KNEE OSTEOARTHRITIS: EXERCISES

WHAT IS IT?

Osteoarthritis, or wear of the knee joint, is a painful, non-inflammatory, irreversible degenerative disease of the knee joint caused by wear of the articular cartilage.

Osteoarthritis of the lower limb is a common condition that affects the elderly, approximately 20% of people over 60 years of age worldwide experience knee pain. It represents 80% - 90% of hip and knee replacements in the United States and the United Kingdom.

KNEE ANATOMY

The knee is formed by the union of 2 important bones, the femur in its distal portion, and the tibia in the proximal portion. It also has a small bone, called the patella, which articulates with the anterior and inferior portion of the femur. It can mainly perform flexion and extension movements. It is surrounded by an articular capsule and several ligaments that give it stability. In its vicinity, powerful muscles are inserted that make limb movement possible.

It is composed of the joint action of the femur, tibia, patella and two fibrocartilaginous discs that are the meniscus. Femur and tibia make up the main body of the joint, while the patella acts as a pulley and serves as an insertion to the quadriceps muscle tendon and the patelar tendon whose function is to transmit the force generated when the quadriceps is contracted.

PROTHESIS

A knee prosthesis is a mechanical element composed of various metal and plastic components that replace the knee joint consisting of tibia, femur and kneecap.

Should I wear a prosthesis? No, we must understand that osteoarthritis is a degeneration of the joint due to its use. Over the years, all people have osteoarthritis to a greater or lesser extent. Osteoarthritis is NOT an indication of putting on a prosthesis, the indication of putting on the prosthesis is given by pain and / or the functional limitation produced by this osteoarthritis.

CAUSES

The main causes of osteoarthritis of the knee are:

Trauma during sports and recreational activities, hard physical work overload, congenital joint deformity, metabolic disorders, overweight.

TREATMENT

The guideline for the treatment of osteoarthritis is exercise as a non-pharmacological therapy. Exercise improves the symptoms and general well-being of people with this pathology, while they are relatively safe as compared to pharmacological treatments. The improvement of pain and functional results after treatment with osteoarthritis exercises are demonstrated by numerous studies.

Great benefits, regarding pain and function, were observed in people with osteoarthritis of the knee who exercised. The effectiveness of the exercise was generally greater at 2 months after starting the exercise, according to the results of the studies.

For the treatment of osteoarthritis pain we also use radiofrequency, deep heat that helps relieve nerve endings and relax symptoms.

MAIN FACTORS

- The age of who suffers from this deficiency affects, trials with younger participants demonstrated a more appreciable functional improvement than older patients after exercise treatment. In the older population, other age-related conditions (eg, reduced functions in the cardiovascular and musculoskeletal systems) may also explain the observed effect.

- Osteoarthritis severity: in general, the results support the inverse association between benefits of exercise and the severity of osteoarthritis of the knee (that is, it is believed that the exercise produces a greater improvement with a milder knee osteoarthritis than more severe). Patients on the waiting list for surgery, who have knee osteoarthritis in the most advanced stage of the clinical spectrum, showed a smaller exercise response compared to those who were not on a waiting list.

EXERCISE PROGRAM

We will perform the exercises 3 sets of 10 repetitions each, 3 times / week.

Exercise 1:

Lying on your back with your leg straight and a towel under your knee, perform quadriceps contractions by crushing the towel with a hollow of your knee. Bring the toe towards us to feel more muscle contraction.

Exercise 2:

Lying on your back with your leg straight, raise it straight until you reach about 45 degrees from the ground, bringing the tip of the foot up and down again, relaxing the tip of the foot.

Exercise 3:

Lying on your side with your hips and knees bent, separate your knees from each other but not your feet Being able to increase the resistance by placing an elastic band between the knees. We want to focus on strengthening the buttocks.

Exercise 4:

Sitting on a high surface, make knee extensions bringing the tip of the foot towards us at the end of the movement and withstand that tension for 5 seconds.

Exercise 5:

Standing with one leg elevated and the support leg slightly bent, balance for 20-30 seconds and rest for a few seconds. If it seems easy you can increase the difficulty by making circles with the leg that is in the air, closing your eyes, using unstable surfaces ...

KINESIOTAPING and KNEE OSTEOARTHRITIS

 

Knee osteoarthritis (OA) is the most prevalent chronic joint disease. Cartilage is the central tissue affected by OA and causes subsequent symptoms, including joint pain, stiffness and joint swelling, which diminishes the range of motion (1,2).

Currently, no reliable treatment has been confirmed to prevent progression of knee OA. The aim this review was to evaluate the efficacy of Kinesio Taping (KT) in reducing pain and increasing knee function in patients with OA.
 

Knee osteoarthritis

(Information extracted from: Lu, Zhijun, et al. "Kinesio taping improves pain and function in patients with knee osteoarthritis: A meta-analysis of randomized controlled trials." International Journal of Surgery (2018))

 

Kinesio Taping Application

Five studies were included in this review. They compared an intervention group who received KT to a placebo group received sham Taping.

1. Cho et al. (3) an I-shaped KT starting at the origin of the rectus femoris and a Y-shaped KT proximal to the superior patellar boarder. While KT was applied, the quadriceps muscle was being stretched.
 

Cho et al.

 2. Wageck et al. (4) three KT elements applied simultaneously. 

A) Drainage element of the experimental application. B) Muscle strength element of the experimental application. C) Pain-relief element of the experimental application. D) Combined experimental application.
 

Wageck et al.

