Does physical therapy really do anything for knee OA?

Let’s cut to the chase. Yes, it does.

If you’re having a busy day, feel free to exit out of our primary care blog now and resume your other activities. You’ve read the take-home message and you’re good to go.

If you have a few more minutes, feel free to read on.

Osteoarthritis of the knee is common, with a penetration of close to 100% as our patients, and we ourselves, all age together. (OK, I know, pediatricians get a pass on this one.) As with OA of other joints, it is a painfully frustrating condition to treat. NSAIDs are the mainstay, along with appropriate rest, heat (or is it ice?), sometimes liniments, sometimes steroid shots. Viscosupplementation has fallen out of favor, thankfully, based on a careful review of objective studies on its efficacy. A number of surgical options are available, but when we start entering the realm of injections and incisions, we’re embarking on a more invasive course fraught with more potential for problems.

So, where does physical therapy fit in to this conundrum? Intuitively, it may seem PT would have little to offer. The osteoarthritic knee is a joint whose cartilage is inflamed and thinned. The bones themselves may be eroded and damaged. How can doing some exercises possibly help? Well, leave it to the rheumatologists to assess this question. In a meta-analysis published in the February 25, 2014, issue of Arthritis and Rheumatology, Dr. C. Juhl from the University of Southern Denmark and his colleagues looked at 48 trials comparing PT to no-PT in knee OA patients. They found a significant trend towards reduced pain in the patients who had PT. The optimal frequency was 3 times weekly for 4 weeks. Quadriceps-specific exercises appeared to be most effective.

While PT does not cure knee OA, its risk of causing side effects is low. And this recent meta-analysis suggests it may provide significant pain relief. So, the next time you are trying to figure out what to do for your patient with knee OA, if PT has not yet been tried, give it a shot. It may help your patient avoid having to get a shot. Or face a surgeon’s scalpel.

Richard Fleming, MD

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