top of page
  • Dr. Brian Abelson

OSTEOARTHRITIS OF THE HIP AND KNEE – PART 2

Updated: Mar 12


MANUAL THERAPY


Effective manual therapy techniques can significantly reduce pain and increase 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 treating hip or knee OA with manual therapy and exercise is far more effective than just exercises. (22)


An important point to note is that even though OA directly affects the joints, manual therapy must also be directed toward the surrounding soft-tissue structures. This is to address both joint stability and shock absorption capacity.

 


OSSEOUS MOBILIZATION


The following films demonstrate the typical procedures we employ, including the Motion Specific Release (MSR) techniques created by Dr. Brian Abelson, to treat osteoarthritis of the hip and knee. These movies are very helpful to our patients.


Mobilizing the Hip Joint - Motion Specific Release™ (MSR)


The anatomy and biomechanics of the hip joint are crucial for the proper function of your body's kinetic chain. As no joint operates in isolation, a lack of hip mobility can have significant impacts on the function of other joints, including the knees, ankles, low back, and even structures of the upper extremity.


The hip joint is a ball-and-socket synovial joint designed to allow for multiaxial motion while transferring load between the upper and lower extremities. The fibrocartilaginous rim of the acetabulum provides depth and stability to the acetabulofemoral joint, enhancing its ability to bear the load and resist forces.


Given the hip joint's crucial role in the kinetic chain, maintaining proper hip mobility is critical. Any loss of mobility can negatively affect the function of other joints and structures. Thus, it is essential to prioritize hip mobility in any treatment plan, particularly for patients with hip and knee osteoarthritis.


4 Point Knee Joint Mobilization - MSR™


Joint mobilization is an essential technique for patients with osteoarthritis, as it can enhance joint mobility, reduce pain, and improve function. It promotes movement between capsular fibers, which can reverse adverse physiological changes and gradually cause the rearrangement of collagen tissue. Proper joint mobility is critical to maintaining the function of the body's kinetic chain, as any loss of mobility can negatively impact the function of other joints and structures. Thus, joint mobilization should be prioritized in any treatment plan for patients with osteoarthritis, particularly in the hip and knees.


 

SOFT-TISSUE THERAPY


Effective therapy for osteoarthritis in the hip and knees involves not only mobilizing the joint itself but also addressing the surrounding soft-tissue structures. These structures, including muscles, tendons, ligaments, and connective tissues, play a critical role in joint stabilization, shock absorption, and control mechanisms.

The biomechanics of the joint and surrounding soft-tissue structures are intricately connected, and addressing one without the other can significantly reduce the effectiveness of therapy. For example, addressing joint mobility without addressing soft-tissue restrictions can result in limited range of motion and decreased function.

Therefore, it is essential to prioritize the mobilization of both the joint and surrounding soft-tissue structures in any treatment plan for patients with osteoarthritis. By promoting proper joint function and addressing soft-tissue restrictions, we can enhance joint stability, shock absorption capacity, and overall function.


The Gluteus Maximus Release - Motion Specific Release™ (MSR)


Dr. Brian Abelson, the developer of Motion Specific Release (MSR) treatment systems, demonstrates in this video how to release restrictions in the Gluteus Maximus muscle using MSR. This muscle is a critical part of the anatomy and biomechanics of the hip and knees, as strong, flexible, and engaged gluteal muscles are necessary for optimum function.

The Gluteus Maximus muscle plays a vital role in the hip joint's stability, shock absorption capacity, and control mechanisms. Without proper gluteal muscle function, patients may experience limitations in joint mobility, decreased strength, and increased pain and dysfunction.


The Quadriceps Release - Motion Specific Release™


The quadriceps are a group of muscles in the thigh that play a crucial role in the biomechanics of the knee joint. However, these muscles are often tight, restricted, and overactive in patients with osteoarthritis in the hip and knees. This is because most people tend to overuse their quadriceps and adductors to perform lower extremity motions, when they should be using their gluteals and hamstrings.

When the quadriceps are overactive and the hamstrings are weak, it creates muscle imbalances that can lead to knee injuries, hamstring strains, gait imbalances (directly related to hip function), and other lower extremity injuries. Additionally, these imbalances can negatively impact joint stability, shock absorption capacity, and overall function of the hip and knee joints.



The Hamstring Release - Motion Specific Release™ (MSR)


The hamstring muscles are a group of muscles that play a critical role in the biomechanics of the hip and knee joints. These muscles are primarily involved in hip extension and knee flexion, while the quadriceps muscles are primarily involved in hip flexion and knee extension.


The hamstrings act as shock absorbers, force generators, and stabilizers for the joints, making them crucial for proper joint function and overall mobility. When the hamstrings are weak or injured, patients may experience limitations in joint mobility, decreased strength, and increased pain and dysfunction.


 

EXERCISE IS NOT OPTIONAL


Studies have shown that exercise is one of the most effective treatments for hip and knee osteoarthritis, as it can decrease pain and improve function in patients. Improving aerobic capacity and focusing on mobility and strength is crucial for addressing hip and knee osteoarthritis. Therefore, exercise should be one of the first lines of treatment for patients with osteoarthritis.


