RECENT ADVANCES IN ‘EXERCISES FOR OSTEOARTHRITIS OF THE KNEE’

Presenter :Dr.Pooja Joshi

Content

Introduction Methodology Traditionally used exercises Recent advances of exercises Implication in clinical practice Evidence for recent advances

Introduction

Osteoarthritis (OA) is one of the most disabling degenerative diseases affecting the elderly

The reported prevalence of knee OA is approximately 3% among individuals between the ages of 45 to 54 years

This number rises to 27% for those between 63 and 69 years, and increases once again to 44% for persons above the age of 80 years

Knee osteoarthritis (OA) is a prevalent chronic musculoskeletal condition associated with pain, physical and psychological dysfunction, and reduced quality of life in affected individuals

The experience of pain is influenced by a multitude of structural, physical, and psychosocial factors

Whilst stimulation of nociceptors in the capsule, subchondra bone, ligaments and other joint tissues contribute to the perception of pain, structural damage in knee OA is in fact not well correlated with pain severity

classification

GRADE FEATURES

GRADE: 0 No features

GRADE:1 Doubtful: Minute osteophyte, doubtfulsignificance

GRADE:2 Minimal: Definite osteophyte, unimpaired joint space

GRADE:3 Moderate: Moderate diminution of joint space

GRADE:4 Severe: Greatly impaired joint space with sclerosis of subchondral bone

Joint pain Altered jOint alignment

malalignment Limited range of motion

Decreased proprioception Joint contracture

Muscle weakness Crepitus

Pain or aching with activity Joint swelling

Radiological presentaion

Osteophytes at joint margins joint space narrowing subchondral sclerosis cysts

Objective

To search a evidence based recent exercise to treat the patient with knee osteoarthritis

LITERATURE SEARCH

PubmedTotal=454Filtered =5

Med lineTotal=343Filtered=4

Cocharane

Total=4Filtered=

Total=9

Inclusion criteria

Articles published in last 3years Cochrane review , systemic review and

randomised controlled trial Population is knee osteoarthritis alone Tibio-femoral arthritis Chronic ( more than 3months) Age above 45 years Both genders Intervention is only exercise therapy Free full text available

Exclusion criteria

Population is whole lower limb osteoarthritis or hip and knee both arthritis together

Interventions other then physical therapy is used

Modalitis or conventional therapy used

Traditionally used

Active exercise – knee ,hip ,ankle Strengthening exercise – isometric ,

isotonic Weight bearing exercise Bicycle treadmill

Recent advance

Proprioceptive exercise Tia-chi exercise Aquatic resisted exercise Neuromuscular exercise

Proprioceptive training

Variation in standing Standing on different surface Walking Computer foot game 10 weeks training 4 sessions /week

Aquatic exercise The pool is heated at 35

degree temperature a Protocol: 12 weeks (4 sessions /

1week ) 1st 3 weeks – with bare foot 2nd 3 weeks-small fins 3rd 3weeks- large foot boot

Tia-chi exercise Patients with

osteoarthritis of the knee benefit from Tai Chi by increasing lower extremity muscular strength and joint stability

Tai Chi typically includes a series of dance-like movements that combine to postures or forms. The forms are executed using slow and smooth movements that flow into each other

1.Sun style 2.Yang style

12 Weeks 40min/session

8weeks should be done in clinic then 4 weeks can be done at home by watching video

Vibration platform for improving balance 1.Static

exercise 2.Dynamic exercise2sessions / week training for 8 weeks Improve muscle strength and proprioception

Neuromuscular exercise Neuromuscular exercises aim to

improve the position of the trunk and lower limb joints relative to one another, as well as quality of movement performance

Standing on even surface Standing on uneven surface (board ) Ball exercise Walking with forward lunges in

between Trunk rotation one leg on chair Knee flexion should not go beyond

30 degree in weight bearing 40 min session 4/week 6 weeks

Systemic review

The effectiveness of proprioceptive-based

exercise for osteoarthritis of the knee: a

systematic review and meta-analysisRCTS Interventions Control

groupresult

10 perturbation exercises: sidestepping, braiding,one leg standing,walking on heels and toes ,computer foot step games .cross over steps during forward and backward walking(10 repetition * 3 sessions )

staticexercise bike, isometric hamstrings, quadricepsand abductor (6 s hold 98), through rangeisotonic resisted quadriceps and hamstringexercises

The findings of this review indicate that proprioceptiveexercises are efficacious in the treatment of people withknee OA. There is some evidence to indicate the effectivenessof proprioceptive exercises compared to generalstrengthening exercises in functional outcomes. the current evidence base is small

