Physical therapy Essay Example

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Knee osteoarthritis

Knee osteoarthritis is a progressive disease that affects the knee ligaments, cartilage and the knee bone simultaneously. Knee osteoarthritis is a major cause of disability especially among the elderly population and in mostly allied to impaired balance and proprioception (Rhon et al, 2013). Knee osteoarthritis affects the entire joint and this includes joint lining, cartilage, ligaments as well as the bone joint. Therefore, the disease is typified by breakdown of the cartilage, joints becoming bony, tendons and ligaments deteriorate and also there is inflammation of synovium. The common symptoms include swelling, presence of baker’s cyst, stiffness, pain and cracking noise when moving the knee. If these symptoms gradually prolong, then one is diagnosed with knee osteoarthritis (Alshami, 2015).

Bhatial et al (2013) explains that knee osteoarthritis is most common in individuals who are involved in intense physical exercises that require massive strain on the knee. It may also occur to the elderly population and people who are obese mostly on the upper body more than the lower body so that a lot of weight is exerted on the knee joints during movements. An injury on the knee is an indicator that such persons will suffer knee osteoarthritis. After the injury, knee cartilage starts wearing out progressively leading to formation of a limp on the knee as more cartilage wears out with time. The patient’s knee becomes bow-shaped (Bhatial et al 2013).

According to Heidari (2011) pain along with other symptoms of knee osteoarthritis profoundly affects the quality of life and hence affects both physical functioning and psychological functioning. Since knee osteoarthritis is not a localized disease of only the cartilage, it is deemed as a choric disease that affects the entire joint and this includes articular cartilage, meniscus, ligament, and peri-articular muscle that might be cause by numerous pathophysiological mechanisms (Heidari, 2011). Generally, knee osteoarthritis is a painful and a disabling disease that affects many patients worldwide. The development of knee osteoarthritis involves various factors and hence the disease pathophysiology includes interplay of various systematic and local factors. In addition, several risk factors such as age, trauma, knee malalignment, obesity and even imbalanced physiological processes contribute to the progression and disabling effect of the disease. Usually, there is no cure but rather treatment and management for knee osteoarthritis. Most treatment administered to the patients is usually done to ease the pain (Zelman, 2016).

Management of knee osteoarthritis involves both pharmacological and non-pharmacological interventions. Non-pharmacological interventions include physiotherapy management of the condition which involves Physiotherapy management includes thermotherapy that lowers spasm, pain and aids in improving joint range of motion, electrotherapy which consists of transcutaneous electrical nerve stimulation as well as ultrasound. Patients with the condition also undergo exercises performed to strengthen knee muscles. Sowers et al (2011) provides some examples of the exercises that encompass strengthening exercises, isometric exercises of quadriceps, and also cycling on a static cycle. Other treatment modalities used in knee arthritis manual therapy that is used in relieving pain and increase joint range of motion; neural mobilization that reinstates the balance between the relative movement of neural tissues and the bordering areas and hence allows reduced pressures on the neural tissues, enabling normal functioning.
Muscle Energy Technique (MET) and also perturbation exercises are some of therapies used to manage knee osteoarthritis and impairments that occur due to the condition (Sowers et al, 2011).

Therapeutic Myotherapy interventions in knee osteoarthritis

Currently the treatment of knee osteoarthritis focuses on the management of the symptoms and not minimizing or stopping disease progression. Heidari (2011) provides that a management approach to knee osteoarthritis should encompass education about the disease and its management which should include pain management and alternatives to improve function, reduce disability and prevent disease progression.

Manual therapy

Manual therapy is among interventions used in treating knee osteoarthritis. Courtney et al (2016) define manual therapy as the therapeutic application of manual where hands are used in mobilizing, adjusting, manipulating, applying traction, massaging and stimulation in order to influence the function of the health of the patient. Since knee osteoarthritis results to loss of joint mobility Rhon et al (2013) explain that manual therapy is utilized as the primary treatment to restore normal joint mechanics. Accordingly, it is essential to improve patient’s symptoms such as stiffness, joint hypomobility, chronic pain as well as joint impairment.

Evidence shows that a combined approach using active and passive mobilizations has better health outcomes. Courtney et al (2016) conducted a manual physiotherapy for knee osteoarthritis where the study participants underwent manual therapy as well as stretching, muscle strengthening, range of motion and home exercises as well. This study had superior health outcomes when compared to the control group. Bhatia et al (2013) also found out that manual therapy along with home exercises for patients with knee osteoarthritis resulted to greater and more symptomatic relieve when compared to the group of patients who only received home exercises. Moreover, in both studies it was observed that the group that received manual therapy took fewer analgesics to reduce pain and had more satisfactory health outcomes when compared to control groups. Accordingly, these studies show that manual therapy combined with supervised exercises are effective in treating knee osteoarthritis.

