Osteoarthritis (OA) is a disease of the entire joint involving the cartilage, joint lining, ligaments, and underlying bone. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands and spine. The specific causes of OA are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Disease onset is gradual and usually begins after the age of 40. Treatment for OA focuses on relieving symptoms and improving function. OA of the knee results in more pain and disability than any other joint in the body.
Research of those affected by knee OA reveals exercise particularly in combination with manual therapy delivered by physical therapists over a 4 week period can significantly reduce symptoms and improve knee function. The research which was initially performed in 2000, compared 4 weeks of exercise and manual therapy to a placebo group that received ultrasound to the knee. The exercise/manual therapy group improved significantly on the 6 minute walk test and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at all follow up periods(week 4,8,and 52). The placebo groups demonstrated no change in outcome measures.
The follow up study was performed in 2005 and compared the same exercise and manual therapy treatment over 4 weeks to a group who performed the same exercise program without the manual therapy unsupervised in their homes. The supervised exercise/manual therapy group improved twice as much on the WOMAC at 4 weeks, and walked about 10% further on the 6 minute walk test than the home exercise group. At the 1 year follow up the supervised exercise/manual therapy group was more satisfied with their treatment outcomes, and were taking less medication for knee OA than the home exercise group.
These studies support the efficacy of supervised exercise and manual therapy techniques for patients with knee OA. To obtain these results the patient with knee OA must be thoroughly evaluated by an experienced orthopaedic physical therapist in order to determine the specific deficits requiring manual treatment. Individually tailored exercises designed to improve range of motion, strength, and function reinforces the manual techniques and develops strength/endurance in specific muscle groups. The exercise can be continued long term unsupervised to maintain the improvements gained during the supervised therapy.
The cost difference between the home exercise and supervised exercise/manual therapy interventions is estimated to be between $500-$800. This cost is comparable to the cost of other interventions such as injections of various sorts in the knee. The cost of the supervised PT is about 1/10 the cost of joint replacement surgery. One should then contemplate whether twice the improvement in knee function is worth the additional $500-$800? If it were my knee the answer would be yes!
Deyle, G. D., Allison, S. C., Matekel, R. L., Ryder, M. G., Stang, J. M., Ghodes, D. D., et al. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the Knee: A randomized controlled trial. Annals of Internal Medicine(132), 173 - 181.
Deyle, G. D., Allison, S. C., Matekel, R. L., Ryder, M. G., Stang, J. M., Ghodes, D. D., et al. (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. JOSPT, 85(12), 1302-1317.
Don Stover PT
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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