By Jerry Moczerniuk PT, DPT
Osteoarthritis (OA) of the knee is the most prevalent joint disease, and one of the leading causes of chronic pain and disability in the United States.
It is estimated that knee OA affects approximately 19 percent of all Americans over the age of 45. Knee OA is most adversely impactful on mobility, including the ability to perform daily activities such as walking, climbing stairs, and getting in and out of a chair. The prevalence of knee OA has been attributed to aging and obesity, but recent research in the journal of Arthritis Research and Theory looked more in depth at the mechanism of knee arthritis progression, and how treating pain early can slow down the progression of the disease.
Pain in the knee has been commonly thought of as a consequence of degenerative and arthritic changes, and that is partially correct.
Newer research however suggests that pain can also be the cause of much faster progression of knee OA. The study in the 2018 Journal of Arthritis and Research Theory looked at x-rays of 4369 individuals with diagnosed knee osteoarthritis, dividing them into two groups based on the severity of their knee osteoarthritis.
Patients with a score of 0-1 on a Kellegren-Lawrence scale were classified as having non-radiographic OA (non-ROA), while patients with a score of 2-4 were classified as having radiographic OA (ROA). MRI to determine volume cartilage loss, and pain assessment using the WOMAC pain scale was performed at baseline and 1- and 4- year follow up.
Participants from both groups with increased knee pain at baseline demonstrated a greater loss in cartilage volume than participants with less or no baseline pain. Likewise patients with persistent pain in both groups, as compared to those without pain or fluctuating pain, demonstrated greater progression of radiographic damage on follow up.
The authors of the study suggest that 37 percent of the progressive ROA risk over 4 years could be attributed to persistent knee pain, and to a lesser extent fluctuating pain as well.
The study suggests that knee pain itself, both early onset, and frequent knee pain may be an important adverse factor in deterioration of knee structures. Furthermore the authors of the study also suggest that treating patients with knee pain early, and over time, to reduce pain, may be important for preserving knee structures. This will also likely result in overall improved functional mobility.
Over the years research strongly suggests utilization of physical therapy (PT) services as primary treatment for knee osteoarthritis. A short term bout of skilled PT, including supervised therapeutic exercises, every 6 months, may significantly reduce pain and improve the quality of life in patients with osteoarthritis.
In New Jersey you can be evaluated and treated by a physical therapist without a referral from your doctor.
Dr. Moczerniuk is a doctor of Physical Therapy, member of American Physical Therapy Association, and a clinical director at db Orthopedic Physical Therapy of Manalapan LLC, located at 120 Craig Road, Suite 2, Manalapan. Dr. Moczerniuk can be reached at 732-462-2162 or via e-mail at Jerry@dborthopt.com. You can also find out more about our practice at dborthopt.com