According to research, exercise can reduce pain and improve function in patients with hip or knee osteoarthritis. (3, 17, 20) In addition, improving aerobic capacity is critical for addressing hip and knee osteoarthritis. (19) The following exercises demonstrate possible exercises that we could prescribe, depending on the individual case.


MOBILITY


8 Great Mobility Exercises for Hip Osteoarthritis


In this video, we showcase some effective mobility exercises for patients with osteoarthritis of the hips. It is important to note that these exercises should be performed regularly, at least once per day, to see significant improvement in mobility and function.


To achieve the best results, we recommend slowly working up to performing these exercises 3 to 4 times per day. Consistency is key, and incorporating these exercises into your daily routine can make a significant difference in your hip mobility and overall function.


Remember to always listen to your body and avoid overexertion or pushing beyond your limits. If you experience any discomfort or pain, please consult with your healthcare provider before continuing with these exercises. With dedication and patience, you can achieve improved hip mobility and function through regular exercise.



6 Great Mobility Exercises for Knee Osteoarthritis


his video showcases effective mobility exercises for patients with osteoarthritis of the knees. To see significant improvement in knee mobility and function, it is recommended to perform these exercises at least once per day.

For optimal results, we suggest slowly working up to performing these exercises 3 to 4 times per day. Consistency is key, and incorporating these exercises into your daily routine can make a significant difference in your knee mobility and overall function.

However, it is important to listen to your body and avoid overexertion or pushing beyond your limits. If you experience any discomfort or pain, please consult with your healthcare provider before continuing with these exercises.



 

STRENGTH


Swiss Ball Squat

The Swiss Ball Squat is an effective exercise for patients with osteoarthritis in the hip and knees who may struggle with performing a standard body weight squat. This exercise can be a great beginner exercise for strengthening not only the quadriceps, but also the gluteal, abdominal, hamstring, and calf muscles.


When performing the Swiss Ball Squat, it is important to maintain proper form to avoid any unnecessary stress on the joints. Begin by standing with your feet shoulder-width apart, with the Swiss Ball placed between your lower back and the wall. Slowly squat down while keeping your knees behind your toes and your weight evenly distributed on both feet. Then, return to the starting position by extending your hips and knees.


When incorporating the Swiss Ball Squat into your exercise routine, it is important to start with a low number of sets and reps and gradually work your way up. For example, begin with 1 or 2 sets of 10 repetitions and gradually increase to 3 or 4 sets of 12 to 15 repetitions as you become stronger and more comfortable with the exercise.


EQUIPMENT

Swiss/Physio Balls at Amazon: https://amzn.to/3gQmpRG



5 - Clam Exercises with a Theraband


The Clam Exercises with a Theraband are an effective way to target and activate the gluteal muscles, making them an ideal exercise for patients with osteoarthritis in the hip and knees. These exercises can also be beneficial for individuals experiencing lower extremity problems, as proper activation of the gluteal muscles is crucial for optimal biomechanics and function.

It is important to start with beginner exercises when first incorporating Clam Exercises with a Theraband into your routine to avoid any unnecessary stress on the joints. Gradually increasing the number of sets and repetitions as you become stronger and more comfortable with the exercise can also help prevent injury and promote optimal biomechanics.


EQUIPMENT

Loop Bands at Amazon https://amzn.to/3FBcg5t


4 Point Band Leg Strengthening Exercise


The 4 Point Band Leg Strengthening Exercise is an effective exercise for targeting multiple muscle groups in the hip and thigh. This exercise can strengthen the adductors, abductors, flexors, and extensors, making it a valuable addition to any exercise routine for patients with osteoarthritis in the hip and knees.


The adductors, abductors, flexors, and extensors are all crucial muscle groups for proper hip and knee function. The adductors and abductors help stabilize the hip joint and control the movements of the thigh bone, while the flexors and extensors work together to support leg movement and maintain balance.


EQUIPMENT

Theraband/Resistance bands at Amazon: https://amzn.to/3VWQheW



Peterson Step Up - Great Knee Stability Exercise


The Peterson Step Up is an effective exercise for improving knee stability, which is crucial for patients with osteoarthritis in the knee joint. This exercise targets the vastus medialis oblique (VMO) muscle, which is a part of the quadriceps muscle group that plays a significant role in knee stability.


The VMO muscle runs along the inner thigh and helps keep the patella (kneecap) properly aligned with the femur bone. When the VMO muscle is weak or imbalanced, it can lead to patellar tracking issues, knee instability, and pain. Therefore, strengthening the VMO muscle through exercises like the Peterson Step Up can help improve knee function and reduce pain and discomfort.


In addition to improving knee stability, the Peterson Step Up can also indirectly benefit hip stability. The hip joint and knee joint are connected and function together as part of the lower extremity kinetic chain. A weakness or imbalance in one joint can often affect the other, leading to compensatory movement patterns and increased risk of injury.



