Exercise Prescription for Osteoarthritic Knee

Osteoarthritis of knee is the commonest of the joint diseases in India. Even conservative estimates put the prevalence rate at 22% and the number goes up to 70 percent in age specific population (above 65 years). How do our people tackle such a widespread problem? Among people who have access to healthcare services most are treated with pain killers. Many consume supplements like glucosamine or chondroitin. A significant number of patients also opt for more intensive form of treatment like knee replacement surgery. However many sufferers are ignorant of the fact that a key component of efficient OA knee care is self management. In fact the number one recommendation of American Academy of Orthop aedic Surgeons (AAOS) is to participate in self management programs like strengthening or neuromuscular training. A carefully designed exercise plan thus goes a long way to help patients alleviate their suffering.


In this post we offer a set of nine exercises which are easy and effective in mild to moderate osteoarthritis knee.

One: Isometric Quadriceps exercise

 

Sit on a firm surface with straight knees. Roll a bath towel and place it under your knees. Now press one knee downwards towards the towel by tightening the front of thigh muscles.  Hold for 10 seconds, without lifting the ankle. Repeat with the other knee. Avoid breath holding and breathe normally while performing this exercise.

This is a staple exercise for OA knee. Start at ten repetitions each leg per set, sets three sets per day (morning, noon, evening).

Two: Quadriceps drill/McKenzie knee extension

 

Sit comfortably on a chair. Then gradually straighten one knee, keeping the toes pointed upwards and outwards (Great toe at 2’O clock position). Once straight the front thigh muscles are tightened as much as possible for 2-3 seconds.  Then bring it down and repeat on the other leg.

Perform this exercise 10 times every two hour.

Three: Straight leg raise

Lie straight on your back. Now lift one of your legs up, at about forty-five degrees.

Keep your knee straight and toes pointed upwards. Hold the position for ten seconds and then bring the leg down slowly.

 

Perform this exercise ten times per set, three sets per day (morning, noon, evening).

 

Four: Ply VMO Training

 

 

VMO is a very important muscle  present next to the knee cap on the inner side. To activate VMO Stand upright, leave a little gap between two legs. Then rotate the feet outwards, as it is shown in the picture. From this position, bend the knees a little, not more than twenty-thirty degrees. If you are low on balance you can grab a chair to prevent yourself from falling down. Start with a set of 3, you can increase once accustomed. Perform three sets per day (morning, noon, evening).

 

 

 

Five: Modified ballet Third-(VMO Training)

 

 

 

The feet need to be positioned correctly to train the VMO efficiently by this exercise. Start at the normal standing position and turn the right feet 45 degrees outward. Now place the heel of the left leg touching the inner border of the right leg between the heel and toe. This leg too is rotated outwards 45 degrees.

From this position push your feet to eachother and  bend your knees just a few inches and straighten up. Perform this exercise throughout the day, whenever you get a chance.

 

 

Six: Patella Mobilization

 

Sit with straight legs, keeping a towel below the knee. Then hold a knee cap by thumbs and index fingers of both hands.  Now slide the knee cap left and right slowly maintaining the same grip. Similarly move it up and down as well. Do this 10 times in each direction.

 

Seven: Calf Muscle Stretch

 

 

Sit on a firm surface keeping the legs straight. Now use a folded towel or belt to hook upper part of your feet. Pull the foot towards you, keeping the knees extended. You will feel a stretch in your calf. Do this one leg at a time, keeping the stretch for 15 seconds. The pull should be strong but not to the extent of producing pain. Repeat this 3 times a day.

 

Eight: Posterior capsule Stretch

Again the starting position is sitting with knees extended. Make a towel roll like exercise 1, but this time put it below the ankle. Now press down with your knee, trying to touch the back of the knee with the resting surface. Hold this for 15 seconds. Repeat 10 times every two hours.

 

 

Nine: Balance Exercise

 

 

Stand next to a wall (for support) while keeping both the feet along a straight line. Now leave the wall support and count how many seconds you can stand in this position. Go easy on yourself with this one, avoid falling down.

 

 

 

 

 

Epilogue

If exercises increase pain, avoid them. Visit a good physiotherapist, they know best when it comes to therapeutic exercise.

In addition to exercises on the knees, manual therapy can provide early and lasting relief. Physiotherapist is the authority here too.

Exercises and lifestyle changes can control your knee pain and prevent worsening of your condition.

TC!

About the author

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.