I
hardly ever read this magazine, "Advance for Physical Therapists and PT Assistants" since it rarely has articles that I find interesting. But, this one caught my eye, "No More Knee Pain" so I decided to dive in.
What I discovered is that state of the art physical therapy for osteoarthritis of the knee is to actually not address the primary issue, the osteoarthritis, but rather focus on the effects of OA - muscle weakness and alterations in how you walk. That seems to me like focusing on shortness of breath from walking when you have heart disease. Why not go to the source, if at all possible, and alter the disease process?
So, I had to send a letter to the editor. Below is what I sent. If I hear back from someone, I'll post it.
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To Whom it may Concern,
I am writing in response to an article that appeared in the December 15, 2008 edition of Advance for Physical Therapists and PT Assistants entitled, "No More Knee Pain." and would like to offer a different perspective on the treatment of people with osteoarthritis of the knee.
The article is quite supportive of the use of physical therapy in the treatment of osteoarthritis of the knee from the perspective of strengthening muscle and correcting gait mechanics based on a recently published article in the New England Journal of Medicine that supports physical therapy as an effective non-surgical treatment. In the article, Christopher Powers, PhD, PT, states, "Physical therapy can't cure osteoarthritis. The best thing PT can do is keep the muscles around the knee strong and work on correcting abnormal gait mechanics that may be putting extra stress and strain across the knee joint."
And according to Gregory Masiko, MSPT, "...once OA changes have started, there is no turning back unless there is a reconstruction of the bone surface with total joint implants. A treating PT must tell patients that they are not affecting the arthritic changes within the knee directly, but instead are focusing on tissue that both supports and governs motion at the joint."
I agree that increasing muscle strength and correcting gait mechanics are important elements of a comprehensive rehab program for a person with osteoarthritis of the knee. But, I disagree that interventions employed by physical therapists do nothing to alter the disease process and that once osteoarthritis is present, that there is nothing left for a patient to do but hope that muscle strengthening will alleviate pain and improve function.
When a patient has a swollen, aching, painful knee that prevents them
from enjoying life and we, as physical therapists, employ interventions
to alleviate the symptoms and restore function, we are effecting a form
of a cure according to the New Oxford American Dictionary.
Although thus far, we cannot change the presence of bone spurs or regions of exposed bone, that does not mean that we cannot have a substantial impact on a patient's joint health prior to the onset of those conditions. In fact, if we do not alter the biochemistry of the joint, we'll have little success in strengthening muscle due to arthrogenous inhibition (3).
By knowing how exercise shifts the biochemistry of the joint and how to use exercise to improve the health of the joint, physical therapists offer tremendous healing potential to patients. We can do more than strengthen muscles and alter mechanics.
Sincerely,
Doug Kelsey, PT, PhD
1. Miyaguchi, M., A. Kobayashi, et al. (2003). "Biochemical change in joint fluid after isometric quadriceps exercise for patients with osteoarthritis of the knee." Osteoarthritis Cartilage 11(4): 252-9.
2. Roos, E. M. and L. Dahlberg (2005). "Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis." Arthritis Rheum 52(11): 3507-14.
3. Hurley, M. and D. Newham (1993). "The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees." Br J Rheumatol 32(2): 127-31.