Courtney et al (2016) conducted a study to examine the relative efficacy of knee joint mobilization and capsaicin cream in patients with knee osteoarthritis. The study results indicated that capsaicin cream was effective in treating knee osteoarthritis. This study found supportive evidence for passive oscillatory mobilization when treating knee osteoarthritis especially when it comes to pain control. It was observed by Moss et al (2012) that there was a prevalent hypoalgesic impact in addition to the instant one where there had been accessory mobilization of a human osteoarthritis knee joint. This was after he conducted a study on 38 patients with knee osteoarthritis and knee pain, those getting passive accessory movements experienced more pain on the immediate part but also on the bordering areas, when compared to those that were getting no-contact treatments. Full kinetic chain and manual knee therapy when used simultaneously produce ideal results according to Jansen (2013). Ensuring that the patella, tibia-femoral joint and manual traction are mobilized ensures is perfect treatment. This is basically the combination of manual therapy and exercise therapy.

Rice & McNair (2010) also found out that manual therapy and exercises significantly reduced pain in individuals with knee osteoarthritis. In addition, the study found that motion improved and also gait speed improved after the manual therapy was combined with stretching, strengthening, along with mobility exercises

Neural mobilization

According to Lee (2013) neural mobilization is a treatment mode that has emerged as an addition to other musculoskeletal injuries. The main objective of this treatment is to reinstate the balance between the relative movement of neural tissues and the bordering areas. This allows reduced inherent pressures on the neural tissues hence enabling normal functioning. Its main advantages include increased neural vascularity, enhancement of nerve gliding, and improvement of axoplasmic flow, low nerve adherence and diffusion of noxious fluids (Butler 2010). Evidence suggests that neural mobilization is an effective mode of treatment aimed at restoring normal neural biomechanics and physiology. There are two alternate mobilization techniques which include the slider and tensioner techniques. These techniques have been tested and positive results found. The study conducted by Lee (2013) was to examine the impacts of the two techniques on knee range of motion of normal subjects when bending. The bend angle was measured before and after these mobilization techniques were applied. The slider technique brought about a mean percentage decrease of 17.5% of the bend angle. The tensioner technique on the other hand had a 12.5% difference. This is an indication of the significance of the techniques in improving knee extension range of motion when bending. In addition, the sensitivity of the neuromeningeal structures and the sciatic nerve to weight is reduced. It was evident that patients who get this combination of techniques demonstrated greater improvement in pain in comparison to those who got placebo treatment (Emshoff, 2011). This indicates the effectiveness of neural mobilization in treatment of knee osteoarthritis. The mechanism behind efficacy of neural mobilization is that muscles strengthen because change that occur at the neuromuscular junction. This means that there is strengthening of the muscles because there is improvement of the connection between the brain and the muscles. With the improvement of the neuromuscular efficiency, the muscle strengthens (Rice & McNair, 2010).

Muscle Energy Technique (MET) in knee osteoarthritis

Muscle Energy Technique is a procedure carried out by a therapist by carefully positioning the affected area, then contracting muscles through isometric and isotonic contractions to relax or strengthen hypertonic muscles (Koh, et al 2-16). The movement of the limb or soft tissues to a new position after the therapy has been completed. The amount of force, duration and direction of the movement are all controlled by the therapist. According to Rhon et al (2013) the manual nature of the procedure means that it is slow. This procedure must meet some requirements, which are; detecting a barrier, using isometric contraction and reacting to the isometric contraction to enhance easier vacation to a different barrier. Reflexive reciprocal inhibition occurs at the antagonistic muscles as the Golgi tendon organ activation simultaneously inhibits the agonist muscles when the isometric contraction is taking place. The antagonistic and agonistic muscles continue to be inhibited during contraction which enables the joint to be transferred into the limited range of motion (Koh et al, 2016).

