Conservative and non-pharmacological options for knee osteoarthritis

Conservative Care Options for Knee Osteoarthritis

Recent recommendations from The Canadian Medical Association and British Medical Journal represent a monumental shift in pain management.

Physicians, now more than ever are recommending conservative treatment including but not limited to: low-impact exercise, acupuncture and manual therapy as part of a multi-modal approach for patients suffering from osteoarthritis knee pain.

This post gives a brief overview of non-pharmacological pain management strategies for osteoarthritis related knee pain.

Manual Therapy for Osteoarthritis of The Knee

Degenerative meniscus and osteoarthritis of the knee is common in the general population. In this condition sensitization of nociceptive pathways may result in patients with osteoarthritis perceiving relatively low level stimuli as being overtly painful.

Manual therapy has been shown to improvement in function in patients who suffer from osteoarthritis related knee pain (Busse et al. 2017, Xu et al. 2017, Salamh et al. 2017).

Why Does Manual Therapy Work?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs.

In terms of clinical responses to massage therapy manual therapy and oscillatory joint mobilization has an effect on supraspinal processes which influence nociceptive processing and therefore OA-related pain.

Acupuncture for Knee Pain

Evidence based acupuncture has been shown to yield short and long-term improvement in function and pain relief in patients who suffer from osteoarthritis related knee pain (Lin et al. 2016, MacPherson et al. 2017, Vickers et al. 2018, Woods et al. 2017).

Why Does Acupuncture Work

If you use Occam's razor, the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system.

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia).

All of these areas are highly innervated and as a result there are a number of physiological changes across different areas of the peripheral and central nervous systems including: peripheral receptors, dorsal horn of the spinal cord, brainstem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas (Chen et al. 2017).

Low Impact Exercise

Good Life with osteoArthritis in Denmark (GLA:D™) is an evidence-based education and supervised neuromuscular exercise program. This program has been shown to have a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave (Skou et al. 2017).

Key Point

Non-pharmacological therapeutic interventions are being embraced by the medical community because they are often simple to carry out, economical, and have relatively minor side effects.

There are a number of non-pharmacological options for osteoarthritis that patients can discuss with their physician. None of these options are a panacea, but they may help you put together a individualized multi-modal program to manage osteoarthritis related symptoms.

More to Explore

Massage Therapy: Injury Specific Treatments
As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of conditions including, but not limited to:
• Sports Related Aches and Pain
• Shoulder Injuries
• Carpal Tunnel Syndrome
• Post-Operative Patients
• Compartment Syndrome
• Dupuytren's Disease
• Low Back Pain
• Neck Pain
• Post-Concussion Syndrome
• Temporal Mandibular Disorder (TMD)
• Scar Management

Research Links
Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C.L., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28504066

Ali, A., Rosenberger, L., Weiss, T.R., Milak, C., Perlman, A.I. (2017). Massage Therapy and Quality of Life in Osteoarthritis of the Knee: A Qualitative Study. Pain Med.
https://www.ncbi.nlm.nih.gov/pubmed/27590465

Arendt-Nielsen, L. (2017). Joint pain: more to it than just structural damage? Pain.
https://www.ncbi.nlm.nih.gov/pubmed/28151834

Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/28483845

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Corbett, M.S., Rice, S.J., Madurasinghe, V., ... Woolacott, N.F. (2013). Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage.
https://www.ncbi.nlm.nih.gov/pubmed/23973143

Courtney, C.A., Steffen, A.D., Fernández-de-Las-Peñas, C., Kim, J., Chmell, S.J. (2016). Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/26721229

Juberg, M., Jerger, K.K., Allen, K.D., Dmitrieva, N.O., Keever, T., Perlman, A.I. (2015). Pilot study of massage in veterans with knee osteoarthritis. J Altern Complement Med.
https://www.ncbi.nlm.nih.gov/pubmed/25966332

Khan, M., Adili, A., Winemaker, M., Bhandari, M. (2018). Management of osteoarthritis of the knee in younger patients. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/29358201

Lin et al. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.
https://www.ncbi.nlm.nih.gov/pubmed/27655986

MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
https://www.ncbi.nlm.nih.gov/pubmed/28121095

Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
https://www.ncbi.nlm.nih.gov/pubmed/27594189

Pan, F., Tian, J., Aitken, D., Cicuttini, F., Winzenberg, T., Jones, G. (2017). The association of knee structural pathology with pain at the knee is modified by pain at other sites in those with knee osteoarthritis. Clin Rheumatol.
https://www.ncbi.nlm.nih.gov/pubmed/28918594

Salamh, P., Cook, C., Reiman, M.P., Sheets, C. (2017). Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis. Musculoskeletal Care.
https://www.ncbi.nlm.nih.gov/pubmed/27860218

Siemieniuk, R.A.C., Harris, I.A., Agoritsas, T., ... Kristiansen, A. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28490431

Skou, S.T., Roos, E.M. (2017). Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord.
https://www.ncbi.nlm.nih.gov/pubmed/28173795

Vickers, A.J., Vertosick, E.A., Lewith, G., ... Linde, K. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/29198932

Woods, B., Manca, A., ... Sculpher, M. (2017). Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One.
https://www.ncbi.nlm.nih.gov/pubmed/28267751

Xu, Q., Chen, B., Wang, Y., Zhou, Y. (2017). The Effectiveness of Manual Therapy for Relieving Pain, Stiffness, and Dysfunction in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Physician.
https://www.ncbi.nlm.nih.gov/pubmed/28535547

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Conservative Care for Knee Osteoarthritis