Treating knee osteoarthritis is, basically, we can break it down into two components. There's reducing the inflammation within the knee, and then there's getting all of the muscles and the biomechanics right to take the pressure off of the knee so that the same forces aren’t going through it so the inflammation doesn’t re-accumulate.
In general, physical therapy can be very effective in terms of getting the pain from arthritis to go away, and importantly, from keeping it away. Essentially, it involves stretching and strengthening the muscles in the right way, so, strengthening the quadriceps, stretching the hip flexors, often stretching the ITB. These things help to unload the knee so that the knee has a chance to rest and to recover itself.
By also, by getting the biomechanics better, it also helps take the pressures 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 in the foot. If people are hyperpronated or if their feet roll in, then sometimes an orthotic, either a custom or over-the-counter orthotic, can be very helpful there as well.
Within physical therapy, there are many passive modalities that physical therapists sometimes employ as well. Such as ultrasound, electrical stimulation, some manual manipulation, that sometimes can help with the symptoms and also to an extent help to take away some of the inflammation.
A lot of people talk about weight loss a lot, 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 of the knee. And with that said, I think there is a very important point here to make, which is that sometimes I see people come into the office or patients present to people who do what I do with knee pain who are grossly overweight and the first thing they’ll say sometimes 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 you have, when it’s hard to walk across the street because the pain’s so bad. You know, exercise is such an important component of losing weight that sometimes you get yourself into this bad vicious cycle, which is that your knee hurts so you stop moving, so you put on weight, so you put on more weight, so there’s more pressure going through the knee, so the knee hurts more, so you move less. And you can see how that can just spiral down, downwards.
So the job of someone like me, with the kinds of interventions that I can do and with physical therapists and all the different healthcare professionals, one of the important things is to break that cycle, right? Because sometimes just breaking the cycle, taking away the pain, allows the person to be more active. And then a lot of times the weight loss will take care of itself. Obviously, things like diet, nutrition, overall exercise, those things are very important, but if you can just take away the pain, break that cycle, the person starts moving better, the weight starts coming off, and then you start spiraling in the right direction instead of the wrong direction.