Manual Therapy and Therapeutic Exercise for Common Orthopedic Conditions and Functional Mobility: Summary 52
Therapeutic Exercise for Knee OA A comprehensive program includes:
■ Dynamic elements: Concentric hamstring strength and eccentric quad strength
• Weight support and stability (through passive elements like joint capsule and ligaments, and dynamic elements like muscles) • Shock absorption (via articular cartilage and muscles): ○ 2-3 times body weight during walking and even more during running/jumping Knee joint movement mechanics include: • Tibiofemoral Joint : Will differ based on moving in open or closed chain position: ○ OKC extension: Concave tibia rolling on convex femur (roll and glide both anterior) ○ CKC extension: Convex femur moving on concave tibia (femur rolls anteriorly and glides posteriorly) • Patellofemoral Joint : Patella moves 7 cm caudally during full extension: ○ Max contact between femur and patella at 45 deg flexion • Screw-Home Mechanism : External rotation (15 deg) of tibia in terminal extension KNEE OSTEOARTHRITIS (OA) Knee OA affects 13% of women and 10% of men, primarily those over 60 years old. LEARNING TIP! Knee OA influences all joint tissues, including: • Progressive damage to articular cartilage
• Aerobic exercise (low intensity for cartilage recovery): ○ High intensity aerobics can benefit from mild OA but accelerate damage in moderate/severe OA • Strength training (low-load isotonic exercises): ○ Indispensable in knee OA to relieve pain, stiffness, and improve strength • Balance and proprioception exercises Exercise prescription requires careful consideration of intensity to avoid both under-training and pain exacerbation. TOTAL KNEE ARTHROPLASTY (TKA) TKA is increasingly common, with an average patient age of 66 years and 63% of patients being women. Only 67% regain full function post-surgery. Manual Therapy for TKA Adding soft tissue and joint mobilization to exercise programs improves pain, function, and patient satisfaction. Massage has shown benefits in early post- operative stages. Therapeutic Exercise for TKA Quadriceps weakness is significant post-surgery (60% decrease) and may persist for a year. Interventions include: • Neuromuscular Electrical Stimulation (NMES) : High-intensity NMES early after surgery combined with traditional quadriceps rehabilitation is more effective than traditional quadriceps rehabilitation alone • Closed Kinetic Chain Exercises : Shown to positively affect physical function, balance, and gait compared to open kinetic chain exercises: ○ Week 1: Quad sets, ankle exercises, wall slides, sit to stands ○ Weeks 2-3: Progression to wall squats and step up exercises ○ Week 4: Advanced to hip abduction, step exercises, mini-squats, toe gait • Power Training : Focus on movement velocity to improve power by stimulating type II muscle fibers through rapid contractions. Power training reduces quadricep impairment and enhances static and dynamic balance • Dynamic Balance Training : Improves knee function and reduces fall risk through progressive exercises: ○ Weeks 1-2: Seated torso twists, sit to stands, lifting heels in standing ○ Weeks 3-4: Standing twists, lateral walking, step exercises
• Subchondral bone deterioration • Synovial membrane inflammation
• Meniscus damage • Muscle dysfunction
Manual Therapy for Knee OA Research supports various manual therapy interventions: • Soft tissue mobilization of quadriceps, hamstrings, gastrocnemius, and peripatellar structures • Mobilization with movement (MWM) with sustained manual glide of tibia during knee extension/flexion • Passive joint mobilization of the patella or tibia These techniques reduce pain and increase functionality through neurophysiological effects, improved joint stiffness, enhanced cartilage properties, and capsule stretching.
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