exercises for osteoarthritis of the knee · exercises for osteoarthritis of the knee osteoarthritis...

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Promoting Health Through Exercise OA OF THE KNEE Exercises for osteoarthritis of the knee OSTEOARTHRITIS Osteoarthritis (OA) is a disease of the joint cartilage associated with secondary changes in the underlying bone which may cause pain and compromise the function of the affected joint. OA is the result of aging and general wear and tear. Exercise is important in order to maintain a full range of movement at the knee, improve strength and preserve joint function. Be careful not to over-exercise as this may cause increased pain. Controlled rehabilitation exercises have been proven to increase leg muscle strength and decrease disability without increasing pain in patients with OA of the knee. Quadriceps muscle Femur Patella tendon Patella Articular cartilage Joint capsule Synovium Damaged cartilage Lipping of bone (osteophyte or ‘spur’) Roughened back of patella Meniscus Healthy knee Knee with OA WWW.SPORTEX.NET USEFUL RESOURCES SportEX Medicine magazine www.sportex.net The Organisation of Chartered Physiotherapists in Private Practice - www.physiofirst.org.uk General Osteopathic Council www.osteopathy.org.uk The Sports Massage Association www.thesma.org The Osteopathic Sports Care Association www.osca.org.uk Treating inflammation with PRICE - immediately after injury and for 3-5 days afterwards Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to the five main signs of inflammation: heat, redness, swelling, pain and loss of function. The inflammato- ry reaction is necessary as it is part of the natural healing process. However the body tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid contains a protein that turns into replacement ‘scar’ tissue. Too much scar tissue may prevent the structure returning to normal function with reduced flexibility and increased risk of re-injury. The advice below should be followed for 3-5 days depending on severity. It can be remembered by the acronym PRICE. PROTECT - Protect the injured tissue from undue stress that may disrupt the healing process and/or cause further injury. Make sure the mode of protection can accommodate swelling. REST - This reduces the energy requirements of the area, avoids any unnecessary increase in blood flow, ensures protection of the area and optimises healing. For example using slings, crutches or static rest (ie. sitting or lying down). ICE - The ice helps constrict the blood vessels thereby limiting bleeding and reducing the accumulation of unnecessary scar tissue. Crushed ice wrapped in a damp towel (to prevent ice burn) is best (ice cubes can be wrapped in the cloth and smashed against a wall to crush the cubes). Ice should be applied immediately after injury for 20 minutes every 3-4 hours or no more than 5-10 minutes at a time on bony areas. COMPRESSION - Simple off-the-shelf compression bandages such as Tubigrip™ and adjustable neoprene supports are adequate. It is impor- tant to ensure the bandages are not too tight to cause pins and needles or any loss of feeling around the joint. ELEVATION - Lowers the blood pressure and helps limit bleeding and encourage drainage of fluid through the lymphatic system. When following PRICE it is also important to avoid HARM, hence the saying: ‘Give PRICE and avoid HARM’. these are counter- productive to PRICE treatment } AVOID H – Heat (eg. hot bath, sauna) A – Alcohol R – Running M - Massage WWW.SPORTEX.NET

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Page 1: Exercises for osteoarthritis of the knee · Exercises for osteoarthritis of the knee OSTEOARTHRITIS Osteoarthritis (OA) is a disease of the joint cartilage associated with secondary

Promoting Health Through ExerciseOA OF THE KNEE

Exercises for osteoarthritis of the knee

OSTEOARTHRITISOsteoarthritis (OA) is a disease of thejoint cartilage associated with secondarychanges in the underlying bone which maycause pain and compromise the function ofthe affected joint. OA is the result of agingand general wear and tear.

Exercise is important in order to maintain afull range of movement at the knee,improve strength and preserve jointfunction. Be careful not to over-exercise asthis may cause increased pain. Controlledrehabilitation exercises have been provento increase leg muscle strength anddecrease disability without increasing painin patients with OA of the knee.

Quadricepsmuscle

Femur

Patellatendon

Patella

Articularcartilage

Jointcapsule

Synovium

Damagedcartilage

Lipping of bone(osteophyte or ‘spur’)

Roughenedback of patella

Meniscus

Healthyknee

Kneewith OA

WWW.SPORTEX.NET

USEFUL RESOURCES

• SportEX Medicine magazinewww.sportex.net

• The Organisation of CharteredPhysiotherapists in Private Practice- www.physiofirst.org.uk

• General Osteopathic Council www.osteopathy.org.uk

• The Sports Massage Association www.thesma.org

• The Osteopathic Sports CareAssociation www.osca.org.uk

Treating inflammation with PRICE - immediately after injury and for 3-5 days afterwards

Tissue injury usually involves damage to small blood vessels that results inbleeding at the site of injury. This bleeding leads to the five main signs ofinflammation: heat, redness, swelling, pain and loss of function. The inflammato-ry reaction is necessary as it is part of the natural healing process. However thebody tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid containsa protein that turns into replacement ‘scar’ tissue. Too much scar tissue may prevent the structure returning to normal function with reduced flexibility andincreased risk of re-injury. The advice below should be followed for 3-5 daysdepending on severity. It can be remembered by the acronym PRICE.

