Proactive Approaches to Treating Knee OA

 Osteoarthritis (OA) is the most common joint condition, and the knee is the most common joint afflicted with OA. Traditional medical approaches to treating knee OA include medication (Non-steroidal Anti-inflammatory Drugs), injections, and surgery. The focus on early treatment is pain control. Yet, OA is a condition that represents mechanical breakdown of joints. This in turn is usually due to inability of joint structural elements to offset loading forces on the joint over time. So why is there not as much focus on altering the loading on joints and protecting them from further breakdown?

There are many options to explore with regard to joint protection interventions for knee OA. Use of a cane on the side opposite the involved joint can help offset the loading on the knee during walking and stair climbing. Even altering the weight distribution over the stance limb during walking can help. Braces can be used to facilitate better joint alignment. Heel wedges placed inside shoes can shift the forces imparted on the joints from body weight more centrally in the joint. Modification of activity may also be necessary when the activity is contributing to abnormal joint loading.

While the joint is protected from further damage, active approaches can then be introduced with the goal of improving the integrity of joint structures. Most important are strengthening exercises to enhance the performance of muscles. Key muscles to target are the quadriceps, which act as shock absorbers during walking and running, the gluteal muscles, and the deeper rotator muscles of the hip (“rotator cuff muscles of the hip”). Core strengthening, muscle endurance exercise, as well as exercise to improve joint mobility, are also part of a comprehensive approach.

When muscles are conditioned to protect the joint more, the knee joint will be able to tolerate more stress and joint protective mechanisms can be scaled back.  

Pain control for OA is important, but without joint protection strategies and interventions to improve joint integrity during the early phases of OA, pain control alone is insufficient to address the underlying mechanisms of OA. Knee OA is a condition that can be managed conservatively when the right care is applied at the right time.

Marcia Miller Spoto, PT, DC, OCS