OSTEOARTHRITIS OF THE HIP AND KNEE – PART 2
Updated: 7 days ago
MANUAL THERAPY OPTIONS FOR OA
Effective manual therapy techniques, such as Motion Specific Release (MSR), can play a significant role in reducing pain and increasing function in patients suffering from hip and knee osteoarthritis. The goal of manual therapy is to increase joint motion that has been lost, reduce the stress on articular cartilage, and enhance joint kinematics (kinematics is the study of the relative motion between two consecutive segments of the human body).
Although more quality research (peer review) needs to be conducted, one study did show that manual therapy combined with exercise reduced the need for surgery by 75%. (21) Other studies have shown that the combination of treating hip or knee OA with manual therapy and exercise is far more effective than using just exercises. (22)
An important point to note is that even though OA directly affects the joints, manual therapy must also be directed towards the surrounding soft-tissue structures. This is in order to address both joint stability and shock absorption.
The following videos demonstrate common procedures that we use to address osteoarthritis for the hip and knees or our patients.
Mobilizing the Hip Joint - Motion Specific Release™ (MSR)
Hip mobility is a key aspect of your body’s kinetic chain. Since no joint operates in isolation, a lack of hip mobility will affect the function of your knees, ankles, low back, and even the structures of your upper extremity. The hip joint is a ball-and-socket synovial joint that is designed to allow for multiaxial motion while transferring load between the upper and lower extremities. The fibrocartilaginous rim of the acetabulum adds depth and stability to the acetabulofemoral joint.
4 Point Knee Joint Mobilization - MSR™
The objective of joint mobilization is to reverse adverse physiological changes by promoting movement between capsular fibers. Joint mobilization can gradually cause rearrangement of collagen tissue to increase mobility. Improving joint mobility is critical to effectively address the needs of the body's full kinetic chain. In fact, if we don’t address restrictions in joint mobility we greatly reduce the effectiveness of any myofascial treatment.
Effective therapy is not just about mobilizing the joint itself, but also the surrounding soft-tissue structures. Muscles, tendons, ligaments, and the surrounding connective tissues are involved in stabilization, shock absorption, and critical control mechanisms. Without addressing these soft-tissue structures, the effectiveness of any therapy would be greatly diminished.
The Gluteus Maximus Release - Motion Specific Release™ (MSR)
In this video I demonstrate how to use Motion Specific Release (MSR) to release restrictions in the Gluteus Maximus muscle. Strong, flexible, engaged gluteal muscles are critical to optimum function of both the hips and knees.
The Quadriceps Release - Motion Specific Release™
The quadriceps are often tight, restricted, and overactive. This is because most people tend to over‐use their quadriceps and adductors to perform lower extremity motions, when they should actually be using their gluteals and hamstrings. This results in the development of muscle imbalances (strong quadriceps and weak hamstrings). When these two structures are out of balance, you set yourself up for knee injuries, hamstring strains, gait imbalances (directly related to hip function), along with a host of other lower extremity injuries.
The Hamstring Release - Motion Specific Release™ (MSR)
The hamstring muscles are primarily involved in hip extension and knee flexion, while the quadriceps muscles are primarily involved in hip flexion and knee extension. Your hamstrings function as shock absorbers, force generators and stabilizers. Hamstring injuries are a common problem that affects both the hips and knees.
4 Point Dorsi Flexion Protocol - Motion Specific Release™
Dorsiflexion is the movement at the ankle joint where the toes are brought closer to the shin. The muscles of the shins help your foot to clear the ground during the Swing Phase (concentric contraction) of your stride, and absorb much of the impact shock during running and walking.
Lack of dorsi flexion is often associated with knee injuries (ACL injuries and osteoarthritis) and in increased foot pronation (hyper-pronation) which in turn is often a factor in cases of Plantar Fasciitis (and other foot problems). Abnormal foot motion affects both the hips and knees.
EXERCISE IS NOT OPTIONAL
Research has demonstrated that one of the first lines of treatment for OA should be exercise as it can decrease pain and improve function in patients with hip or knee OA. (3, 17, 20)
Besides focusing on mobility and strength, improving aerobic capacity is also critical for addressing both hip and knee OA. (19) The following exercises demonstrate some of the possible exercises we could prescribe depending on the case.
