Treating knee osteoarthritis can be broken into two components. There’s reducing the inflammation within the knee, and then there’s getting all of the muscles and biomechanics right to take the pressure off the knee so that the same forces are not going through it.
In general, physical therapy can be very effective in getting the pain from arthritis to go away, and importantly, keeping it away. Essentially, it involves stretching and strengthening the muscles in the right way, such as strengthening the quadriceps, stretching the hip flexors, often stretching the ITP, these things help to unload the knee so that the knee has a chance to rest and recover itself.
By getting the biomechanics better, it also helps to take the pressure off so that the inflammation doesn’t re-accumulate. Also, it’s often important to look at the feet to make sure that the pressure is being dissipated appropriately. If people are hyperpronated or if their feet roll in, then sometimes a custom or over-the-counter orthotic can be very helpful as well.
Within physical therapy, there are many passive modalities that physical therapists sometimes employ. These include ultrasound, electrical stimulation, and manual manipulation. These sometimes can help with the symptoms and also help to take away some of the inflammation. A lot of people talk about weight loss – and for good reason. When people are overweight, for every extra pound that we put on, there’s three extra pounds of pressure going through the knee. So certainly getting the weight under control can be very helpful in terms of taking the pressure off the knee.
And with that said, I think there is a very important point here to make, which is that sometimes I see patients and the first thing they say is, “I know, I know, I know, I have to lose weight.” And while that may be true, to pin it all on that is a mistake, because it’s very difficult to lose weight when it’s hard to walk across the street because the pain is so bad. Exercise is such an important component of losing weight that sometimes you get yourself into a vicious cycle: your knee hurts so you stop moving, you put on weight so you put on more pressure on the knee, the knee hurts more and you move less. That can start spiraling downwards.
So the job of someone like me, with the kinds of interventions that I do with physical therapists and all the different healthcare professionals, one of the important things is to break that cycle. Sometimes just breaking the cycle (taking away the pain), allows the person to be more active, and a lot of the times the weight loss will take care of itself. Obviously, things like diet, nutrition, and overall exercise are very important, but if you can just take away the pain and break the cycle, the person will start moving better, the weight starts coming off and then you start spiraling in the right direction instead of the wrong direction.