Rhon et al (2013) argues that relaxing the hypertonic muscle through active contraction then stretching of the muscle is one of the chief aims of MET. There are many similarities with other stretching methods used by therapists. However, MET is a combination of reciprocal inhibition and postisometric relaxation with isokinetic procedures. A variety of procedures involving isometric contractions that barely involve active to total strength contractions are invoked. However, Fryer (2010), deduced that MET was not an ideal remedy for low back pain due to deficiency of evidence. There were 12 different random trials in the research that had 500 partakers for the sample exercise. They resulted into short term outcomes that were regarded to be highly biased apart from one. There was little to indicate that MET had extra advantage in comparison to other therapies. This was on short term pain results (Fryer, 2010). As the results indicated, when compared to corticosteroid injections (CSI), MET is an ideal for treatment of lateral epicondylitis in the long term. Both the CSI and the MET group were assigned 82 participants. CSI was found to be a better treatment for returning strength and reducing pain as a short term treatment as compared to MET. However, as a long term treatment MET is a better treatment for chronic lateral epicondylitis (Koh & Seffinger, 2016). Fryer infers that MET is an efficient technique for treating pain, promoting hypoalgesia, minimizing edema, maximizing muscle extensibility and improving lymphatic flow (Fryer, 2010).

Fryer (2010) conducted a study on 120 patients with knee osteoarthritis where the study participants were randomly assigned to a MET group and a control group. According to the study results there was improvement in both hamstring flexibility and strength and hence this study indicated that MET is ideal treatment for suboccipital tenderness, hamstring altered flexibility, contraction duration of atlanto-axial joint and gross trunk range of motion. In addition, Choksi and Tank (2016) established that MET to be helpful in improving flexibility and hamstring strength in knee osteoarthritis patients.

Perturbation exercises in knee osteoarthritis

As Rhon et al (2013) provides knee osteoarthritis often impairs balance and proprioception. Perturbation exercises can aid in improving these impairments. A study conducted by Rhon et al (2013) found out that therapeutic effects of manual physiotherapy increase when combined with proprioception. This study further found out that perturbation exercises can elevate joint load in the knee and treat balance and proprioceptive deficits and hence lower the risk of falls. However, Rhon et al (2013) provide that whereas perturbation exercises might be helpful, it can cause inflammation and increase pain especially when done in a standing position. Therefore, more studies are needed to establish if is possible for patients with knee osteoarthritis to be administered with intensive perturbation during the manual physical therapy without increasing the pain or disturbing functional outcomes.

Supplementary forms of rehabilitation

. Bhatia et al, 2013) who found that the therapy can increase the efficacy of isokinetic exercise for functional improvement of knee osteoarthritis. Electrical stimulation is also used in treating complications of knee osteoarthritis. Transcutaneous electrical nerve stimulation is among the most effective physical modalities in the management of knee osteoarthritis. Evidence shows that transcutaneous electrical nerve stimulation is an effective pain reliever due to its analgesic mechanisms which generates analgesic effects (Naryana et.al (2012) ultrasound has been shown to be effective in treatment of musculoskeletal disorders. The efficacy of ultrasound in treating musculoskeletal disorders was evident in Bhatia et al (2013). Heat agent can use heat packs to relax muscles or use ultrasound to generate high temperatures. According to Naryana et.al, 2012)Different types of rehabilitation that use physical agents have been shown to be effective in treating various musculoskeletal disorders. The devices used utilize physical modalities to achieve therapeutic effects. For instance, heat, cold and pressure have been used for a long time to speed up healing and reduce pain (

Yoga therapy has also been shown to assist in building body strength, flexibility and also in reducing arthritis pain and joint stiffness (Bhatia et al, 2013). The slow and controlled physical movement of joints is what helps in improving range of motion and reducing pain and also in increasing blood circulation within the joints (Bhatia et al, 2013).

References

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Bhatia D, Bejarano T & Novo M, 2013, Current interventions in the management of knee osteoarthritis, J Pharm Bioallied Sci, 5(1): 30–38.

Bhatia D, Tatiana B & Novo M, 2013, Current interventions in the management of knee osteoarthritis, J Pharm Bioallied Sci. 5(1): 30–38.

Courtney CA, Steffen AD, Fernández-de-Las-Pñas C, Kim J, Chmell SJ, 2016, Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee, J Orthop Sports Phys Ther,46(3):168-76.

Deyle GD, Gill NW, Allison SC, Hando BR, Rochino DA, 2012, Knee OA. Which patients are unlikely to benefit from manual PT and exercise? J Fam Pract,  61:E1–8.

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Heidari B, 2011, Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I, Caspian J Intern Med, Spring; 2(2): 205–212.

Hinman RS, Hunt MA, Creaby MW, Wrigley T, McManus FJ & Bennell KL, 2010, Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res, 62(1):1190–3.

Koh, C., & Seffinger, M. A. (2016). Muscle energy technique improves chronic lateral epicondylitis. The Journal of the American Osteopathic Association, 116(1), 58.

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