� PROTECT - Protect the injured tissue from undue stress that may disruptthe healing process and/or cause further injury. Make sure the mode ofprotection can accommodate swelling.

� REST - This reduces the energy requirements of the area, avoids anyunnecessary increase in blood flow, ensures protection of the area andoptimises healing. For example using slings, crutches or static rest (ie.sitting or lying down).

� ICE - The ice helps constrict the blood vessels thereby limiting bleedingand reducing the accumulation of unnecessary scar tissue. Crushed icewrapped in a damp towel (to prevent ice burn) is best (ice cubes can bewrapped in the cloth and smashed against a wall to crush the cubes).Ice should be applied immediately after injury for 20 minutes every 3-4hours or no more than 5-10 minutes at a time on bony areas.

� COMPRESSION - Simple off-the-shelf compression bandages such asTubigrip™ and adjustable neoprene supports are adequate. It is impor-tant to ensure the bandages are not too tight to cause pins and needlesor any loss of feeling around the joint.

� ELEVATION - Lowers the blood pressure and helps limit bleeding andencourage drainage of fluid through the lymphatic system.

When following PRICE it is also important to avoid HARM, hence the saying:‘Give PRICE and avoid HARM’.

these are counter-productive to PRICEtreatment}

AVOIDH – Heat (eg. hot bath,sauna)A – AlcoholR – Running M - Massage

WWW.SPORTEX.NET

6 Osteoarthritis of the knee 11/7/70 7:51 am Page 1

Page 2: Exercises for osteoarthritis of the knee · Exercises for osteoarthritis of the knee OSTEOARTHRITIS Osteoarthritis (OA) is a disease of the joint cartilage associated with secondary

PATIENT ADVICE

Exercises for osteoarthritis of the knee

Early rehabilitationexercises1Quadriceps stretch – Lie on the floor (or

bed if the floor is difficult) with your kneestraight, slowly bend the affected knee asfar as possible (moving your ankle as closeto your bottom as possible). When you feela stretch in the thigh muscle hold theposition for 10 seconds then return to astraightened position and hold again for 10seconds. Repeat 10 times.

2Quadriceps tense – Remain lying on yourback with your legs straight and place arolled up towel under the knees. Tightenthe front thigh muscle (quadriceps) bypushing the knee in to the towel. Hold for10 seconds and then release for 20seconds. Repeat this process 10 times.

3Hamstring stretch(tight hamstringsare a commonfinding in OA) –Stand upright andplace the foot ofyour affected leg ona stool or chair. Trynot to push down on

your knee with your hands but slowly leanforward until you feel a stretch at the backof the thigh. Hold the stretch for 20seconds. Repeat 5 times.

4Inside thigh musclesand gluteal musclestense – Sit on a chair,place a towel or ballbetween the thighs,tighten buttocks andsqueeze thigh musclestogether. Hold for 10seconds. Repeat 5 times.

Later rehabilitationexercises1Straight leg raise – Lie on your back, lean

on forearms with the knee of the affectedleg straight and foot pulled up (bend theknee of the unaffected leg for balance). Lift

the straight leg about 4-6inches off the ground andhold for 10 seconds.Repeat 10 times.

2Quadriceps strengthening– Sit on a chair with yourarms folded, slowly standup without using yourarms. When upright, return

slowly to the sitting position again withoutusing your arms. Repeat 10 times.

3Quadriceps strengthen-ing - step down – Placethe affected leg on ashallow step about 3inches high. Step downwith the good leg (slow-ly), taking 3-4 seconds tocomplete the step. Repeat7 times. You can hold onto a bannister for support.

4Quadricepsstrengthening -minisquats - Using achair, squat downbending both kneesbut keeping the backstraight. The squatshould be to approxi-mately 45 degrees.Repeat 10 times.

Additional exercisesSwimming and cycling may be appropriate forcertain individuals as mobility, strength andaerobic capacity can be increased without toomuch stress to the joint.

The information contained in this leaflet is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept noliability for any loss, injury or damage howsoever incurred (including negligence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this leaflet.

WWW.SPORTEX-MEDICINE.COM

PRACTITIONER CONTACT DETAILS

Your rehabilitation programmeThis exercise programme has specific exercisesto help maintain your range of jointmovement, and strengthen the muscles aroundyour knee. In order to achieve these goals it isimportant to ensure the exercises areperformed with a good technique. The follow-ing leaflet includes some exercises to help inyour rehabilitation.

Warm up and warm downIt is important that you warm up if possiblewith a gentle pain free walk for 3-4 minutesbefore you start your exercises. This increasesyour circulation and helps prepare yourmuscles for the activity to come.

When you have finished your exercises it isalso important to allow your heart rate to slowdown gradually by ending the session with agentle walk for a few minutes.

General guidelinesDuring acute attacks, rest will help bydecreasing inflammation but you’re likely alsoto experience increased stiffness and reducedmuscle power.

When attempting the following exercises thereshould be no pain but it is relevant to workthe muscles as hard as feasible. If theexercises cause pain and swelling then youshould allow a period of time, perhaps twodays, for the irritation to settle.

All exercises should be performed gently,slowly and ideally little and often.

6 Osteoarthritis of the knee 11/7/70 7:51 am Page 2