Is it possible for those with osteoarthritis (OA) to avoid or delay hip and knee replacement surgery through physical therapy and exercise? Studies show that minimizing OA pain and getting people moving improve function and may delay the need for surgery. With the help of technology, physical therapists can encourage movement by decreasing or eliminating pain for these OA patients.
OA is the breakdown of cartilage that results in pain, swelling, decreased range of motion and stiffness. The most common chronic joint condition, OA impacts more than 27 million Americans. One in four Americans will develop hip OA by age 85, and one in two will develop knee OA in his or her lifetime.
Many people with OA feel the condition is inevitable, can’t handle the pain and become sedentary while waiting for a surgical intervention. Consider the pain cycle: Pain -> Decreased Movement-> Loss of Flexibility and Strength -> Deconditioning -> Poor Lower Extremity Mechanics. This pain cycle often leads to a sedentary lifestyle, which also results in an increased risk for diabetes, weight gain/obesity, coronary artery disease (CAD), hypertension and falls.
The vision of the American Physical Therapy Association (APTA) is to transform society by optimizing movement to improve the human experience. For those with OA, a physical therapist can help patients break the pain cycle and improve their quality of life by:
- Encouraging mobility
- Helping improve flexibility and strength
- Helping maintain cartilage health
- Helping normalize gait
Because cartilage is avascular and aneural, there is not a lot of blood flow in cartilage or excessive pain until it breaks down enough to expose the bony layer beneath it. Cartilage exists to absorb shock and withstand pressure, and loading it enough is important for cartilage health, just as load is important for all body tissue. While excessive loading is detrimental to someone with OA, moderate exercise with loads that are pain-free have proven beneficial.
More Movement = More Function
A randomized, controlled trial on the efficacy of tailored exercise therapy on the physical function of 126 patients with knee OA (KOA) and comorbidities (CAD, type-2 diabetes, obesity, COPD, ) was recently published in Arthritis Care & Research (August 26, 2016). An intervention group received a 20-week, individualized, comorbidity-adapted exercise program of aerobic and strength training. The control group received their current medical care for KOA and were placed on a waiting list for exercise therapy. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale physical functioning and six-minute walk test. Measurements were performed at baseline, after 20 weeks treatment (post treatment) and at 3 months post treatment. The results showed statistically significant physical functioning differences over time between the intervention and control group in favor of the intervention group. There were no serious adverse events during the intervention.
To get those with OA moving, pain must be minimized. Aquatic therapy is a traditional recommendation to reduce body weight during exercise, which in turn reduces stiffness and inflammation after exercise. But aquatic exercise does not ensure a normal gait pattern.
The AlterG® Anti-Gravity Treadmill® can take PT for OA patients to the next level by:
- Allowing walking and running with a normalized gait pattern. The PT can work with the patient on gait kinematics in a safe environment.
- Decreasing pain by controlling the load from 20% to 100% of body weight with NASA-patented Differential Air Pressure technology.
- Decreasing stiffness and inflammation through motion to assist with joint health and improved range of motion that allows for proper cartilage loading.
In studies conducted by AlterG in 2014, it was proven that:
- The Anti-Gravity Treadmill can be used safely to manage knee OA and improve physical health (Peeler et al. Managing KOA: The Effects of Body Weight Supported Activity on Joint Pain, Function and Thigh-Muscle Strength.)
- The Anti-Gravity Treadmill may help decrease stress to knees while maintaining cardiovascular strength (Denning et al. Body Weight Independently Affects Articular Cartilage Catabolism)
With a changing health-care landscape that is value-based and focused on outcomes measures for quality and quantity, the role of the physical therapist in helping to make surgery a last resort for OA patients is welcomed. Outcomes measures include: Dynamic Gait Index, Berg Balance Score, Timed Up-and-Go, Lower-Extremity Functional Scale and FIM levels. Educating the public, your peers and other clinicians on how to improve functional levels and prevent decline should be a priority for physical therapists. Host seminars, post information on your social media pages and website, and develop health and wellness private-pay programs. Maintenance programs after PT has ended can help extend cardiovascular health, weight management and diabetes management and prevent TAK/THA.
Let AlterG help you put “fun” back into function by allowing you to include standing tolerance, balance and gait activities and lower-extremity strength gains in your care plan. Contact us to learn more.