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Physiotherapy Superior to Injections in Management of Knee Pain from Arthritis

Unnecessary knee injections surgeries cause of mounting medical expenses

 Physio for Knee Arthritis

Knee replacement surgery is an option for those suffering from knee arthritis. But should it be the first option? Probably not – says Dr Nicholas Bedard in his latest study. Patients who have knee surgery or steroid injections in the early stages of knee arthritis pay more out of their pocket than those who choose other options like physiotherapy.

If you are interested in having Physiotherapy, visit our Physio clinic in Naas.

Surgery And Steroids – How effective are they?

Dr Bedard’s study proclaims that many of the knee arthritis patients are pushed for steroid or hyaluronic acid injections that have little or no benefit in the long run. Scores of studies highlight that steroid injections only mask the pain and do not treat the root cause. Hyaluronic acid injections prescribed with the aim of initiating articular cartilage regeneration, are often unsuccessful. The same is true for glucosamine and chondroitin sulphate supplements according to the American Association of Orthopaedic Surgeons. Many patients are also prescribed opioids which do more harm than good.

These kinds of treatments are an absolute waste of time and money as the patient is not relieved and has to finally go in for surgery. Yet all these approaches are used indiscriminately. Knee replacement surgeries are no doubt effective but have a prolonged recovery period with weeks of physiotherapy and weight management. The majority patients are left dissatisfied after the surgery as some degree of pain remains. Not to mention the medical bills.

Physiotherapy is the Preferred Choice for Knee Arthritis

Lately, clinicians have begun acknowledging the benefits of non-surgical options like physiotherapy, weight loss strategies and mild painkillers over knee replacement surgery. They have been shown to be effective in the management of osteoarthritis. The guidelines set by a number of rheumatology committees (ACR, AAOS, OARSI) endorse the long term benefits of supervised physiotherapy intervention and guided weight loss on patients with knee arthritis.

Interestingly the Journal of Arthroplasty has recommended physiotherapy, NSAID’s (like Ibuprofen and naproxen) and opioid’s (like Tramadol) as the first line of treatment for patients with knee arthritis. Yet a survey conducted shows that these made up little more than 10% of the treatment received by patients. Instead knee braces, shoe insoles and opioid analgesics formed a larger chunk of the treatment administered.

How does Physiotherapy help?

To understand how exercise can help, it is important to understand the pathology of osteoarthritis.

Osteoarthritis is a degenerative disease involving wear and tear of the articular cartilage located on the joint surfaces. Loss of the cartilage increases the friction between joint surfaces resulting in pain, swelling, stiffness and difficulty in walking. Excess body weight and reduced quadriceps muscle strength can add to the problem.

6-8 weeks of regular supervised physical therapy aims to reduce weight, increase muscle strength, balance and joint mobility which help to arrest the condition. It also breaks the pain- muscle weakness- reduced mobility- increased pain cycle. This can stall surgery.

8 Best ways to tackle knee arthritis pain:

  • Quadriceps strengthening exercise – mainstay of OA treatment, builds up the muscles around the joint offsetting the weight bearing forces. Outcome- significant pain reduction.
  • Strengthening of hamstrings and hip muscles increases joint stability and shock absorption which further relieves the pain.
  • Stretching exercises to correct flexibility imbalance. Outcome- Increased mobility at hip, knee and ankle
  • Joint mobilisation to correct any malalignment between patella, femur and tibia.- Outcome- decreased pain with knee movement
  • Proprioceptive exercises to increase lower limb balance. Outcome – Ease of walking on uneven terrain
  • Encourage less stressful exercises like walking, swimming and static cycle. Outcome – weight loss and reduced joint stress
  • Biomechanical evaluation followed by use of right combination of taping, insoles and braces help reduce pain and improve knee function.
  • Self-management advice that includes how certain activities increase or decrease pain

Beyond Convention

Though further research is needed to establish the efficacy and reliability of these techniques, there seems no harm in exploring these in the initial stages of knee OA. Clinicians advise knee replacement surgery as the last resort in end stage osteoarthritis of the knee if all above options fail to help.

                           Don’t allow knee pain to stop you from enjoying life

           Note: Always consult with your physio and GP before embarking on an exercise program.

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