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Knee Osteoarthritis

Spring has arrived and better weather calls for people to get out walking!

Unfortunately, knee osteoarthritis affects 1 out of 11 people over the age of 60, causing pain and increasing difficulty with daily activities.  Osteoarthritis of the knee affects the articular cartilage and the subchondral bone of the synovial joint leading to joint failure.  Initial management for osteoarthritis of the knee involves weight loss and exercise therapy.  Exercise therapy can seem to the patient as counter-intuitive, as walking alone produces pain.  However, in the latest review by the British Journal of Sports Medicine – Exercise for osteoarthritis of the knee: a cochrane systematic review, they showed quite the opposite effect.

The exercise advised involved a range of activities that directly aimed to improve muscle strength, neuromotor control, joint range of motion and aerobic fitness.  The enhanced strength is thought to lessen internal knee forces, thereby reducing pain and improving physical function.  The enhanced strength may also modify biomechanics, resulting in decreased joint loading and play a role in delaying progression of osteoarthritis.  Improved fitness may allow greater range of tasks that can be completed daily, improving function.

In the latest review by the British Journal of Sports Medicine – Exercise for osteoarthritis of the knee: a Cochrane systematic review, they looked to determine if land-based, therapeutic exercise was beneficial for people with knee osteoarthritis.  Overall, the meta-analysis demonstrated an immediate treatment benefit for knee pain, physical function and quality of life.  The majority of studies showed a treatment benefit that was moderate and similar to that reported with analgesics/NSAIDS.  The pain relieving benefit was significant but did not last beyond 6 months following the cessation of exercise.  The small but significant treatment benefit for physical function remained 2-6 months following exercise and at times longer than 6 months in some studies.  The results also suggest that most people need some form of ongoing monitoring or supervision to optimize clinical benefits.

Bottom-Line: Exercise prescription involving strength and aerobic conditioning through a monitored/supervised program may offer pain reduction and improved physical function for individuals with knee osteoarthritis.

Written by: Jody Murray – Sport Medicine Fellow

Submitted by Advisor: Dr. Taryn Taylor, Carleton Sport Medicine Clinic

Article: Exercise for Osteoarthritis of the knee: A Cochrane Systematic review.  Fransen et al. Br J Sports Med 2015; 49:1554-1557.

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