Osteoarthritis (OA) is a common cause of progressive degeneration in a joint. It is common in adults particularly over 65 years of age. As it progresses, OA can cause pain and disability. When a major joint like the knee is involved it can lead to difficulty with basic activities like walking. This can lead to lower quality of life. Severe impairments may require a knee replacement to fix, but there are several steps to decrease pain and disability before this point. The most common steps include medications and a physical therapy program.
Researchers at the University of Minnesota wanted to better understand which types of physical therapies may best help people with OA. The systematic review, published in Annals of Internal Medicine, found that strength, aerobic and pool exercises were effective at reducing pain and disability due to osteoarthritis.
The systematic review included 193 randomized trials that compared different physical therapy techniques to usual care or no active treatment. The trials included adults 50 years or older with knee osteoarthritis. Exercises that showed benefit included:
- Strength exercises—associated with reduced pain and improved function in 17 trials
- Water exercises—associated with decreased disability in 3 trials
- Aerobic exercises—associated with decreased disability in 11 trials and reduced pain and improved function in 19 trials
Tai chi was not associated with significant improvements in pain or function.
A systematic review is generally a reliable form of research, but it is only as reliable as the studies that are involved. In this case, the majority of the studies included were low quality studies. The lower quality of trials lowers the reliability of the outcomes. The review has shown that the individual treatments may have some benefits compared to no treatment or usual care but it does not indicate which treatment is best. Future research will help to determine which treatment may be best. Researchers also noted that as with any exercise program, the better the adherence to the program the better the results.
Aerobic and strength exercises have a long history of physical benefits. It is generally known that regular exercise is beneficial for muscles and joints but it can be difficult to do if your joints are already painful. Work with a physical therapist or talk to your doctor about adjustments you can make to your exercise program. Small changes can help you get started. Gradually build your program to continue to see improvements without placing extra stress on your knees. Water exercises can provide strength and aerobic benefits with reduced impact on knees.
Wang SY, Olson-Kellogg B, et al.
Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review.
Ann Intern Med. 2012 Nov 6;157(9):632-44.
Last reviewed February 2013 by Brian Randall, MD
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