Knee OA – The importance on strength training

Knee osteoarthritis can cause major disability. This piece of current literature supports that resistance training plays a major role in pain relief.

Bartholdy 2017

Knee osteoarthritis is a condition that gets treated overly careful due to its painful nature and limiting factors functionally.

Osteoarthritis is the gradual wearing down of the joint surfaces (cartilage) over time. Deterioration over time based on may factors, from the type of work and sport, injury history, genetics (collagen type) etc.

Knee Extensors OA

An exacerbation of osteoarthritis, especially in the knee can be debilitating. Reducing strength, restricting movement and limiting mobility. This recent study analysed almost 5000 participants from 45 trials. It found that the best results for reducing pain and disability was through increasing quads strength by over 30%.

This puts resistance training top of the agenda when trying to alleviate pain in an arthritic knee. Grading the exercises appropriately with the guidance of an expert. This study shows good results of strengthening the quads, we should approach it balanced by also working the other connecting muscles.

Original Abstract

OBJECTIVES: To analyse if exercise interventions for patients with knee osteoarthritis (OA) following the American College of Sports Medicine (ACSM) definition of muscle strength training differs from other types of exercise, and to analyse associations between changes in muscle strength, pain, and disability.

METHODS: A systematic search in 5 electronic databases was performed to identify randomised controlled trials comparing exercise interventions with no intervention in knee OA, and reporting changes in muscle strength and in pain or disability assessed as standardised mean differences (SMD) with 95% confidence intervals (95% CI). Interventions were categorised as ACSM interventions or not-ACSM interventions and compared using stratified random effects meta-analysis models. Associations between knee extensor strength gain and changes in pain/disability were assessed using meta-regression analyses.

RESULTS: The 45 eligible trials with 4699 participants and 56 comparisons (22 ACSM interventions) were included in this analysis. A statistically significant difference favoring the ACSM interventions with respect to knee extensor strength was found [SMD difference: 0.448 (95% CI: 0.091-0.805)]. No differences were observed regarding effects on pain and disability. The meta-regressions indicated that increases in knee extensor strength of 30-40% would be necessary for a likely concomitant beneficial effect on pain and disability, respectively.

CONCLUSION: Exercise interventions following the ACSM criteria for strength training provide superior outcomes in knee extensor strength but not in pain or disability. An increase of less than 30% in knee extensor strength is not likely to be clinically beneficial in terms of changes in pain and disability

https://www.ncbi.nlm.nih.gov/m/pubmed/28438380/

Ligament Sprains & Timeframes

Ligament sprains are one of the most common injuries, as their main role is to support the
joint. If poorly managed there is a risk of further injury.

Patience is not about doing nothing. Patience is about doing everything you can. But being patient about Results

What are ligaments?

Ligaments are fibrous tissues that attach from one bone to another across a joint. The tissue is very strong, varies in thickness and is dense with nerve receptors. Its role is to provide stability, guide movement, maintain joint shape and act as position sensors for the joint.

Previously ligaments were thought of as inactive structures, they are in fact complex structures that influence the localised joint and the entire body once injured (1).

How are ligaments injured?

Ligament sprains are the result of loads exceeding the maximum strength of the ligament with little/no time to recover. This force causes acute tears of the ligament fibres.

These structures can be damaged through several mechanisms, like contact or direct trauma, dynamic loading, repetitive overuse, structural vulnerability and muscle imbalance (2). A sprain of ligaments usually affect the following joints:

How does it affect us?

As with most soft tissue damage there will be the typical acute pain and swelling. Injury to a ligament will compromise joint stability and ability to control movement. It can also reduce our balance, proprioception and muscle reflex time (3). With poor joint position comes restriction in movement and weakness of the surrounding muscles.

What types of ligament sprains are there?

The severity of ligament injury is graded using various clinical classifications. The most common is a three-level system that determines structural involvement.

Grade 1 Grade 1 sprain1

  • Slight stretching and microscopic tearing of the ligament fibres
  • Mild tenderness and swelling around the ankle
  • Heals within 1-2 weeks 

Grade 2

  • Partial tearing of 10-90% of the ligament fibresGrade 2 sprain1.jpg
  • Moderate tenderness and swelling around the ankle
  • Partial structural instability when tested by Physio or doctor
  • Healing takes up to 6 weeks

Grade 3

  • Complete tear of the ligamentGrade 3 sprain1
  • Significant tenderness and swelling around the ankle
  • Complete instability when put under stress
  • Poor weight bearing
  • Conservative treatment can take 12-16 weeks
  • Potential reconstructive surgery is required

*Timeframes are based upon the guidance of a professional. Treating injuries on your own poses a risk of not fully recovering and a greater chance of re-injury.

For an appointment, call on 095290990 

  1. Frank, (2004) Ligament structure, physiology and function. J Musculoskelet Neuronal Interact
  2. Gabriel (2002) Ligament injury and Repair: Current concepts. Hong Kong Physiotherapy J
  3. Hauser (2013) Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics. The Open Rehabilitation Journal

What’s wrong with my knee?

Knee injuries are very common during sport and at work. For a faster recovery see your Dr or Physio to understand what structure you have damaged and how to rehab the injury effectively.

A knee sprain managed correctly will allow the tissue to heal fast and strong. Getting you back into what you enjoy most.

The knee is one of the most common joints injured in the body. A joint that absorbs a huge amount of force when running, jumping and lifting. Fortunately the femur and tibia are surrounded by many structures, but it’s usually these supporting structures that take the stress when we have an injury.

What could I have damaged?

Ligaments: About 40% of injuries to the knee involve ligaments either by a sprain or tear. These structures help give extra stability to the knee. When it has been put under excessive tension it damages the fibers. This results in pain, swelling and instability.Ligament injury knee

Patellofemoral: 24% of injuries are involving the knee cap. The patella sits within a small channel and if not guided correctly from surrounding muscles and ligaments pain can develop. This becomes particularly sore when squating, running and even basic functions like climbing stairs and sitting.Patella dysfunction

Meniscus:  11% involve the meniscus. It is fibrocartilage that sits within the knee, providing a level of stability to the ligaments and an element of shock absorption when weight bearing. This can cause a lot of swelling, pain and restrictions. In some cases the knee may lock in certain positions.

Knee injury meniscus

Other Injuries: The remaining 25% consists of fractures to knee, dislocation of the patella, Iliotibial band syndrome, hamstring and quads strains/tears etc.

What to do if I’ve injured my knee?

Firstly if you’ve just injured your knee and struggling with weight-bearing seek medical attention, where a Dr may consider an Xray, prescribe medication and will likely refer you to a physiotherapist. If the symptoms are not too severe, but you’re still concerned, come straight to physio. At Fundamental Physio Newmarket I can provide you with the following:

  • A detailed assessment of your knee using a range of tests to identify the structures involved, also looking at the mechanics of the hip and ankle.
  • Manual therapy to encourage normal movement and faster rate of healing.
  • A personalised exercise program for your identified weakness’. This may involve strength exercises, stretches and balance exercises.
  • Biomechanical assessment and correcting movement dysfunctions that may delay your recovery.
  • Providing you with an understanding of the structures affected and a treatment plan to meet your overall goals.
  • If recovery is slower than expected referrals can be made for Xrays/scans to sports or orthopaedic specialist.

Fundamental Physio Newmarket is supported by ACC. If you have hurt the knee during an accident, whether it was at home, work or on the sports field you will receive treatment cover for the injury.

For an appointment, call on 095290990