Treatment Pathways to Knee Osteoarthritis Relief Within Your Control: Discussing the Essentials

Knee Osteoarthritis and It's Various Treatment Approaches

Knee osteoarthritis (KOA) is the most common form of arthritis, acting as the primary cause of disability that come with ageing and impacting millions on a global level. It is a joint disease defined by the degeneration and breakdown of cartilage, leading to increased pain and reduced functionality of the knee. 

Figure 1. Stages of KOA disease development. Stage I: A loss of approximately 10% of cartilage causing minimum disruption of functionality. Stage II: Spacing between the joints begins to narrow with increasing cartilage degeneration. Stage III: Gaps in the cartilage continue to expand and introduce bone damage.  Stage IV: A loss of approximately 60% of cartilage leads to greatly reduced joint-space and function.

Treatment methods that have become traditional with time often rely on surgical interventions that may not always align with patients’ preferences due to the risk and long term recovery periods that accompany it. This has led to a growing emphasis on non-surgical treatments, that manage the disease through a holistic approach focused on improved quality of life through the utilization of physical therapy and lifestyle modifications. The approach aims to gain maximal benefits of all fields of play, taking into account the interplay of biomechanical forces, bodily inflammation management, and personal health practices.

Non-surgical treatments are becoming increasingly advocated for, by both healthcare providers and patients, for their ability to provide symptomatic relief and joint function improvements while avoiding the inherent risks associated with surgical procedures. Through an combined focus on the general population’s education, behavioural modification, and physical rehabilitation, this paper aims to offer knowledge that promotes independent and proactive maintenance of optimal knee joint health.

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Key Takeaways

  1. Objective of Non-Surgical Treatments: Discussing the importance of non-surgical methods in the management of knee osteoarthritis. 
  2. Exercise Therapy Benefits: Explaining the goals of exercise through the combination of strength and flexibility aimed at improved joint health and stability. 
  3. Lifestyle Modifications: Highlighting the relationship between weight management and the reduction of joint stress.
  4. Aquatic Exercise Advantages: Outlining the benefits of aquatic physical therapy through with a complete absence of aggravating knee exercise. 
  5. Biomechanical Assistance: Discussing careful management of the use of knee braces to alleviate pain through redistributed biomechanical forces.
  6. Knee Rehabilitation Programs: Uncovering the educational advantages of personalized exercise routine and tailored management. 
  7. Alternative Therapies: Presenting alternative non-surgical approaches used to complement traditional therapies for osteoarthritis management. 

Exercise Therapy

The fundamental approach most often consulted in the non-surgical management of KOA is exercise therapy, as it offers various benefits that impact an individual’s life beyond simple pain relief and improvement of overall joint health and functionality. This method of treatment tackles this disease through the strengthening of muscles and tissue surrounding the knee, leading to an enhancement of joint stability and reduction of stress placed on the joint. 

The approach often consists of a combination of strength training, flexibility exercises, and aerobic conditioning aimed at the provision of maximal, holistic benefit. The process is described as the focused building of thigh and hip muscle through strength training, leading to improved stabilization of the knee and a more even distribution of biomechanical forces across the joint’s surface area. Additionally, aerobic exercises such as swimming and cycling provide benefit through the improvement of cardiovascular health as well as weight management, which are key factors leading to the reduction of stress on weight-bearing areas of the joint. Flexibility exercises enhance the joint’s range of motion and improved awareness of joint positioning, considered vital roles in the prevention of injuries. 

Figure 2. Guide on various rehabilitation exercises that can be integrated into daily lifestyle for knee joint health management. 

The effectiveness accompanied with such a treatment approach has been heavily supported and advocated for by scientific evidence and research over the years, showcasing significantly consistent improvement of pain management, functionality, and quality of life that helps patients build regular physical activity habits that are tailored towards the constant conditioning of their health.

