Exercise therapy in the management of hip and knee Osteoarthritis
The National Council for Osteopathic Research have provided a snapshot summary (2017) of key Osteopathic and Osteopathically relevant literature on the subject of Exercise therapy in the management of hip and knee Osteoarthritis (OA). OA is a very common condition affecting over 8.5 million people over the age of 45 in the UK. It is effectively ‘wear and tear’ where the cartilage within the joints of the body starts to wear away and various other changes take place within the joint. The muscles around the joint start to tighten and stiffen resulting in symptoms including gradually developing pain aggravated or triggered by activity, stiffness lasting under 30 min on awakening and after inactivity and occasional joint swelling. Management of OA is divided into three areas: pharmacological; non-pharmacological; and surgical. Appropriate exercise or physical activity is recommended in all patient groups, irrespective of demographics, severity of the condition, and pain levels experienced.
Although it may seem sometimes counter-intuitive, there is strong evidence that exercise reduces OA pain and improves physical function. The 2014 NICE guidelines for the care and management of osteoarthritis in adults suggest that exercise is appropriate for all sufferers of osteoarthritis, irrespective of age, comorbidity, and pain levels. They also recommend a mix of aerobic and strength exercises, and that the patient be encouraged to carry out the exercise themselves.
The main findings of the report were as follows:
• There is strong evidence suggesting that exercise in general can help patients manage the pain of hip and knee osteoarthritis (OA).
• The benefits of exercise on pain levels continue after the intervention period, with some patients reporting a reduction in pain for between 3 - 18 months after cessation.
• Appropriate exercise can be prescribed irrespective of age, pain level, comorbidity and disability. Catering to the patient’s specific needs and circumstances may improve adherence, which is important for improvements in outcomes.
• Exercises in group or individual settings are equally effective, so patient preference should drive this decision.
• There is no evidence to suggest that one type of exercise (aerobic, strength, or range of motion) is superior to another. Management plans often combine these approaches in an attempt to improve effectiveness.
• There is some evidence that specifically strengthening the muscles of the leg through resistance exercises will reduce pain in sufferers of knee OA.
• Effectiveness of specific exercises, dosage, frequencies and intensities are unclear due to a lack of both quality and quantity of data.