:

1. Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. J Orthop Sports Phys Ther 2017; 47(2):67-79.

2. Deyle G, Henderson N. Effectiveness of manual physical therapy and exercise in osteoarhritis of the knee. Annals Of Internal Medicine. February 2000;132(3):173-181.