Physical therapy for knee osteoarthritis – Treating roots of pain instead of bandaging the symptoms

Climbing stairs, getting in and out of a chair, walking more than a mile — all body movements associated with the knee we take for granted until arthritis sets in.

Knee arthritis, especially its most common form osteoarthritis, is a condition that causes inflammation and pain in the knee joint. Osteoarthritis occurs when, over time, there is a breakdown of cartilage—the smooth, protective tissue that covers the end of the bones in the joint. As the cartilage goes away, a narrowing tightness occurs, creating pain, grinding or a clicking sensation. This is referred to as degenerative joint disease (DJD).

While most common in older adults, knee pain and stiffness can occur at any age with the risk increasing after the age of 45. Here’s the truth — osteoarthritis is a natural consequence of aging, but losing the ability to function because of it doesn’t have to be the result.

Read that again.

Through physical therapy, you can have some control over how fast the joint deterioration progresses and create strength where it is needed to live robustly with knee arthritis.

When to start physical therapy

Physical therapy for knee osteoarthritis can and should begin in the early stages of diagnosis. Similar to any other chronic disease, preventive health care keeps knee pain at bay, allowing you to build strength, stopping it from going further, faster.

Just like you don’t wait until you have a heart attack to treat cholesterol, you don’t wait until your joint is completely worn away before exploring ways to reduce loss of function.

Here’s what your physical therapist knows — when diagnosed with osteoarthritis, the joint is degenerating, it is getting weaker, which causes pain and reduced balance. Rather than waiting as it festers in the background or until the joint is bone on bone, physical therapists want to attack and manage the condition through exercises designed to get at the root of the pain through strengthening.

Key components of a good program

So when it comes to osteoarthritis in knees, what should you be looking for in a physical therapy program?

Osteoarthritis is a lifetime condition, so you want a physical therapy regimen and a trusted provider that is an investment in a lifetime of progress, management and support. There are a few hallmarks to note of a program worth the time commitment.

Any solid program should start with a complete and thorough assessment. Therapists can see as many as 10 patients a day with knee osteoarthritis and each one will have different limitations or areas where they are lacking. Their goals are different, their function is different, their needs are different.

A comprehensive assessment by a trained physical therapist includes baseline testing to see where you are in the disease journey and what impacts it is having. It’s an open conversation about what you are feeling, your symptoms are and where you need to be to enjoy the lifestyle that is uniquely yours. That testing is used to create a program specifically for you and to create benchmarks for your treatment to see where you are making progress or where you may be losing abilities.

Essential areas of focus for arthritis in the knee:

• Strength – The most important concept in the maintenance of an osteoarthritic knee is building up the strength in the quadriceps. One of the largest muscle groups in the body, quadriceps, or quads, are the four muscles located on the front of the thigh. Quads play a crucial role in extending the knee joint and are essential for walking, running, climbing stairs and squatting.
  Your physical therapist addresses this muscle grouping through weight resistance training. Loading the joint through this type of training prepares your body for what you may demand of it.
• Flexibility – As people lose the ability to straighten their knee, the body reacts accordingly, sometimes compensating for the loss of action in the joint. This may cause limping that could starts a chain reaction leading to back and hip pain. Physical therapists use stretching motions and strengthening exercises to fight against the loss of flexibility.
• Balance – When the knee joint deteriorates, people begin to see a decline in balance, putting them at higher risk for falls, and falls lead to a series of other problems or medical issues. Strength again becomes a focus for physical therapy to help prevent falls. Also effective are balance exercises or programs like yoga or tai chi that are gentle on the joints but work on the component of balance.

Any good program should make functional movements a priority. You want to be able to do squats because you’ll need that movement to get in and out of a chair or up from the toilet. You’ll want to take part in exercises that help you go up and down stairs.

The saying “use it or lose it” definitely applies to anyone experiencing knee osteoarthritis — you want your therapist to push you so you can continue to do the activities required to move through and enjoy life.

Other possible treatments

Some physical therapy programs may offer blood flow restriction (BFR) therapy or dry needling, which can be helpful in the treatment of osteoarthritis. 

BFR is a specialized, medically-approved treatment done by trained therapists. This is a great way to build strength for people limited by pain or post-operative restrictions. This method uses cuffs that expand, restricting blood flow to the muscles. This allows for lower impact exercises to be completed in a meaningful way without overloading a joint, but makes the body have the same burn in the muscles as someone who is doing extreme exercise. 

Dry needling, a technique that involves inserting thin, solid needles into specific locations of the neuromuscular system (the network of nerves and muscles that control movement) is helpful in the managing muscle pain, spasms and tightness. 

No one wants to add a medication to their pill box. Long-term use of any drug can have side-effects. If you need medications to make it possible to participate in physical therapy, the recommendation is to start there. As your physical therapy plan progresses it is the hope that as strength and function return at a safe, comfortable pace, you’ll be able to wean off of medications.

Injections for osteoarthritis is common. Physical therapy working in conjunction with injections is actually quite productive. Injections temporarily provide relief from pain. 

In those pain-free periods, a therapist can maximize your strength building results. Another chain reaction, but this time a positive one, when you’re stronger, you can move better and push harder, making it so when the injection wears off, you may not need another because you are physically better.

When it comes to cold or heat use on the knee at home to relieve discomfort after doing physical therapy or exercises, everyone has a different experience. A recommendation would be, if you’re having a flare up caused by inflammation, ice can bring it under control. If you’re stiff, heat tends to loosen things up for relief. If the chosen ice or heat method doesn’t work, flip the method and see if that helps.

Commit to controlling what you can control – consistency is key

Your journey with knee arthritis in large part is written by you. Your physical therapists are with you, providing support, education, empowerment and showing you the exercises and tools you need to keep your osteoarthritic knee or knees in check. It’s a partnership.

Consistent exercise, in the presence of your therapists and at home and in life, are key to staying on top of pain and retaining function. Be open in communication about what works for you and what is feasible for you to stick with the plan. Your therapists want you to succeed, so creating a care plan that gets you results and then maintains strength and function is their top priority. 

Change your mindset toward exercise. Don’t be afraid of pain from exercise. Work your way through the building blocks of progress.  Try what is given to you to help build strength and share with your therapist how your body is responding. As your trusted partner, they can be your greatest advisors on when it is okay to push through pain and when to pull back.

Also on the list of caring for you is weight management. There is a definite link between increased weight and degenerative joint disease progression. It makes sense that when you’re heavier, you’re placing more weight on the knee joints for just about any activity. If you can work toward a healthy weight goal, you’ll not only feel better but you’ll take pressure off of the joints.

Recognizing foods that cause inflammation in the joints is also important. The more you understand what foods may be making your arthritis reactions worse, the more you can avoid flare ups.

What do you have to lose?

Giving a physical therapy program for knee arthritis a try has no downsides. While you can’t regrow the cartilage in your knees, you can grow in strength, balance and flexibility. 

Physical therapists can be part of your lifelong strategy to manage arthritis, allowing you to be an active participant in the most meaningful parts of life. 

Clinical contribution to this blog provided by Erica Fritz Eannucci, national director of the comprehensive degenerative joint disease program.