1. RECENT ADVANCES IN
‘EXERCISES FOR
OSTEOARTHRITIS OF THE KNEE’
Presenter :Dr.Pooja Joshi

2. Content
 Introduction
 Methodology
 Traditionally used exercises
 Recent advances of exercises
 Implication in clinical practice
 Evidence for recent advances

3. Introduction
 Osteoarthritis (OA) is one of the most
disabling degenerative diseases affecting the
elderly
 The reported prevalence of knee OA is
approximately 3% among individuals
between the ages of 45 to 54 years
 This number rises to 27% for those between
63 and 69 years, and increases once again to
44% for persons above the age of 80 years

4.  Knee osteoarthritis (OA) is a prevalent chronic
musculoskeletal condition associated with pain,
physical and psychological dysfunction, and
reduced quality of life in affected individuals
 The experience of pain is influenced by a
multitude of structural, physical, and
psychosocial factors
 Whilst stimulation of nociceptors in the capsule,
subchondra bone, ligaments and other joint
tissues contribute to the perception of pain,
structural damage in knee OA is in fact not well
correlated with pain severity

7. classification
GRADE FEATURES
GRADE: 0 No features
GRADE:1 Doubtful: Minute osteophyte, doubtful
significance
GRADE:2 Minimal: Definite osteophyte,
unimpaired joint space
GRADE:3 Moderate: Moderate diminution of
joint space
GRADE:4 Severe: Greatly impaired joint space
with sclerosis of subchondral bone

8. Joint pain Altered jOint alignment
malalignment Limited range of motion
Decreased proprioception Joint contracture
Muscle weakness Crepitus
Pain or aching with activity Joint swelling

9. Radiological presentaion
 Osteophytes at joint margins
 joint space narrowing
 subchondral sclerosis
 cysts

10. Objective
To search a evidence based recent exercise to
treat the patient with knee osteoarthritis

11. LITERATURE SEARCH
Pubmed
Total=454
Filtered =5
Med line
Total=343
Filtered=4
Cocharane
Total=4
Filtered=
Total=9

12. Inclusion criteria
 Articles published in last 3years
 Cochrane review , systemic review and
randomised controlled trial
 Population is knee osteoarthritis alone
 Tibio-femoral arthritis
 Chronic ( more than 3months)
 Age above 45 years
 Both genders
 Intervention is only exercise therapy
 Free full text available

13. Exclusion criteria
 Population is whole lower limb osteoarthritis
or hip and knee both arthritis together
 Interventions other then physical therapy is
used
 Modalitis or conventional therapy used

14. Traditionally used
 Active exercise – knee ,hip ,ankle
 Strengthening exercise – isometric , isotonic
 Weight bearing exercise
 Bicycle
 treadmill

15. Recent advance
 Proprioceptive exercise
 Tia-chi exercise
 Aquatic resisted exercise
 Neuromuscular exercise

16. Proprioceptive training
 Variation in standing
 Standing on different surface
 Walking
 Computer foot game
 10 weeks training
 4 sessions /week

17. Aquatic exercise
 The pool is heated at 35 degree
temperature a
 Protocol:
 12 weeks (4 sessions / 1week )
 1st 3 weeks – with bare foot
 2nd 3 weeks-small fins
 3rd 3weeks- large foot boot

18. Tia-chi exercise
 Patients with
osteoarthritis of the
knee benefit from
Tai Chi by increasing
lower extremity
muscular strength
and joint stability
 Tai Chi typically
includes a series of
dance-like
movements that
combine to postures
or forms.The forms
are executed using
slow and smooth
movements that
flow into each other

19. 1.Sun style
2.Yang style
12 Weeks
40min/session
8weeks should be
done in clinic
then 4 weeks can
be done at home
by watching
video

20. Vibration platform for
improving balance 1.Static exercise
2.Dynamic
exercise
2sessions / week
training for 8
weeks
Improve muscle
strength and
proprioception

21. Neuromuscular exercise
 Neuromuscular exercises aim to
improve the position of the trunk and
lower limb joints relative to one
another, as well as quality of
movement performance
 Standing on even surface
 Standing on uneven surface (board )
 Ball exercise
 Walking with forward lunges in
between
 Trunk rotation one leg on chair
 Knee flexion should not go beyond 30
degree in weight bearing
 40 min session 4/week
 6 weeks

22. Systemic review

23. The effectiveness of proprioceptive-based
exercise for osteoarthritis of the knee: a
systematic review and meta-analysis
RCTS Interventions Control
group
result
10 perturbation exercises:
side
stepping, braiding,one
leg standing,walking
on heels and toes
,computer foot step
games .cross over
steps during forward
and backward walking
(10 repetition * 3
sessions )
static
exercise bike,
isometric
hamstrings,
quadriceps
and abductor
(6 s hold 98),
through range
isotonic
resisted
quadriceps
and hamstring
exercises
The findings of this review indicate
that proprioceptive
exercises are efficacious in the
treatment of people with
knee OA.
There is some evidence to indicate
the effectiveness
of proprioceptive exercises
compared to general
strengthening exercises in
functional outcomes.
the current evidence base is small

24. The effects of therapeutic exercise on the
balance of women with knee osteoarthritis: a
systematic review
Rcts intervention Control group Result
Resistance training Quadriceps
strengthening ex
SLR
Moderate evidence
for therapeutic
exercises improved
the balance of women
with knee OA
9 Vibration platform :
dynamic and static
Abductor and
quadriceps isotonic
strengthening
Mini-squat with
anterior-posterior
displacement and side
to side displacement
Walking
One leg standing
Strengthening and
balance exercise in
heated pool

