Physical Therapy Is Beneficial in Knee Osteoarthritis

Summary and Comment |
March 18, 2014

Physical Therapy Is Beneficial in Knee Osteoarthritis

  1. Jonathan S. Coblyn, MD

Thrice-weekly exercise focused on quadriceps strengthening is a useful adjunct for OA patients.

  1. Jonathan S. Coblyn, MD

Patients with knee osteoarthritis (OA) can be offered arthroscopy, medications, physical therapy (PT), or other treatment modalities. However, several randomized trials have suggested that arthroscopic interventions do not benefit most patients with knee OA (NEJM JW Gen Med Sep 16 2008 and NEJM JW Gen Med Jul 16 2002). In another study, PT was as effective as arthroscopy for meniscal tears in patients with OA (NEJM JW Gen Med Mar 28 2013). PT alone alleviates pain for many patients, but the optimal regimen is unknown.

To evaluate various PT regimens for patients with knee OA, researchers evaluated 48 trials in which PT was compared with non-exercise control interventions. The most efficacious PT programs provided aerobic, resistance, or performance exercises but did not mix exercise types. More pain reduction occurred with quadriceps-specific exercises than with other types of exercise. Best results were obtained with supervised, thrice-weekly PT programs with durations of at least 4 weeks.


Treating patients with knee osteoarthritis is not standardized. Patients can be offered analgesia, nonsteroidal anti-inflammatory drugs, steroid injections, hyaluronate compounds, arthroscopic interventions, or physical therapy. This study helps clinicians choose among these options. PT clearly helps relieve pain in patients with OA, and perhaps thrice-weekly PT for 4 weeks should be an adjunct treatment for all patients who are not responding to their current therapy.

Editor Disclosures at Time of Publication

  • Disclosures for Jonathan S. Coblyn, MD at time of publication Equity Johnson & Johnson


Reader Comments (7)

RICHARD LENON Physician, Oncology, retired

How do we know that it wasn't just that people with less severe/progressive disease walked more, simply because they had less severe/progressive disease?

SImon Locke Physician, Other, Bendigo Australia

Quadriceps strengthening is old news. the real question is what are you trying to achieve? Is it an increase in "strength"? If so 3 times a week is adequate training; 4/52 provides a temporary gain only (neurological). So how long and what is ideal level and ratios of H/Q? Is the purpose to effect muscle change? how do you maintain gains/

jishanth Other Healthcare Professional, india

Strengthening should be done to both ham nd quads .vmo, short arcs , slr in supine, prone nd side lying . Avoid long walking in irregular areas or outside initial two months at least first month until quads get enough strength . Do quads table exercises nd ham curls too. Do cycling or swimming nd curl ups if you have overweight for minimum 4 months nd then go for walking.

Mongjam Meghachandra singh, MD, DNB (SPM), DNB(HHA) Physician, Preventive Medicine, Department of Community Medicine, Maulana Azad Medical College, New Delhi

I agree with the authors recommendation on the usefulness of quadriceps exercises in addition to other treatment modalities for osteoarthritis. The choice of types of quadriceps exercises, duration needs to be considered in relation to the severity of the case. The role of aerobic exercise in a patient with moribund obesity may have limitations as compared to a patient with normal or underweight Body mass index (BMI). A severely affected patient of OA may require arthroscopy and quadriceps exercises as an adjunct. I think the treatment has to be based on patient to patient, individual case and the exercises has to be individualized.

arthur saltz,m.d., facog Physician, Obstetrics/Gynecology, kaiser- permanente

which ''quadriceps-specific excercise'' regimen is suggested?

M.D. Physician, Orthopedics, Office

Disappointed in PRP, Hyaluronates and transient improvements with Salicylates, Ibuprofens, turned to Biopuncture with FDA approved ampoules of Bioregulatory medications and now getting far better results that have been lasting more than one year with surprisingly scant down side.

TRUNG PHAM Other, Private medical office in SGN Việt Nam!

I,treating myself my OA of my right knee more than 10 years by using NSAID ,analgesic, and most of all by stretching , exercise the quadriceps , it,s better now , sometime I wear the kneecap

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