Sports Medicine

, Volume 32, Issue 11, pp 729–739 | Cite as

Exercise Recommendations in Athletes with Early Osteoarthritis of the Knee

  • Vijay Vad
  • Hoyman M. Hong
  • Michael Zazzali
  • Nergis Agi
  • Dilshaad Basrai
Injury Clinic

Abstract

Osteoarthritis of the knee is a common condition that afflicts millions of individuals annually. The benefits of exercise are self evident as athletes and middle- aged individuals grow older, and the focus has centered on pain-free participation in their sports and activities. In the past, medical treatment has primarily relied on oral medications to manage symptoms, without the incorporation of therapeutic exercise. Consequently, as the osteoarthritis progresses, patients are offered surgical management and eventual joint replacement. A goal-oriented progressive rehabilitation programme that incorporates medical management in the initial stages would allow patients a greater ability to participate in sports, thereby obtaining the numerous benefits of exercise and perhaps delaying surgery.

A progressive rehabilitation programme consists of five stages (I to V). Medical management is primarily reserved for stage I: protected mobilisation and pain control. It entails the use of pain medications, nonsteroidal anti-inflammatory drugs, with or without the use of chondroprotective agents such as glucosamine. Injection therapy is usually incorporated at this stage with intra-articular injections of corticosteroids or viscosupplementation, either of which may be combined with minimally invasive single-needle closed joint lavage procedure.

Stages II and III introduce open kinetic-chain non-weight bearing exercises to the affected joint, with progression to closed kinetic-chain exercises. Stage IV focuses on return to sporting activities, with continued closed kinetic-chain exercises. There is also the incorporation of sport-specific exercises to improve neuromuscular coordination, timing and protect against future injury. Finally, stage V, or the maintenance phase, is primarily aimed at educating the patient on how to reduce the risk of re-injury and optimise their current exercise programme. Medical management of knee osteoarthritis within the framework of a progressive rehabilitation programme that includes active therapeutic exercise may delay the progression of this disease and allow patients years of greater pain-free activity and improved quality of life.

