21/08/2025
Osteoarthritis – Physiotherapy Management (Evidence-Based)
🔹 Definition
Osteoarthritis (OA) is a chronic degenerative joint disease characterized by articular cartilage breakdown, osteophyte formation, and joint space narrowing. Most commonly affects the knee, hip, spine, and hand joints.
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🔹 Stages of OA (Kellgren–Lawrence Classification)
1. Stage I (Doubtful OA): Minor osteophytes, minimal symptoms.
2. Stage II (Mild OA): Definite osteophytes, mild joint space narrowing, intermittent pain.
3. Stage III (Moderate OA): Multiple osteophytes, moderate joint space narrowing, stiffness, reduced ROM.
4. Stage IV (Severe OA): Large osteophytes, marked joint space loss, deformity, chronic pain, disability.
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🔹 Physiotherapy Management According to Stages
1. Stage I–II (Early / Mild OA)
Goals: Prevent progression, reduce pain, improve function.
✅ Evidence-Based Interventions:
Patient Education: Lifestyle changes, weight management. (Messier et al., 2013)
Exercise Therapy (Strong Evidence – OARSI, NICE):
Quadriceps & Hip Strengthening (straight leg raises, mini squats)
Low-impact aerobic exercise (cycling, swimming, walking)
Flexibility & Stretching for hamstrings, calves.
Manual Therapy: Joint mobilization (Maitland Gr I–II for pain relief).
Electrotherapy (Short-term): TENS, IFT, Ultrasound – for pain modulation.
Orthotics / Bracing: Patellar taping or unloader braces in knee OA.
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2. Stage III (Moderate OA)
Goals: Pain reduction, maintain mobility, delay surgery.
✅ Evidence-Based Interventions:
Progressive Strength Training: Closed-chain exercises (leg press, step-ups).
Balance & Proprioceptive Training: Wobble board, single-leg stance.
Hydrotherapy: Reduces joint load, improves ROM.
Functional Training: Sit-to-stand, stair climbing practice.
Assistive Devices: Cane/walker for off-loading.
Adjunct Modalities: Shockwave therapy (emerging), Kinesio-taping (mixed evidence).
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3. Stage IV (Severe OA)
Goals: Reduce pain, maintain independence, prehabilitation (before surgery).
✅ Evidence-Based Interventions:
Pain Management: TENS, Heat/Cold packs.
ROM & Gentle Mobilization: To prevent contractures.
Strength Maintenance: Isometric quadriceps, glute sets.
Gait Training with Aids: Walker, cane.
Prehabilitation before Joint Replacement: Strengthening quads & hips to improve post-op recovery (Bandholm & Kehlet, 2012).
Post-Surgical Physiotherapy: Early mobilization, CPM (continuous passive motion), progressive strengthening, gait re-education.
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🔹 Key Evidence-Based Guidelines
NICE Guidelines (2022): Exercise and education are first-line, pharmacological & surgical only if conservative fails.
OARSI Guidelines (2019): Strong evidence for exercise therapy, weight reduction, self-management strategies.
Cochrane Reviews (2019): Exercise improves pain and function significantly in knee OA.
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🔹 Summary Table
Stage Physiotherapy Focus Evidence
I–II (Mild) Exercise, Education, Manual Therapy, Orthotics Strong (OARSI, NICE)
III (Moderate) Progressive Strengthening, Hydrotherapy, Balance, Functional Training Moderate–Strong
IV (Severe) Pain Relief, Mobility Aids, Prehab before Surgery Moderate Evidence