8 Great Mobility Exercises for Hip Osteoarthritis
In this video we go over some great mobility exercises for osteoarthritis of the hips. These mobility exercises should be performed at least once per day. For the best results slowly work up to 3 to 4 times per day.
6 Great Mobility Exercises for Knee Osteoarthritis
n this video we go over some great mobility exercises for osteoarthritis of the knees. These mobility exercises should be performed at least once per day. For best results slowly work up to 3 to 4 times per day.
The Swiss Ball Squat
If you have trouble doing a standard body weight squat try the Swiss-Ball Version. These are great beginner exercises for strengthening your gluteals, abdominal, hamstring, quadriceps and calve muscles.
5 - Clam Exercises with a Theraband
These clam-shell exercises really target the gluteal muscles. They are great hip activation exercises for any one with a hip, knee, or lower extremity problem. Just be sure to start with the beginner exercises.
Theraband - The Adductor Muscles
Using a Theraband is a great way to strengthen the adductor muscles. Your abductor muscles are responsible for moving your leg away from your body's midline, while the adductors are responsible for moving the leg back towards your body's midline.
Peterson Step Up - Great Knee Stability Exercise
This exercise works your vastus medialis oblique muscles (in the quadriceps), an essential muscle that you need for knee stability. Knee stability commonly affects hips stability, and hip stability affects knee stability.
Weight Loss: Weight loss can have a huge effect on reducing the progression of OA. The combination of dietary changes and exercise is much more effective than addressing just one aspect. (18)
Dealing with hip or knee osteoarthritis is pretty much inevitable for the majority of people; but surgery is NOT inevitable for resolving either condition. Neither is it necessary to suffer from the pain and dysfunction that often accompanies OA. Fortunately, a combination of manual therapy (such as MSR procedures) and exercise can make a significant difference on showing OA progression, reducing or eliminating pain, and improving overall function.
My advice is to address OA with manual therapy and exercise long before the need for surgery arises. One of the best ways to do this is with monthly maintenance appointments accompanied by a specific exercise program that is designed to meet your body’s specific needs.
In some cases, a hip or knee replacement may become your best option. From a personal prospective, I am no longer doing Ironman Triathlons, but I am hiking, sea kayaking, dancing and enjoying life. This would not have been possible without a full hip replacement in my case.
Bottom line, life is far too short to live a life of pain and dysfunction, so explore your options (you have many).
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.
Make an appointment with our incredible team at Kinetic Health in NW Calgary. Just scan the QR code with your phones camera and click the link, or call Kinetic Health at 403-241-3772 to make an appointment today!
Benchmarking the burden of 100 diseases: Results of a nationwide representative survey within general practices, Grimaldi-Bensouda L, Begaud B, Lert F, Rouillon F, Massol J, Guillemot D, et al, BMJ Open. 2011; 1(2):e000215.
Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study, van Dijk GM, Veenhof C, Spreeuwenberg P, Coene N, Burger BJ, van Schaardenburg D, et al, Arch Phys Med Rehabil. 2010; 91(1):58-66.
Osteoarthritis Research Society International. OARSI Primer on Osteoarthritis. In: Henrotin Y, Hunter D, Kawaguchi H (Eds). Osteoarthritis Research Society International; 2010. http:// primer.oarsi.org/content/oarsi-primer.
Transforming osteoarthritis care in an era of health care reform, Gruber WH, Hunter DJ. Clinics in Geriatric Medicine, 2010; 26(3):433-44.
Physiotherapy for osteoarthritis of the knee: predictors of outcome at one year. Chapple CM. Dunedin: School of Physiotherapy, University of Otago; 2011.
Physical Therapy: Treatment of Common Orthopedic Conditions (p. 250). Baheti, Neeraj D. Jaypee Brothers Medical Publishers. Kindle Edition.
Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data, Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Arthritis Rheum. 2009 Dec. 60 (12):3546-53.
Serum adipokines in osteoarthritis; comparison with controls and relationship with local parameters of synovial inflammation and cartilage damage, de Boer TN, van Spil WE, Huisman AM, Polak AA, Bijlsma JW, Lafeber FP, et al. Osteoarthritis Cartilage. 2012 Aug. 20(8):846-53.