References

  1. 1.
    Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41: 778–99PubMedCrossRefGoogle Scholar
  2. 2.
    Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994; 84: 351–7PubMedCrossRefGoogle Scholar
  3. 3.
    Meenan RF, Mason JH, Anderson JJ, et al. AIMS2: the content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum 1992; 35: 1–10PubMedCrossRefGoogle Scholar
  4. 4.
    Oliveria SA, Felson DT, Reed JI, et al. Incidence of symptomatic hand, hip and knee osteoarthritis among patients in a HMO. Arthritis Rheum 1995; 38: 1134–41PubMedCrossRefGoogle Scholar
  5. 5.
    Wilson MG, Michet Jr CJ, Ilstrup DM, et al. Idiopathic symptomatic osteoarthritis of the hip and knee: a population based incidence study. Mayo Clin Proc 1990; 65: 1214–21PubMedCrossRefGoogle Scholar
  6. 6.
    Sharma L, Hayes KW, Felson DT, et al. Does laxity alter the relationship between strength and physical function in knee osteoarthritis? Arthritis Rheum 1999; 41: 25–32CrossRefGoogle Scholar
  7. 7.
    Kirwan J, Elson C. Is the progression of osteoarthritis phasic? Evidence and implications [editorial]. J Rheumatol 2000; 27 (4): 834–6PubMedGoogle Scholar
  8. 8.
    Murray CJL, Lopez AD. The global burden of disease. Geneva: World Health Organization, 1997Google Scholar
  9. 9.
    Cooper C, Shelagh S, McAlindon T, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 2000; 43 (5): 995–1000PubMedCrossRefGoogle Scholar
  10. 10.
    McAlindon TE, Cooper C, Kirwan J, et al. Knee pain and disability in the community. J Rheumatol 1992; 31: 189–92CrossRefGoogle Scholar
  11. 11.
    Altman RD, Dean D. Pain of osteoarthritis. Semin Arthritis Rheum 1989; 18 Suppl. 2: 1–3PubMedCrossRefGoogle Scholar
  12. 12.
    Buckwalter J, Lane N. Athletics and osteoarthritis. Am J Sports Med 1997; 25 (6): 873–81PubMedCrossRefGoogle Scholar
  13. 13.
    Kujala UM, Kettunen J, Paananen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 1995; 38: 539–46PubMedCrossRefGoogle Scholar
  14. 14.
    Lane NE, Michel B, Bjorkengren A, et al. The risk of osteoarthritis with running and aging: a 5-year longitudinal study. J Rheumatol 1993; 20: 461–8PubMedGoogle Scholar
  15. 15.
    Ravaud P, Moulinier L, Giraudeau B, et al. Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee: results of a multicenter randomized controlled trial. Arthritis Rheum 1999; 42: 475–82PubMedCrossRefGoogle Scholar
  16. 16.
    Levy AS, Lohnes J, Suclley S, et al. Chondral delamination of the knee in soccer players. Am J Sports Med 1996; 24: 634–9PubMedCrossRefGoogle Scholar
  17. 17.
    Zimmerman NB, Smith DG, Pottenger LA, et al. Mechanical disruption of human patellar cartilage by repetitive loading in vitro. Clin Orthop 1988; 229: 302–7PubMedGoogle Scholar
  18. 18.
    Crowther C. Approach to knee problems in primary care. Lippincotts Prim Care Pract 1999 Jul-Aug; 3 (4): 355–75PubMedGoogle Scholar
  19. 19.
    Vad VB, Bhat A. The athlete with early knee arthritis. Phys Med Rehabil Clin N Am 2000; 11 (4): 881–94PubMedGoogle Scholar
  20. 20.
    Bank R, Soudry M, Maroudas A, et al. The increased swelling and instantaneous deformation of osteoarthritic cartilage is highly correlated with collagen degradation. Arthritis Rheum 2000; 43 (10): 2202–10PubMedCrossRefGoogle Scholar
  21. 21.
    Leadbetter WB. Anti-inflammatory therapy in sports injury: the role of nonsteroidal drugs and corticosteroid injections. Clin Sports Med 1995; 14: 353–410PubMedGoogle Scholar
  22. 22.
    Mckenna F, Borenstein D, Wendt H, et al. Celecoxib versus diclofenac in the management of osteoarthritis of the knee: a placebo controlled randomized double blind comparison. Scand J Rheumatol 2001; 30: 11–8PubMedCrossRefGoogle Scholar
  23. 23.
    Benson WG, Fiechtner JJ, McMillen JI, et al. Treatment of osteoarthritis with celecoxib a COX-2 inhibitor: a randomized controlled trial. Mayo Clin Proc 1999; 74: 1095–105CrossRefGoogle Scholar
  24. 24.
    Ehrich EW, Schnitzer TJ, McIlwain H, et al. Effect of specific COX-2 inhibition in osteoarthritis of the knee: a 6-week double blind placebo controlled pilot study of rofecoxib. J Rheumatol 1999; 26: 2438–47PubMedGoogle Scholar
  25. 25.
    Hollander JL. Intra-articular hydrocortisone in arthritis. J Bone Joint Surg Am 1953; 35: 983–90PubMedGoogle Scholar
  26. 26.
    Adams ME, Atkinson MH, Lussier AJ, et al. The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with nonsteroidal anti- inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoarthritis Cartilage 1995; 3 (4): 213–25PubMedCrossRefGoogle Scholar
  27. 27.
    Miller PV. Prospective study of 108 OA knees treated with Hylan GF 20. Presented at AAOS; 1999 Feb 2–4; Anaheim (CA)Google Scholar
  28. 28.
    Chang RW, Falconer J, Stulberg SD, et al. A randomized controlled trial of arthroscopic surgery vs closed needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum 1993; 36: 289–96PubMedCrossRefGoogle Scholar
  29. 29.
    Edelson R, Burks RT, Bloebaum RD. Short term effects of knee washout for osteoarthritis. Am J Sports Med 1995; 23: 345–9PubMedCrossRefGoogle Scholar
