3-Knee osteoarthritis treatment

Eighty-three patients with confirmed osteoarthritis of the knee were randomized to receive treatment or placebo. The end points of the study were improved function, decreased pain and stiffness, and increased walking distance in six minutes. The treatment group received a combination of manual physical therapy and supervised exercise, while the placebo group received ultrasound therapy at a subtherapeutic intensity. For a detailed review of the patient exercise program used in the study. Both groups were treated twice weekly for four weeks, for a total of eight sessions. Patients in the treatment group also performed the same exercises at home. Neither group was aware of the treatment being given to the other group. Knee radiographs were obtained at baseline so that severity ratings could be assigned for each patient. Both groups returned one year after treatment for additional testing and to identify the patients who required knee surgery.

Exercise & Measures:

1. Stretching exercises:
- Standing calf stretch ,Three repetitions with 30-second hold.

- Supine hamstring stretch ,Three repetitions with 30-second hold.

- Prone quadriceps stretch ,Three repetitions with 30-second hold.

2. Range-of-motion exercises:

- In long sitting position, knee mid-flexion to end-range extension , Two 30-second bouts with 3-second hold at end range.

- In long sitting position, knee mid-flexion to end-range flexion ,Two 30-second bouts with 3-second hold at end range.

- Stationary bicycle ,Five minutes; increase time as tolerated.

3. Strengthening exercises:

- Static quadriceps sets in knee extension ,One set of 10 repetitions with 6-second hold; 10-second rest between repetitions.

4. Closed-chain progression:

- Standing terminal knee extension ,One 30-second bout; increase resistance as tolerated.

- Seated leg press ,One 30-second bout; increase resistance as tolerated.

- Dips weight-lessened ,One 30-second bout; 1 second during concentric phase and 2 seconds during eccentric phase; progress from 2 legs to 1 leg as tolerated.

- Step-ups ,One 30-second bout; increase step height as tolerated.

*--The number of exercise bouts was increased according to the patient's tolerance.
**--Patients performed closed-chain exercises B, C, or D, depending on which one they could perform pain-free.Reprinted with permission from Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 2000; 132:180.

Of the 69 patients who completed all treatment and testing, 33 were in the treatment group and 36 were in the placebo group. Patients in the treatment group had improved symptom scores and significantly increased average distances walked in six minutes compared with those in the placebo group. These improvements were maintained after one year. After one year, patients in the placebo group had significantly more knee surgeries than those in the treatment group.
The authors conclude that patients with osteoarthritis who are treated with a regimen that combines manual physical therapy with supervised exercise have improved function and less reported pain and stiffness than patients who are not treated with a physical therapy program. This type of treatment may decrease the need for knee surgery.
RICHARD SADOVSKY, M.D.
Deyle GD, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med February 1, 2000; 132:173-81