 

Weight Loss

Weight loss can significantly slow the course of osteoarthritis, according to numerous research (OA). More weight places strain on the joints, especially the hips and knees, which causes more discomfort and inflammation. Patients can lessen joint stress, enhance joint function, and control pain by losing weight.


According to a study that appeared in the journal Arthritis & Rheumatology, a 10% weight loss led to a 28% improvement in knee OA symptoms and a 24% decrease in knee joint load. According to a different study in the journal Osteoarthritis and Cartilage, overweight or obese patients who lost weight experienced less pain and had better physical function than those who did not. (35,36)


It is crucial to remember that weight loss should be accomplished by combining healthy eating practices with frequent exercise. Weight loss can be aided by eating a balanced diet that is rich in nutrient-dense foods and low in processed food. Exercise can enhance muscle strength and flexibility, boost calorie expenditure, and aid in weight loss. For people with OA, low-impact workouts like walking, cycling, or swimming are advised to reduce joint stress.



 

CONCLUSION


Dealing with hip or knee osteoarthritis may seem like a foregone conclusion for most people, but fear not! Surgery is not inevitable, and you don't have to suffer from the pain and dysfunction that often accompanies OA. A combination of manual therapy (such as MSR procedures) and exercise can make a significant difference in slowing down OA progression, reducing or eliminating pain, and improving overall function.


My advice? Don't wait until surgery becomes the only option. Address OA with manual therapy and exercise early on, and be sure to maintain regular appointments to keep your body in tip-top shape. Think of it like giving your car regular tune-ups to avoid costly repairs down the road.


Of course, in some cases, a hip or knee replacement may become the best option. From a personal perspective, I may not be doing Ironman Triathlons anymore, but I'm still hiking, sea kayaking, dancing, and enjoying life thanks to my full hip replacement.


The bottom line? Life is too short to live in pain and dysfunction. So, explore your options, keep moving, and don't forget to laugh along the way. As they say, laughter is the best medicine - though I'm not sure how effective it is against osteoarthritis!

 

DR. BRIAN ABELSON DC.

Dr. Abelson is committed to running an evidence-based practice (EBP) that incorporates the most up-to-date research evidence available. He combines his clinical expertise with the specific values and needs of each patient to deliver personalized care that is both effective and patient-centered.


As the developer of Motion Specific Release (MSR) Treatment Systems, Dr. Abelson operates a clinical practice in Calgary, Alberta, under the name Kinetic Health. He has authored ten publications to date and continues to offer online courses, in addition to his live programs, to healthcare professionals seeking to expand their knowledge and skills in treating patients with musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.

 

We Look Forward to Seeing You

We are excited to welcome you to Kinetic Health, our clinic located in NW Calgary, Alberta. Our dedicated team is committed to providing exceptional care and personalized treatment plans to help you achieve optimal health and wellness.


To schedule an appointment with our incredible team, please call us at 403-241-3772 or click on the MSR logo to the right. We are eager to assist you and look forward to helping you feel your best.


 


REFERENCES

  1. 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.

  2. 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.

  3. 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.

  4. Transforming osteoarthritis care in an era of health care reform, Gruber WH, Hunter DJ. Clinics in Geriatric Medicine, 2010; 26(3):433-44.

  5. Physiotherapy for osteoarthritis of the knee: predictors of outcome at one year. Chapple CM. Dunedin: School of Physiotherapy, University of Otago; 2011.

  6. Physical Therapy: Treatment of Common Orthopedic Conditions (p. 250). Baheti, Neeraj D. Jaypee Brothers Medical Publishers. Kindle Edition.

  7. 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.

  8. 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.

  9. Risk factors for osteoarthritis: understanding joint vulnerability. Felson DT. Clin Orthop Relat Res. 2004 Oct. S16-21.

  10. The role of muscle weakness in the pathogenesis of osteoarthritis. Hurley MV. Rheum Dis Clin North Am. 1999 May. 25(2):283-98, vi.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. National Institute for Health and Clinical Excellence. Osteoarthritis: the care and management of osteoarthritis in adults. NICE clinical guideline. 2008; 59:1-22.

  18. 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.

  19. 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.

  20. 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.

  21. 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

  22. 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.

  23. 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.

  24. 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.

  25. 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.

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. Comprehensive physical examination for instability of the knee, Lubowitz JH, et al. Am J Sports Med 2008; 36(3):577-594.

  31. 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.

  32. Comprehensive physical examination for instability of the knee, Lubowitz JH, et al. Am J Sports Med 2008; 36(3):577-594.

  33. 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.

  34. 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.

  35. Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004 May;50(5):1501-10.

  36. Gudbergsen H, Boesen M, Lohmander LS, et al. Weight loss is effective for symptomatic relief in obese subjects with knee osteoarthritis independently of joint damage severity assessed by high-field MRI and radiography. Osteoarthritis Cartilage. 2012 Apr;20(4):495-502.



#osteoarthritis #OA #brianabelson #kinetichealth #Chiropractor #Calgary #MSR #motionspecificrelease #hip #pain #knee #royaloak

300 views0 comments
bottom of page