 3. Mutlu et al. (5) KT on their quadriceps femoris and hamstring muscle. First, patients were taped with a Y-shaped Kinesio type at the quadriceps femoris. The tape was applied a point 5 cm inferior to the anterior superior iliac spine to the knee cap (origin to insertion), with the patient in a supine position with 25% tension. Then, each patient flexed his or her knee, and the Y-shaped tape (the tails of the tape) was circled around the patella, ending at its inferior side with no tension.
 

Next, patients were taped with a Y-shaped Kinesio type at the hamstring muscle. The tape was applied from ischial tuberosity to the back of the knee, with the patients in a standing position with their trunk bent. Then, the Y-shaped tape (the tails of the tape) was applied around the lateral side of the knee and medial side of the knee.
 

Mutlu et al.

 4. Aydogdu et al. (6) KT on quadriceps and hamstring muscles was performed with Y-shaped technique. The subjects lay in the supine position with the hip flexed at 30◦ and the knee flexed at 60◦. In the supine position, taping was first applied to the quadriceps femoris. The tape was applied from a point 10 cm inferior to the anterior superior iliac spine, bisected at the junction between quadriceps femoris tendon and the patella, and circled around the patella, ending at its inferior side. The first 5 cm of the tape were not stretched. The portion between the first part of tape and superior patella was stretched to 50–70%. The remaining tape around the patella remained un-stretched. After that, in the prone position, hamstring was taped secondly with the same method.
  

Aydogdu et al.

5. Rahlf et al. (7) KT on their quadriceps femoris and hamstring muscle. A medial and a lateral “I” strap as well as 1 “I” strap over the patella were applied. “I” strap means the tape is not cut into different parts; The strap across the patella was applied in individual maximum knee flexion. The base of the tape was applied at the tibial tuberosity and pulled in maximum tension over the patella, ending at the lower third of the quadriceps femoris muscle. The medial and lateral straps were applied in 45° knee flexion along the collateral medial and lateral ligaments.
  

Rahlf et al.

Outcomes after place KT

Visual analog scale (VAS)

VAS scale was adopted to measure pain and it was considered a subjective method.

Taping was associated with a significantly reduction in VAS scale at rest, as well as at movement in patients with knee OA. This pain reduction can be attributed to neurological suppression, due to stimulation of cutaneous mechanoreceptors.

Anandkumar et al. (8) showed that there was a decreased pain in Kinesio Taping groups while climbing stairs. The present meta-analysis indicated that Kinesio Taping was associated with a significantly reduction in VAS scale at rest.

Range of motion and McMaster Universities Arthritis Index (WOMAC) scale
Articular cartilage can be damaged by normal wear and abnormal mechanical loading which may cause abnormal cellular activities in cartilage and synovium, resulting in stiffness, loss of range of motion (9).

Our review demonstrated that Kinesio Taping was associated with an improved WOMAC compared with sham Taping. So Kinesio Taping could significantly improve knee flexion range of motion.
 

Muscle strength

Quadriceps femoris muscle weakness is a common symptom in knee OA and this may affect joint function and accelerate progress of degeneration (10,11). There was no significant difference in quadriceps femoris muscle in patients with knee OA.
 

Conclusions

Kinesio Taping is effective in improving for pain and joint function in patients with knee OA.
 

Bibliography

 1. M. Hurley, K. Dickson, R. Hallett, R. Grant, H. Hauari, N. Walsh, C. Stansfield, S. Oliver, Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review, Cochrane Database Syst. Rev. 4 (2018) CD010842. 

2. S. Demehri, D. Shakoor, Structural Changes in Aging-knee versus Early-knee Osteoarthritis: Review of Current Evidence and Future Challenges, Osteoarthritis and cartilage, 2018. 

3. H.Y. Cho, E.H. Kim, J. Kim, Y.W. Yoon, Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial, Am. J. Phys. Med. Rehabil. 94 (3) (2015) 192–200. 

4. B. Wageck, G.S. Nunes, N.B. Bohlen, G.M. Santos, M. de Noronha, Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial, J. Physiother. 62 (3) (2016) 153–158. 

5. E. Kaya Mutlu, R. Mustafaoglu, T. Birinci, A. Razak Ozdincler, Does kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis?: a randomized controlled clinical trial, Am. J. Phys. Med. Rehabil. 96 (1) (2017) 25–33. 

6. O. Aydogdu, Z. Sari, S.U. Yurdalan, M.G. Polat, Clinical outcomes of kinesio taping applied in patients with knee osteoarthritis: a randomized controlled trial, J. Back Musculoskelet. Rehabil. 30 (5) (2017) 1045–1051. 

7. A.L. Rahlf, K.M. Braumann, A. Zech, Kinesio taping improves perceptions of pain and function of patients with knee osteoarthritis. A randomized, controlled trial, J. Sport Rehabil. (2018) 1–21. 

8. S. Anandkumar, S. Sudarshan, P. Nagpal, Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study, Physiother. Pract. 30 (6) (2014) 375–383. 

9. D. Chen, J. Shen, W. Zhao, T. Wang, L. Han, J.L. Hamilton, H.J. Im, Osteoarthritis: toward a comprehensive understanding of pathological mechanism, Bone Res. 5 (1) (2017) 1–13. 

10. C. Slemenda, D.K. Heilman, K.D. Brandt, B.P. Katz, S.A. Mazzuca, E.M. Braunstein, D. Byrd, Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum. 41 (11) (1998) 1951–1959. 

11. M.B. Conroy, C.K. Kwoh, E. Krishnan, M.C. Nevitt, R. Boudreau, L.D. Carbone, H. Chen, T.B. Harris, A.B. Newman, B.H. Goodpaster, Muscle strength, mass, and quality in older men and women with knee osteoarthritis, Arthritis Care Res. 64 (1) (2012) 15–21.