25. Physical Therapy Interventions
for Knee Pain Secondary
to Osteoarthritis
No of rcts Interventions used result
193 rcts Proprioceptive Exercise Proprioceptive and aquatic
and ti-chi has moderate
evidence in improving
functional activities of
knee than othrs .
Aerobic Exercise
Aquatic Exercise
Strengthening Exercise
Tai Chi
Massage

26. A systematic review and meta-analysis of
Tai Chi for osteoarthritis of the knee
Total rcts Experimental
groups
Control groups result
5 Yang style ti-chi
(12 weeks
40 min session
4/week)
sun style ti-chi
(12 weeks
20-40 min session
3/ week)
Treadmill walking
Bicycle
Recreational
Activitis
moderate
evidence for
short-term
improvement of
pain, physical
function and
stiffness in
patients with
osteoarthritis of
the knee
Further research
is required

27. randomized controlled trial

28. A Comparative Study of Proprioceptive
Exercises versus traditional
Training Program on Osteoarthritis of
Knee
subjects Group-1 Group-2 result
50 Quadriceps
strengthening
Knee extension in
high sitting
SLR
Normal walking
One leg standing
One leg standing
with closed eyes
Toe walking
Heel walking
( 20 meters )
proprioceptive
exercises
are more
beneficial than
traditional
exercises
group
Cross body leg
swing(15
repetition )

29. Comparison of neuromuscular and quadriceps
strengthening exercise in the treatment of varus
malaligned knees with medial knee osteoarthritis: a
randomised controlled trial protocol
Subjects Group-1 Group-2 Group-3 result
100 Dynamically and
functional
strengthening
Knee extension
with hold at 30°
knee flexion-
start
sitting with knee
at 90° flexion,
extend to 30°
using
resistance of
ankle weights.
Control group
(no intervention )
innovative
neuromuscular
exercise
program that aims
to reduce medial
knee load and
pain and improve
function in people
with medial
compartment
OA and varus
malalignment.
With trunk
control pelvic in
proper alignment
and knee is in
neutral position
on foot
Quads over a roll
using resistance
of ankle weights.
SLR up to 30 with
weight cuff
Theraband
exercise

30. Impact of exercise on the functional
capacity and pain of patients with knee
osteoarthritis: a randomized clinical trial
patient Group -1 Group-2 result
100 included stationary
bicycle, hamstrings
stretching, and
quadriceps
strengthening
which received a
manual with
information about
knee osteoarthritis
and instructions
on how to deal with
knee symptoms in
daily activities
Quadriceps
strengthening
exercises for eight
weeks are effective
to improve pain,
function, and
stiffness in patients
with knee
osteoarthritis

31. Effects of a progressive aquatic resistance exercise
program on the biochemical composition and morphology
of cartilage in women with mild knee osteoarthritis:
protocol for a randomised controlled trial
patient Group-1 Group-2 result
80 The intervention
group will
participate in a
progressive aquatic
resistance exercise
program of 1-hour
duration 3
times a week for
four months
Warmup
session:15min
Strengthning
:35min
warmup;;10
Control group with
no intervention
Progressive aquatic
exercise program
has evident effect
on morphology and
cartilage

32. Comparison of proprioceptive functions between
computerized proprioception facilitation
exercise and closed kinetic chain exercise in
patients with knee osteoarthritis
subjects Group-1 Group-2 Group-3 result
60 person’s foot
pressed the
pedal to the
bottom, a
snake’s head
immediately
appeared
on the
computer
screen, ready
to catch prey
20 repetition
3 sessions
Closed chain
exercise
knee in the
supine
position with
their foot
placed on the
centre of the
pedal of
the Shuttle
Mini Clinic
resistance
device (90 to 0
degree)
(10 repetition)
Control group Both
treatments
are beneficial
in improving
proprioceptive
functions

33. References :
 Mondam, S. et al., 2012. A Comparative Study of Proprioceptive
Exercises versus traditional exercise program on Osteoarthritis of
Knee. , 1(12), pp.31–35.
 Smith, T.O., King, J.J. & Hing, C.B., 2012. The effectiveness of
proprioceptive-based exercise for osteoarthritis of the knee: a
systematic review and meta-analysis. Rheumatology international,
32(11), pp.3339–51.
 Vincent, K.R. & Vincent, H.K., 2013. NIH Public Access. , 4(5 0),
pp.1–14.
 Waller, B. et al., 2013. Effects of a progressive aquatic resistance
exercise program on the biochemical composition and morphology of
cartilage in women with mild knee osteoarthritis: protocol for a
randomised controlled trial. BMC musculoskeletal disorders, 14, p.82.
 Wang, S. et al., 2014. Annals of Internal Medicine Physical Therapy
Interventions for Knee Pain Secondary to Osteoarthritis.

34.  Bennell, K.L. et al., 2011. Comparison of neuromuscular and
quadriceps strengthening exercise in the treatment of varus
malaligned knees with medial knee osteoarthritis: a randomised
controlled trial protocol. BMC musculoskeletal disorders, 12(1),
p.276.
 Lauche, R. et al., 2013. A systematic review and meta-analysis
of Tai Chi for osteoarthritis of the knee. Complementary
therapies in medicine, 21(4), pp.396–406.
 Lin, D.-H. et al., 2010 Comparison of proprioceptive functions
between computerized proprioception facilitation exercise and
closed kinetic chain exercise in patients with knee
osteoarthritis. Clinical rheumatology, 26(4), pp.520–8.
 Mizusaki, A. et al., 2012. Impact of exercise on the functional
capacity and pain of patients with knee osteoarthritis : a
randomized clinical trial. , 52(6), pp.870–876