A stiff, arthritic knee and the loss of extension that usually accompanies it can be debilitating. Despite a widespread belief that little can be done about stiffness other than surgery, appropriate physical therapy can relieve and even reverse stiffness.
“Lack of full extension creates increased pain and leads to weak quadriceps,” says Laura Bray-Prescott, PT/LATC, a physical therapist/athletic trainer at Shelbourne Knee Center. That’s why the research-based Knee Rehabilitation Program for osteoarthritis (OA) focuses on improving range of motion (ROM), primarily extension.
Less Pain and Stiffness in 4–6 Weeks
Most patients have less pain and stiffness after 4–6 weeks of physical therapy (1), and are able to return to their normal daily activities. The Knee Rehabilitation Program for OA is appropriate for patients of all ages.
“Our emphasis is on getting the knee as straight as possible. When the knee is bent all the time, the quadriceps cannot work efficiently,” says Bray-Prescott. Improving extension and flexion often strengthens the quadriceps significantly. Physical therapy for strengthening could include cycling and other exercises, such as the step-up exercise.
Research-Based OA Physical Therapy
The Knee Rehabilitation Program for OA is based on the practice’s long-term data on ACL reconstruction patients, which shows the importance of full ROM in good long-term outcomes (2). Bray-Prescott and the other physical therapists worked with K. Donald Shelbourne, MD, and Rodney Benner, MD, to modify the program for OA patients.
“Our goal is to keep people out of the operating room. We want to make sure they have the best motion and strength in the knee as possible,” says Bray-Prescott.
Results for 396 patients who participated in the OA Rehab Study show that:
- Most patients improved with non-operative treatment
- Only 24% went on to have a total knee arthroplasty (TKLA) (1).
Patients who improve their ROM through rehab but still have significant pain usually have TKA. The pre-op improvements made through rehab facilitate a better surgical outcome and a faster, easier recovery.
Empowering Patients
During the first visit, Bray-Prescott or another physical therapist teaches the patient how to do the exercises and observes the patient as he/she does them. “We make sure patients have a good understanding of what they’re doing and why they’re doing it, and that they’re doing it correctly,” she says. At every visit, the physical therapist spends 45 minutes with the patient.
After the first visit, patients do their exercises at home, 3–5 times a day. “We teach patients how to treat and manage their knees. We don’t bring them in to our center for us to do therapy to them,” says Bray-Prescott.
For patients with a long-term stiff knee, a cortisone injection or pain medicines are often used to manage pain and facilitate physical therapy. Devices such as the IdealStretch or Elite Seat are also used.
Other visits help ensure that patients continue to do the exercises correctly. The frequency of visits depends on the patient’s progress and location. Patients who are doing well and don’t live in Indianapolis might come in every 2–4 weeks. Patients who live closer and aren’t making as much progress might come in once a week.
Managing Arthritis After Rehab
Patients who follow the rehab protocol correctly usually see improvements in the first month. Those with a long-term stiff knee may need about 2 months to feel better.
Shelbourne Knee Center discharges patients from the Knee Rehabilitation Program for OA after 2–4 months. But patients need to continue the daily exercises and strengthening at least 3 times a week.
“Arthritis in the knee is like high blood pressure. If you stop taking your blood pressure medicine, your blood pressure will go up. If you stop doing your exercises, your arthritis pain and stiffness will come back,” says Bray-Prescott.
Over time, patients may be able to do their exercises less often, however, they may need to go back to the full rehab protocol when they’re more active.
For more information about the Knee Rehabilitation Program for OA, call 888-FIX-KNEE.
References:
- Shelbourne DK. Nonoperative Treatment of Knee Osteoarthritis, presentation at the Herodicus Society Meeting, June 2018.
- Shelbourne DK. Thirty-five Years of ACL Reconstruction, presentation at Andrews University, February 2018.