Lifestyle Modifications

Patients leading unhealthy lifestyles that leads to comorbidities such as obesity, diabetes, and cardiovascular diseases often experience significant impact on the progress of KOA due to increased mechanical stress on joints and cartilage degeneration due to systemic inflammation within the body. Such comorbidities hinder the nutrient supply to joint tissue causing the worsening of KOA. This requires treatment approaches to address these conditions when offering joint health care. 

Figure 3. Prevalence of comorbidities in adult patients with doctor-diagnosed arthritis in the US. 

Patients leading unhealthy lifestyles that leads to comorbidities such as obesity, diabetes, and cardiovascular diseases often experience significant impact on the progress of KOA due to increased mechanical stress on joints and cartilage degeneration due to systemic inflammation within the body. Such comorbidities hinder the nutrient supply to joint tissue causing the worsening of KOA. This requires treatment approaches to address these conditions when offering joint health care. 

Modifications of individual’s lifestyle aimed at the improvement of knee joint health primarily revolve around dietary adjustments and weight management, which are critical in the management of the knee’s load bearing capabilities and inflammation control. Anti-inflammatory benefits through a diet rich in nutrition from leafy vegetables, nuts, fatty fish, and fruits assist in the management of arthritis-related symptoms. Other dietary measures such as caloric control and regularly physical activity help in avoiding potentially damaging stress on the weight-bearing components of the knee caused by excess body weight. 

The importance of nutritional impact on such a disease should not be underestimated, as the modification of lifestyle choices plays a major factor in holistic management of KOA, and strong evidence has been established backing their ability to pave the way for better outcomes of pain management, physical functionality, and overall quality of life.

Aquatic Exercise

A common limitation among patients attempting to manage KOA is the worsening of symptoms when attempting to deal with more severe injuries. 

The benefit offered through using aquatic exercises during knee rehabilitation is the floatability associated with performing movement in water, allowing for load-free movement. This enables the achievement of resistance training and aerobic exercise without the potentially harsh impacts of training on ground. The natural water resistance effectively leads to muscle strengthening, while simultaneously improving blood circulation and reducing inflammation. 

Furthermore, this approach of treatment has been found to improving the psychological well-being of due to offering an environment that’s free from the limitations caused by KOA, while decreasing associated pain levels and enhancing their functional mobility. 

Biomechanical assistance

Biomechanical devices have become an integral player in the management of KOA. The benefits gained from knee straps and braces are achieved through modifying the joint’s mechanical dynamics with the goal of improving overall functionality and pain management. 

Unloader knee braces are specifically helpful in cases with medical compartment KOA, redistributing loads from the damaged medial areas to surrounding, healthier lateral compartments, providing significant pain relief and mobility improvement. 

Figure 4. Biomechanical load-relief mechanism for patients suffering from KOA. 

Studies have further showcased their benefit by affecting the functionality of adjacent joints and impacting limb mechanics, acting as a method that is also used to avoid further damage on partially treated joints.

Knee Rehabilitation Programs

The advantages that come with seeking tailored knee rehabilitation programs to the specific needs of a patient managing KOA offers the significant improvement of knee joint health outcomes through a combination of physical therapy and education on self-management plans. Programs often utilize technology to constantly monitor progress in functionality, allowing for real-time adaptation of training and effectiveness of the treatment. 

Through gaining information on the specific mechanics of their conditions, patients learn about the importance of the various types of training that improve strength and mobility, and develop insight that helps them manage KOA routinely throughout their daily motions. Access to such self-management programs has been found particularly helpful when offered in community settings, as well as digital platforms. This enables patients worldwide to seek immediate and personalized care and advice on managing KOA. 

Figure 5. Types of physical activity programs recommended by physicians in a survey of 1,366 adult patients seeking treatment of KOA. 

Alternative Therapies

Non-surgical treatment methods have also expanded beyond physical therapies, such as neuromuscular electrical stimulation and thermal treatments like acupuncture and heat applications. These complementary approaches to managing KOA have been found to be beneficial for pain relief and management, as well as functional improvements of the knee joint. 

