Study Shows PT Bests Steroid Injections for Knee Osteoarthritis

To wrap up our study of the knee this April, we wanted to share more real-life situations where Physical Therapy should be first choice in treating pain and injuries instead of more invasive treatment. We previously covered some basic Knee Anatomy and ACL Rehabilitation after ACL Reconstruction Surgery. Now we’ll look at Osteoarthritis in the Knee and compare different treatments.

Osteoarthritis is the most common type of arthritis found in the knee. It usually occurs in people age 50 and older, but can occur in younger people as well. Osteoarthritis is a degenerative “wear and tear” type of arthritis,  where the cartilage in the knee joint gradually wears away. Ouch!

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease.

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Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.

 

 

In addition to physcial therapy, or in place of therapy all together, some knee osteoarthritis patients resort to glucocorticoid injections in hopes of decreasing pain and increasing movement.   

According to a new study published in The New England Journal of Medicine (see image above) there is a significant diffence between people getting physical therapy versus knee injections as treatment for knee osteoarthritus. 

Researchers analyzed data from 156 patients (average age, 56, 48% female) diagnosed with knee osteoarthritis between 2012 and 2017. The patients were divided into two groups: one that received physical therapist services, and the other that received glucocorticoid injections(a mixture of triamcinolone acetonide and lidocaine) into their knee joint.  Those who received physical therapy services, averaged 11.2 visits.  The patients in the injection group received up to 3 injections per year. 

 

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There were 4 significant findings in favor of Physical Therapy over injections:


 1 )  The physical therapy group reported a bigger improvement in the  test scores that were used to measure the progress. Lower scores meant less pain and better function and those who participated in physical trherapy saw a 70 point drop, whereas those who got the injections saw 55.8 point drop after 1 year.

2)Perceived improvement was also greater in the physical therapy.  group reporting they were feeling “quite a bit better”, while the other group perceved their improvements as “moderately better”.

 3)Physical therapy participants had better step and up-and-go test  results than the injection group.

4) The rate of improvement, even after one year seemed to keep increasing for the physical therapy group. 

 

Overall, those patients who participated in physical therapy instead of receiving an injection to contol their knee osteoarthritis, apeared to have better, longer lasting results and functional improvements.

What are some home exercises for Osteoarthritis in the Knee? The Hospital for Special Surgery suggests several low impact stretches. Below Lisa Konstantellis, MSPT , from the Joint Mobility Center, Hospital for Special Surgery, gives a few excercise examples.

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Quadriceps Setting

This exercise helps to strengthen the quadriceps muscle and to improve stabilization of the knee.

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Lie on your back with the leg you want to exercise straight.  Place a small rolled towel underneath the knee. Slowly tighten the muscle on top of the thigh (quadriceps) and push the back of the knee down into the rolled towel.  Hold contraction for 5 seconds and then slowly release, resting 5 seconds between each contraction. Perform 3 sets of 10 repetitions, 1 time daily.

 

Straight Leg Raise

This exercise is for strengthening the quadriceps muscle.

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First, lie on your back with the leg you want to exercise straight. Bend your opposite knee to support your lower back. Tighten the muscle on the top of thee thigh of your straightened leg and lift to the level of your bent knee. Slowly lower. Perform 3 sets of 10 repetitions, 1 time daily.

 

Hamstring Stretch

When you have knee Osteoarthritis, the hamstring muscles (the muscles that run along the back of your thigh to your knee) tend to get tight. This exercise helps to stretch the hamstring muscles, improve range of movement, and flexibility!

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Lie on your back with the leg to be stretched straight with a strap around the bottom of your foot. Using the strap for support, elevate your leg until you feel a gentle stretch at the back of you knee and thigh. Hold up to 30 seconds. Slowly lower. Perform 3 repetitions, 1 time daily.

 

Calf Stretch

This exercise will help your lower leg and ankle stay flexible, helping to improve your balance and the way you walk.

Thumbnail photo of calf stretch exercise

Stand facing a wall with the leg to be stretched behind you and the other leg in front. Place your hands or forearms on the wall for support. Slowly bend the front knee, keeping the heel of the leg behind you down on the floor. Once you feel a stretch in you calf muscle at the back of your ankle, hold for 30 seconds. Slowly relax. Perform 3 repetitions, 1 time daily.

 

Do you have pain in your knee or in other parts of your body? Call BeneFIT Physical Therapy to set up a free medical exam with one our highly trained Doctors of Physical Therapy. To make an appointment at our Chester,NJ office call: (908) 879-5700. To make an appointment at our Bridgewater, NJ location, call: (908) 203-5200. We also offer Telehealth visits.   Call us to find out how our services can BeneFIT you today! 📞😃🏃‍♀️😎🏆

Resources
G. Deyle et al., “Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee”, April 9, 2020, N Engl J Med 2020; 382:1420-1429.
https://www.nejm.org/doi/full/10.1056/NEJMoa1905877?query=featured_home
http://www.apta.org/PTinMotion/NewsNow/?category=New%20in%20Research&blogid=10737418615

https://www.hss.edu/conditions_exercises-for-knee-osteoarthritis.asp

https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-knee