Physiotherapy Exercises for Knee Osteoarthritis

Introduction

Osteoarthritis is a musculoskeletal disorder characterized by cartilage loss and the affected joint enlargement. It causes significant pain in older adults. Cartilage is the connective tissue present between joints, and if it is lost, the support for bones is also lost, leading to loss of resistance against external compressive forces.

What Are the Causes of Knee Osteoarthritis?

The causes of knee osteoarthritis include:

• Genetic factors like skeletal dysplasia, which is characterized by malformation of bone and cartilage.

• Obesity is the most common cause of the development of knee osteoarthritis.

• Repetitive action and movements on the knee can cause knee osteoarthritis.

• Ageing can cause gradual degeneration of bones forming knee joint..

• In surgeries like meniscectomy (surgical removal of meniscus), a torn meniscus can lead to knee osteoarthritis.

• Trauma can be a cause of knee osteoarthritis.

• Hormonal factors like deficiency of estrogen can also lead to osteoarthritis.

• In conditions like tears and rupture of ligaments of the knee, osteoarthritis can arise.

What Are the Symptoms of Knee Osteoarthritis?

The symptoms of knee osteoarthritis include:

• Pain is the most common symptom, and it is gradual in onset and lasts for several months in certain patients.

• Pain is aggravated on movement and when trying to lift weights.

• There will be functional restriction of the affected knee.

• Stiffness of the knee joints during morning time.

• The patient has difficulty walking, climbing stairs, and moving from one place to another.

• A crackling sound may be heard when bending and extending the knee.

• The walking pattern is changed, and adults will have an increased risk of falls.

How Is It Managed?

Knee osteoarthritis can be managed by taking the following measures:

• Pain medications are given to reduce pain and swelling, and non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed for the same.

• Strengthening exercises are incorporated into the treatment plan to improve mobility and function.

• Obesity is managed through weight-loss programs.

• Walking aids are given to old patients to prevent falls.

• Intra-articular injections are given every three months to control the symptoms.

• Physiotherapeutic modalities like knee joint mobilization and ultrasound are integrated with the management plan to improve the function of the affected joint.

• In severe compromised cases, joint replacement surgery is done.

• Osteotomy is another surgical procedure that involves trimming the bony extension of the malaligned joints to improve function.

What Are the Physiotherapy Exercises Done to Relieve Osteoarthritis?

The physiotherapist advises certain exercises to reduce pain and inflammation. The main aim of doing all these exercises is to improve the range of motion of the joint without overexerting the joints. At the end of the exercise program, the pain and inflammation should be reduced, stiffness should be relieved, and there should be increased efficiency of the joints in performing various activities.

1. Heel Slides: Sit on a comfortable surface like a bed or floor by placing a small towel folded under the heel of the affected leg. Use another towel or belt to hook around the heel of the affected leg and start pulling the leg towards the body until a stretch is felt. Hold this stretch for a second, and repeat the same on the other leg. Do this exercise for three sets ten times a day.
2. Straight Leg Raises: Lie flat on a comfortable surface like a bed or floor with face and palm facing the ceiling. Now slowly raise the affected foot off the ground while bending the unaffected leg and keeping the foot in contact with the surface. Hold the raised leg for a second and repeat the same in the opposite direction. Repeat ten times for three sets in a day.
3. Gastroc and Soleus Stretch: Sit on a comfortable surface like a bed or floor with the legs and knee extended on the floor and attached to the floor. Now drape or strap a towel around the affected foot and pull the towel with both hands holding the ends of the towel. The other leg can be bent while doing this exercise, making sure the foot alone is in contact with the floor. Try to hold this stretch for at least ten seconds, and then repeat the same in the other leg. Perform this exercise ten times a day.
4. Hip Abduction: Lie sideways on a comfortable surface like a bed or floor with one knee over the other. Keep one hand supported under the head and the other in a comfortable position. Now, slowly raise the above leg, with the fingers pointing outward and stabilizing the leg right in line with the body. The leg that is below can be kept stretched or bent depending on the comfort of the patient. Repeat this exercise on the other leg, and perform it ten times, three sets in a day.
5. Hamstring Stretch: Lie flat on a comfortable surface like a bed, floor, or on a table. Wrap a towel under the affected foot in a hooking manner, and hold both the free ends of the towel using both hands. Now, slowly raise the hooked leg using the towel until the knee is straight and the stretching is felt along the backside of the leg. Try to hold this stretch for at least ten seconds, and then repeat the same in the other leg. Repeat this exercise ten times a day.
6. Quad Set: Try to lie flat on a table or a bed and keep a towel rolled under the back of the knees. Slowly tighten the top thigh muscle while pressing the back of the knee towards the table. Hold this position for ten seconds, and repeat this exercise ten times a day.
7. Clamshell: Lie sideways on a comfortable surface like a bed or floor with one hand rolled and folded as head support and the other hand free. Try to bend both knees that are placed one above the other. Slowly lift the knee that is above while holding both feet attached. While doing this, do not roll the pelvis. Then relax back to the normal position. Repeat this exercise on the other leg, and perform it ten times, three sets in a day.
8. Bridging: Lie flat on a comfortable surface like a bed, floor, or on a yoga mat and bend the knees. Keep the hands fixed near the body with the palm facing the ceiling. Now slowly tighten the abdominal muscles while trying to lift the hip up, keeping the head, hand, and shoulders fixed on the floor. Hold this bridge position for a second and then relax back to the original starting position. Repeat these exercises ten times, three sets in a day.

Conclusion

If knee osteoarthritis is left untreated for a long time, it can lead to lifelong disabilities. So intervening at the earliest through physiotherapy can help restore the form and function of the affected knee. Stretching and strengthening exercises are done to improve the range of motion of the affected joints while also providing relief from pain, swelling, and joint stiffness. Many patients have benefitted from doing these exercises, and at the end of the exercise program, the restricted functionalities of the affected muscles and joints are restored.