Are you or your client experiencing chronic knee pain interfering with daily living? The likely culprit is arthritis courtesy good ole wear and tear. This post explores non-invasive O&P rehabilitation strategies for unicompartmental osteoarthritis.
Medial Compartment Osteoarthritis 1,2,3,4
Medial compartment osteoarthritis is a common cause of knee pain particularly in those with a varus deformity of the knee. This change in anatomical alignment places the knee in a more bow-legged position thereby increasing pressure at the inner aspect of the knee. The decreased joint space and increased loading pressure leads to arthritic changes, i.e., degeneration of cartilage and medial meniscus. Repetitive cycles of malaligned movement leads to further breakdown of the joint ultimately causing pain for the individual and negatively impacting daily function. Early stages of treatment are non-invasive which include physical therapy, orthotic interventions, pharmacological management, weight reduction and patient education.
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Orthotic Management 3,4,5,6
Orthotic interventions aim to decrease the loading of the degenerative medial compartment to help redistribute the forces and relieve pain. By applying a valgus moment at the knee, the load is shifted away from the affected medial joint space. A proven effective method of addressing this condition is a knee unloader orthosis. Unloading of the medial compartment of the knee is achieved via pads and straps attached to a stabile frame utilizing opposing counterforces. The pull mechanism of the orthosis helps to open up the joint space. While pressure redistribution, pain reduction and improved function have been well-documented, many individuals experience side effects such as skin irritation from the pads. Decreased tolerance leads to decreased adherence.
There are other orthotic options available. A less effective orthotic intervention is the use of a foot insole with a lateral wedge. This eliminates skin irritation as there is no contact at the knee, however it cannot reduce the adduction moment at the knee to the same extent as the knee orthosis. Increasing the trimlines proximally from the foot insole and providing greater counterforces to the varus knee has shown to improve patient signs and symptoms. There are ankle foot orthoses available which meet these requirements. Ask your orthotist about which options might meet your needs.
Physical Therapy Management 6,7,8,9
Individualized physical therapy assessment is needed to provide you with the best plan of care. In general, there a few exercises you can try to improve your symptoms and preserve your knee joint. Aerobic activity is an ideal place to start. Low impact exercises like swimming, yoga and Tai Chi improve your body metabolism and strength while minimizing stress at your knee joint. These activities are also helpful in loosening tight structures and increasing stability to improve overall anatomical alignment. Stretching hamstring muscles and strengthening quadriceps & hip abductor muscles are key targeted areas to address. Speak with your PT about the best course of action for you.
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References
- Stoddart, J.C., Dandridge, O., Garner, A., Cobb, J., & van Arkel, R.J. (2021). The compartmental distribution of knee osteoarthritis-a systematic review and meta-analysis. Osteoarthritis and Cartilage, 29(4), 445-455. https://doi.org/10.1016/j.joca.2020.10.011
- X-ray of knee arthritis. Mayo Clinic Foundation for Medical Research and Education. Accessed September 6, 2023. https://www.mayoclinic.org/tests-procedures/knee-braces/multimedia/knee-arthritis/img-20006349
- Petersen W, Ellermann, A, Henning J, et al. Non-operative treatment of unicompartmental osteoarthritis of the knee: a prospective randomized trial with two different braces-ankle-foot orthosis versus knee unloader brace. Archives of orthopaedic and trauma surgery. 2019; 139:155-166.
- Ruscinski, K., Williams, J., Crecelius, C.R., Redington, L., Guess, T.M., & Cook, J.L. (2022). Are all unloader braces created equal? Recommendations for evidence-based implementation of unloader braces for patients with unicompartmental knee OA. The Journal of Knee Surgery, 35(3), 249. https://doi.org/10.1055/s-0041-1740931
- Petersen W, Ellermann A, Zantop T, Rembitzki IV, Semsch H, Liebau C (2016) Best biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 420150261136). Archives of orthopaedic and trauma surgery 136(5):649-656.
- Nelligan, R.K. (2023). Appraisal of Clinical Practice Guideline: National Institute for Health and Care Excellence (NICE) Clinical Practice Guideline for Osteoarthritis in over 16s: diagnosis and management. Journal of Physiotherapy, 69(3), 196. https://doi.org/10.1016/j.phys.2023.04.002
- McMurray, M., Bruneau, M., Feldman, K., & Jones, C. (2017). Knee Osteoarthritis. American Physical Therapy Association. apta.org/patient-care/evidence-based-practice-resources/clinical-summaries/knee-osteoarthritis
- Wang, W., Niu, Y., & Jia, Q. (2022). Physical therapy as a promising treatment for osteoarthritis: A narrative review. Frontiers in physiology, 13, 1011407. https://doi.org/10.3389/fphys.2022.1011407
- Yuenyongviwat V, Duangmanee S, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T. Effect of hip abductor strengthening exercises in knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord. 2020;21(1):284. Published 2020 May 7. doi:10.1186/s12891-020-03316-z