The effects of therapeutic exercise on the balance of women with knee osteoarthritis: a systematic review

Rcts intervention Control group Result

Resistance training

Quadriceps strengthening exSLR

Moderate evidence for therapeutic exercises improved the balance of women with knee OA

9 Vibration platform : dynamic and static

Abductor and quadriceps isotonic strengthening

Mini-squat with anterior-posterior displacement and side to side displacement

Walking One leg standing

Strengthening and balance exercise in heated pool

Physical Therapy Interventions for Knee Pain Secondaryto Osteoarthritis

No of rcts Interventions used result

193 rcts Proprioceptive Exercise

Proprioceptive and aquatic and ti-chi has moderate evidence in improving functional activities of knee than othrs .

Aerobic Exercise

Aquatic Exercise

Strengthening Exercise

Tai Chi

Massage

A systematic review and meta-analysis ofTai Chi for osteoarthritis of the knee

Total rcts Experimental groups

Control groups

result

5 Yang style ti-chi (12 weeks 40 min session 4/week) sun style ti-chi (12 weeks 20-40 min session 3/ week)

Treadmill walkingBicycle Recreational Activitis

moderate evidence for short-term improvement ofpain, physical function and stiffness in patients with osteoarthritis of the kneeFurther research is required

randomized controlled trial

A Comparative Study of Proprioceptive Exercises versus traditional Training Program on Osteoarthritis of Knee

subjects Group-1 Group-2 result

50 Quadriceps strengthening Knee extension in high sittingSLRNormal walking

One leg standingOne leg standing with closed eyesToe walkingHeel walking( 20 meters )

proprioceptive exercises are more beneficial than traditional exercisesgroup

Cross body leg swing(15 repetition )

Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocolSubjects Group-1 Group-2 Group-3 result

100 Dynamically and functional strengthening

Knee extension with hold at 30° knee flexion-startsitting with knee at 90° flexion, extend to 30° usingresistance of ankle weights.

Control group (no intervention )

innovative neuromuscular exerciseprogram that aims to reduce medial knee load andpain and improve function in people with medial compartmentOA and varus malalignment.

With trunk control pelvic in proper alignment and knee is in neutral position on foot

Quads over a rollusing resistance of ankle weights.SLR up to 30 with weight cuff Theraband exercise

Impact of exercise on the functionalcapacity and pain of patients with kneeosteoarthritis: a randomized clinical trialpatient Group -1 Group-2 result

100 included stationary bicycle, hamstrings stretching, and quadriceps strengthening

which received a manual with information about knee osteoarthritis and instructionson how to deal with knee symptoms in daily activities

Quadriceps strengtheningexercises for eight weeks are effective to improve pain, function, and stiffness in patients with knee osteoarthritis

Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trialpatient Group-1 Group-2 result

80 The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3times a week for four monthsWarmup session:15minStrengthning :35minwarmup;;10

Control group with no intervention

Progressive aquatic exercise program has evident effect on morphology and cartilage

Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritissubjects Group-1 Group-2 Group-3 result

60 person’s foot pressed thepedal to the bottom, a snake’s head immediately appearedon the computer screen, ready to catch prey20 repetition 3 sessions

Closed chain exercise knee in the supineposition with their foot placed on the centre of the pedal ofthe Shuttle Mini Clinic resistance device (90 to 0 degree)(10 repetition)

Control group

Both treatments are beneficial in improving proprioceptive functions

References :

Mondam, S. et al., 2012. A Comparative Study of Proprioceptive Exercises versus traditional exercise program on Osteoarthritis of Knee. , 1(12), pp.31–35.

Smith, T.O., King, J.J. & Hing, C.B., 2012. The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis. Rheumatology international, 32(11), pp.3339–51.

Vincent, K.R. & Vincent, H.K., 2013. NIH Public Access. , 4(5 0), pp.1–14.

Waller, B. et al., 2013. Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial. BMC musculoskeletal disorders, 14, p.82.

Wang, S. et al., 2014. Annals of Internal Medicine Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis.

Bennell, K.L. et al., 2011. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol. BMC musculoskeletal disorders, 12(1), p.276.

Lauche, R. et al., 2013. A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee. Complementary therapies in medicine, 21(4), pp.396–406.

Lin, D.-H. et al., 2010 Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clinical rheumatology, 26(4), pp.520–8.

Mizusaki, A. et al., 2012. Impact of exercise on the functional capacity and pain of patients with knee osteoarthritis : a randomized clinical trial. , 52(6), pp.870–876