Knee osteoarthritis is among the leading causes of disability among older people worldwide [1]. The condition is characterised by progressively worsening knee joint stiffness and pain, which may or may not correlate with increased signs of joint degeneration on imaging.

There is an ongoing shift from invasive medical treatments for knee osteoarthritis and towards conservative care that involves structured exercise. This has partially been facilitated by:

• High-quality evidence that knee arthroscopy for knee osteoarthritis is no better than a placebo (diagnostic arthroscopy) [2]
  
• A lack of evidence supporting the usefulness of common injection therapies, such as protein rich plasma (PRP) injections [3].

How Physiotherapy Can Help

International guidelines for the management of knee osteoarthritis prioritise treatments that can be effectively delivered by a physiotherapist [4].

These include:

• Education about the nature and course of knee osteoarthritis
• Reassurance;
• Manual therapy
• Taping and bracing
• Supervised exercise programs;
• Prescription of aerobic and strengthening exercises;
• Advice to stay active;
• Advice on self-management strategies;

Physiotherapists are in a unique position to deliver guideline-based care to patients with knee osteoarthritis. They have expertise in exercise prescription and more time to spend with patients than many other healthcare professionals. Further, physiotherapists can work with patients on developing self-management strategies to reduce the impact pain flare-ups could have on their ability to work, engage in physical activity and socialise.

Pain management is vital for patients with knee osteoarthritis, particularly those that are starting with an exercise program. Physiotherapists should therefore work closely with doctors to ensure pain medication is being prescribed and taken appropriately. Dieticians also play an important role in managing patients with knee osteoarthritis. This is because guidelines consistently highlight the importance of advice on weight loss and weight loss interventions.

References

[1]Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., et al. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. doi:10.1016/s0140-6736(15)60692-4

[2]Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, et al. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med. 2002;347(2):81-8.

[3]Fitzpatrick J, Bulsara M, Zheng MH. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. The American Journal of Sports Medicine. 2017;45(1):226-33.

[4]National Institute for Health and Care Excellence (NICE) Guidelines. Osteoarthritis: care and management. Februrary 2014. https://www.nice.org.uk/guidance/cg177.