No specific cure for OA exists and the severity of condition varies from individual to individual. Hence, a more generic approach to current treatment methods revolves around some combination of non-pharmacological and pharmacological treatment modalities. Mostly, all exercise programs for knee OA should be practical, albeit simple, but should be helpful in gradual and progressive cure of the condition. Each program should be individually designed for proper accommodations based on the severity, age, gender, weight, lifestyle, and the individual’s functional capabilities. These program settings should typically not involve any high-impact axial loading and should allow for proper rest intervals as set forth by the individual’s needs toward the frequency, intensity, and duration of the treatment. The goal of the program should be to decrease pain, increase the range of motion, increase the overall functional strength, educate about posture and gait, as well as to improve physical fitness levels and mobility.Pro Physiotherapy is the Top Physiotherapist in Bangalore.
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Weight reduction is one of the first and unproblematic measures that can be taken to reduce knee OA. Studies of OA have constantly shown that overweight people have higher rates of knee OA than non-overweight control subjects. This is due to the fact that force across the knees is 3–6 times the body weight; therefore, people who have more mass cause extreme forces on their knees, leading to the early onset or steady progression of knee OA condition.2] Individuals who are overweight may have circulation problems, possibly including a cartilage growth problem or a bone problem, which has the ability to cause cartilage breakdown or affect the bone underneath the cartilage, thereby leading to OA. Finally, overweight people have higher bone mineral densities, and high bone mineral density (or the absence of osteoporosis) may itself be a risk factor for OA. Weight loss is therefore a logical step to relieve pain in these joints and to slow the progression of degenerative arthritis. According to a study conducted by Mao-Hsiung Huang and group, pain reduction and improvement of walking speed in various degrees of severity of arthritis was observed in the OA population undergoing prescribed weight loss procedures.Suggestions from the Top Physiotherapist in Bangalore — Stress affects the condition of arthritis.
Apart from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there has been no specific treatment to prevent cartilage degeneration or to repair damaged cartilage in OA. Therefore, for the past several years, research has focused on determining the causes of knee OA and to discover how to stop the progression of the disease, aside from lowering the effects such as pain and discomfort by therapy. Some studies have even hoped to help reform the lost cartilage to return the knee back to health. A potential technique that can augment cartilage growth (stem cell tissue engineering approaches) is the use of electromagnetic field therapy (EFT). Modulation of cell signaling events by weak electromagnetic fields is associated with binding of hormones, antibodies, and neurotransmitters to their specific binding sites. Pulsed electromagnetic fields (PEMF) treatment preserves the morphology of articular cartilage and retards the development of OA lesions. However, while supply limitations of stem cells can be overcome, the lack of tissue quality, specifically in the preparation of the differentiated stem cells toward the articular cartilage phenotype is still a major challenge for the researchers.
However, the most widely used remedy for knee OA is rehabilitation and physical therapy (PT). PT has proved to be useful in helping patients with pain and mobility. Fitness walking, aerobic exercise, and strength training have all been reported to result in functional improvement in patients with OA of the knee. Having a clinical PT program has the benefits of onsite direction and availability of sophisticated equipment. By and large, various studies have shown that having these added benefits contributes to program adherence and overall higher outcomes while in the care of the PT. These programs may be divided into PT at rehabilitation center under the supervision and monitoring of doctors and trained specialists and the other one carried out through personal care as prescribed by medical practitioner at home.
Rehabilitation-centered approach
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The specific programs that are typically run are a combination of programs such as strength training, aquatic, Tai Chi, aerobic, and hydrotherapy. Strength training, being the most common treatment approach for the management of patients with functional limitations, is prescribed to address the need to increase muscular strength and joint stability for improving in WOMAC pain scores and overall health benefits. The common equipment used is based on fundamentally different movement progression and resistance patterns such as isotonic (unchanged tension but change in length), isometric (no change in length or angle), and isokinetic (constant resistance with variation in speeds). Though isometric activities show effective results in reducing pain levels, they are avoided when working with the elderly due to increases seen in heart rate and blood pressure, which could be contraindicative to other co-morbidities. Typically the programs last for 6–24 weeks with an average of 8 weeks, while working at an average frequency of three sessions per week for an average duration of 30 min each.
Aerobic exercise programs may make OA patients feel better, help reduce the joint pain, and make it easier for them to perform daily tasks. Exercise programs under medical supervision should be balanced with rest and joint care. Aerobic programs truly border both clinical (rehabilitation) and home programs. Regardless of the setting, this program type was found to be effective for reducing pain in hip and knee. Patients are typically recommended to exercise between 50% and 70% target heart rate for a minimum of 30 min, 3 times a week, for overall weight management, health benefits, and a reduction in pain which was noted after a 6-month program.
Yoga therapy for osteoarthritis rehabilitation
Although many people think yoga involves twisting the body into pretzel-like poses, it can be safe and effective for people with OA. Yoga’s gentle movements can aid to build body strength, flexibility, and balance, and reduce arthritis pain and stiffness. The slow, controlled physical movement of joints is helpful for the arthritis patients. It improves the blood circulation in joints, removing unwanted toxins and other waste products. However, the problem is if the patient tries to move his limbs and joints then pain increases, which may lead to task avoidance, thereby further increasing the problem. So, it is a vicious cycle, i.e., because of pain no movements and because there is no movement, the situation becomes even worse. So, the patient should keep doing the movements which are possible for him/her. A pilot study conducted by the University of Pennsylvania, School of Medicine, examined one type of yoga, Iyengar yoga, suitable for people with OA of the knee. After an 8-week course of weekly 90-min beginner classes, there was a statistically significant reduction in pain, physical function, and mood, indicating the positive effects of yoga therapy for OA rehabilitation.
Tai Chi is a Chinese martial art that is primarily practiced for its health benefits, including a means for dealing with tension and stress. It emphasizes complete relaxation, and is essentially a form of meditation, or what has been called “meditation in motion.” Unlike the hard martial arts, Tai Chi is characterized by soft, slow, flowing movements that emphasize force, rather than brute strength. Though it is soft, slow, and flowing, the movements are to be executed precisely. Tai Chi as a form of therapy was typically conducted within the clinical setting and followed a host of different focus styles (Sun, Wu, Yang, Baduanjin, and Qigong), all of which were used as an intervention protocol for hip and knee OA. Each Tai chi session on average ran a length of 8–24 weeks with a frequency of one to five sessions per week at a length of 20–60 min. The use of Tai Chi showed significant improvements in reducing pain levels, and ultimately good program adherence. Out of all the styles selected, the Yang style (comprising 13 basic body movements) proved to have the best results.
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