  30. 30.
    Ike RW, Arnold WJ, Rothschild EW, et al. Tidal irrigation vs conservative medical management in patients with osteoarthritis of the knee: a prospective randomized study. J Rheumatol 1992; 19: 772–9PubMedGoogle Scholar
  31. 31.
    DeAndrade JR, Grant C, Dixon A. Joint distension and reflex inhibition in the knee. J Bone Joint Surg Am 1965; 47: 313–22PubMedGoogle Scholar
  32. 32.
    Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knee. Br J Rheumatol 1993; 32 (2): 127–31PubMedCrossRefGoogle Scholar
  33. 33.
    Radin EL, Paul IL. Does cartilage compliance reduce skeletal impact loads? The relative force-attenuating properties of articular cartilage, synovial fluid, periarticular soft tissues and bone. Arthritis Rheum 1970; 13: 139–44PubMedCrossRefGoogle Scholar
  34. 34.
    Fisher NM, Pendergast DR. Reduced muscle function in patients with osteoarthritis. Scand J Rehabil Med 1997; 29: 213–21PubMedGoogle Scholar
  35. 35.
    Minor M. Exercise in the treatment of osteoarthritis. Rheum Dis Clin North Am 1999; 23 (2): 397–415CrossRefGoogle Scholar
  36. 36.
    Wigerstadt-Lossing I, Grimby G, et al. Effects of electric muscle stimulation combined with voluntary contractions after knee ligament surgery. Med Sci Sports Exerc 1998; 20: 93–8Google Scholar
  37. 37.
    Draper V. Electromyographic biofeedback and recovery of quadriceps femoris muscle function following anterior cruciate ligament reconstruction. Phys Ther 1999; 70: 11–7Google Scholar
  38. 38.
    Draper V, Ballard L. Electric stimulation versus electromyographic biofeedback in the recovery of quadriceps femoris function following anterior cruciate ligament surgery. Phys Ther 1991; 71: 455–46PubMedGoogle Scholar
  39. 39.
    Lephart SM, Borsa PA. Functional rehabilitation of knee injuries. In: Fu F, Harner C, editors. Knee surgery. Baltimore (MD): Williams & Wilkins, 1993: 38–114Google Scholar
  40. 40.
    Steinkamp LA, Dillingham MF, Markel MD, et al. Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med 1993; 21 (3): 438–44PubMedCrossRefGoogle Scholar
  41. 41.
    Lephart SM, Kocher MS, Fu FH, et al. Proprioception following anterior cruciate ligament reconstruction. J Sports Rehabil 1992; 1: 188–96Google Scholar
  42. 42.
    Bland JH, Cooper SM. Osteoarthritis: a review of the cell biology involved and evidence for reversibility. Management rationally related to known genesis and pathophysiology. Semin Arthritis Rheum 1984; 14: 106–32PubMedCrossRefGoogle Scholar
  43. 43.
    Lephart S, Henry T. Functional rehabilitation for the upper and lower extremity. Sports Med 1995; 26 (3): 579–92Google Scholar
  44. 44.
    Markey KL. Functional rehabilitation of the anterior cruciate deficient knee. Sports Med 1991; 12: 407–17PubMedCrossRefGoogle Scholar
  45. 45.
    Jones GM, Watt DG. Muscular control of landing from unexpected falls in man. J Physiol 1971; 219: 729–37PubMedGoogle Scholar
  46. 46.
    Voloshin D, Wosk J. Influence of artificial shock absorbers on human gait. Clin Orthop 1981; 160: 52–6PubMedGoogle Scholar
  47. 47.
    Giove TP, Miller SJ, Kent BE, et al. Non-operative treatment of the torn ACL. J Bone Joint Surg Am 1983; 65 (2): 184–92PubMedGoogle Scholar
  48. 48.
    Davies G. Open and closed kinetic chain exercises: implications to assessment and rehabilitation with emphasis on the lower extremities. Presented at Advances on the Knee and Shoulder; 1999 May 31; Hilton Head (SC)Google Scholar
  49. 49.
    Keating EM, Faris PM, Ritter MA, et al. Use of lateral heel and sole wedges in the treatment of medial osteoarthritis of the knee. Orthop Rev 1993; 22: 921–4PubMedGoogle Scholar
  50. 50.
    Ogata K, Yasunaga M, Nomiyama H. The effect of wedge insoles on the thrust of osteoarthritic knees. Int Orthop 1997; 21: 308–12PubMedCrossRefGoogle Scholar
  51. 51.
    Tohyama H, Yasuda K, Kaneda K. Treatment of osteoarthritis of knee with heel wedges. Int Orthop 1991; 15: 31–3PubMedCrossRefGoogle Scholar
  52. 52.
    Kirkley A, Webster-Bogaert S, Litchfield R, et al. The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am 1999; 81: 536–48Google Scholar
  53. 53.
    Komistek RD, Dennis DA, Northcut EJ, et al. An in vivo analysis of the effectiveness of osteoarthritis knee brace during heel strike gait. J Arthroplasty 1999; 14: 738–42PubMedCrossRefGoogle Scholar
  54. 54.
    Reginster JY, Derolsy R, Rovati LC, et al. Long term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001; 357: 251–6PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Vijay Vad
    • 1
  • Hoyman M. Hong
    • 2
  • Michael Zazzali
    • 3
  • Nergis Agi
    • 4
  • Dilshaad Basrai
    • 5
  1. 1.Cornell University Medical CenterNew YorkUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA
  3. 3.Physical Therapy Associates of New YorkNew YorkUSA
  4. 4.Healthsouth RehabilitationNew YorkUSA
  5. 5.Columbia UniversityNew YorkUSA

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