Risk factors for osteoarthritis: understanding joint vulnerability. Felson DT. Clin Orthop Relat Res. 2004 Oct. S16-21.
The role of muscle weakness in the pathogenesis of osteoarthritis. Hurley MV. Rheum Dis Clin North Am. 1999 May. 25(2):283-98, vi.
Type 2 diabetes and osteoarthritis: a systematic review and meta-analysis. Williams MF, London DA, Husni EM, Navaneethan S, Kashyap SR. J Diabetes Complications. 2016 Jul. 30(5):944-50.
Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention.Anderson DD, Chubinskaya S, Guilak F, Martin JA, Oegema TR, Olson SA, et al. J Orthop Res. 2011 Jun. 29 (6):802-9.
Weight loss reduces the risk for symptomatic knee osteoarthritis in women. Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. The Framingham Study. Ann Intern Med. 1992 Apr 1. 116(7):535-9.
Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, et al. Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008; 16(4):415-22.
Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association, Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Arthritis Rheum. 1986; 29(8):1039-49.
The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip, Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. Arthritis Rheum. 1991; 34(5):505-14.
National Institute for Health and Clinical Excellence. Osteoarthritis: the care and management of osteoarthritis in adults. NICE clinical guideline. 2008; 59:1-22.
Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial, Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. JAMA. 2013; 310(12): 1263-73.
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007; 15(9):981-1000.
Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. Phys Ther. 2005; 85(9):907-71.
Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial, Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Intern Med. 2000; 132(3):173-81
Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness, Abbott JH, Robertson MC, Chapple C, Pinto D, Wright AA, Leon de la Barra S, et al. Osteoarthritis and Cartilage. 2013; 21(4):525-34.
Links between Osteoarthritis and Diabetes:Implications for Management from a Physical Activity Perspective, Sara R. Piva, PhD, PT, OCS, FAAOMPT, Allyn M. Susko, PT, DPT, Samannaaz S. Khoja, PT, MS, Deborah A. Josbeno, PhD, PT, NCS, CSCS, G. Kelley Fitzgerald, PhD, PT, FAPTA, and Frederico G. S. Toledo, MD, Clin Geriatr Med. 2015 Feb; 31(1): 67–87.
The Roles of Mechanical Stresses in the Pathogenesis of Osteoarthritis Implications for Treatment of Joint Injuries Joseph A. Buckwalter, Donald D. Anderson, Thomas D. Brown, Yuki Tochigi, and James A. Martin, Cartilage 2013 Oct; 4(4): 286–294.
The test of Lasegue: systematic review of the accuracy in diagnosing herniated discs, Deville WL van der Windt DA Dzaferagic A Bezemer PD Bouter LM Spine (Phila Pa 1976). 2000; 25(9):1140‐1147.
Stress fractures of the femoral shaft in women's college lacrosse: a report of seven cases and a review of the literature, Kang L Belcher D Hulstyn MJ Br. J. Sports Med. 2005; 39(12):902‐906.
Stress fractures of the femoral shaft in athletes‐‐more common than expected. A new clinical test, Johnson AW Weiss CB Jr. Wheeler DL Am. J. Sports Med. 1994; 22(2):248‐256.
Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests, Laslett M Aprill CN McDonald B Young SB Man Ther. 2005; 10(3):207‐218.
Diagnostic accuracy of clinical tests of the hip: a systematic review with meta‐analysis, Reiman MP Goode AP Hegedus EJ Cook CE Wright AA Br. J. Sports Med. 2013; 47(14):893‐902.
Comprehensive physical examination for instability of the knee, Lubowitz JH, et al. Am J Sports Med 2008; 36(3):577-594.
Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests, Malanga GA, et alArch Phys Med and Rehab 2003; 84(4):592-603.
Comprehensive physical examination for instability of the knee, Lubowitz JH, et al. Am J Sports Med 2008; 36(3):577-594.
Anatomy and physical examination of the knee menisci: A narrative review of the orthopedic literature, Chivers MD and Howitt SD. J Can Chiro Assoc 2009; 53(4):319-333.
Validity of the McMurray’s Test and modified versions of the test: A systematic literature review, Hing W, et al. J Manual & Manip Therapy 2009; 17(1):22-34.