Neuromuscular electrical stimulation of muscles surrounding the knee leads to gains observed in the strength and endurance of muscle tissue, playing a supporting role that helps build physical foundations capable of performing beneficial physical therapy. Alternatively, acupuncture procedures work through alleviating pain and improving circulation within targeted points of the body. Heat application similarly acts through offering modulation of pain and inflammation through the simulation of blood flow to damaged areas of the knee joint. 

These approaches to KOA management are used by healthcare providers to compliment, and in some cases even enhance, the benefits achieved through more conventional and traditional physical therapies. 

The Holistic Approach to Knee Osteoarthritis Management

Non-surgical treatments have are approaches that are heavily backed by scientific evidence for their various capacities in management KOA. The range of benefits encompassed by therapeutic physical exercises, modifications of daily lifestyles, and personalization of treatment through education, highlight the importance of holistic approaches when treating for chronic joint diseases with the goal of achieving functional restoration to health levels that significantly impact the quality of patients’ lives. 

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References:

Evidence-based articles:
  • Ferreira RM, Torres RT, Duarte JA, Gonçalves RS. Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Acta Reumatol Port. 2019 Jul 29;44(3):173-217.
    Skou ST, Roos EM. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clin Exp Rheumatol. 2019 Sep-Oct;37 Suppl 120(5):112-117.
    Li LC, Sayre EC, Kopec JA, Esdaile JM, Bar S, Cibere J. Physical activity in people with physical disabilities: the role of self-efficacy and pain. Arthritis Care Res (Hoboken). 2021 Feb;73(2):234-242.
    Bennell KL, Nelligan RK, Dobson F, Rini C, Keefe F, Kasza J, French S, Bryant C, Dalwood A, Harris A. Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial. Ann Intern Med. 2017 Apr 4;166(7):453-462.
    Kim HS, Shin JS, Lee J, Lee YJ, Kim MR, Bae YH, Park KB, Lee EJ, Kim JH, Ha IH. Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study. PLoS One. 2016 Oct 20;11(10):e0165325.
  • Hinman RS, McClelland JA, Bennell KL. Effect of water-based exercise on pain and physical function in people with hip and/or knee osteoarthritis: synthesis of evidence from randomized controlled trials. J Physiother. 2020 Jan;66(1):45-55.
  • McGibbon CA, Brandon S, Bishop EL, Cowper-Smith C, Biden EN. Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis. Front Bioeng Biotechnol. 2021 Jan 28;8:604860.
    Budarick AR, MacKeil BE, Fitzgerald S, Cowper-Smith CD. Design Evaluation of a Novel Multicompartment Unloader Knee Brace. J Biomech Eng. 2020 Jan 1;142(1):014502.
Infographic materials:
  • Figure 1: Infographic taken from “Do I Have Arthritis In My Knee?” by The Center of Orthopedic & Neurosurgical Care & Research”, accessed through https://www.thecenteroregon.com/medical-blog/do-i-have-arthritis-in-my-knee/
  • Figure 2: Infographic taken from “Runner’s Knee Treatment: How to Strengthen the Knee to Avoid Re-injury” by Widdicombe B, accessed through https://runningstats.com/runners-knee-treatment-injury/
  • Figure 3: Infographic taken from “Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2013–2015” by Barbour KE et al., accessed through https://www.cdc.gov/mmwr/volumes/66/wr/mm6609e1.htm#F1_down
  • Figure 4: Infographic taken from “The Science Behind the Freestyle OA Knee Brace: How It Works to Relieve Pain” by Avana Surgical Systems Pvt Ltd, accessed through https://www.linkedin.com/pulse/science-behind-freestyle-oa-knee-brace-rbefc/
  • Figure 5: Infographic taken from “Physical Activity Types and Programs Recommended by Primary Care Providers Treating Adults With Arthritis, DocStyles 2018” by Guglielmo D et al., accessed through https://www.cdc.gov/pcd/issues/2021/21_0194.html

 

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