Drug-Free Treatment for Osteoarthritis

Once mobility and range of motion improve, strength training is started with the idea of giving more support to the joint and removing stress from the bone and cartilage.

Osteoarthritis of the knee, the most common type of arthritis, is a crippling disease that affects 1 in 3 Americans over the age of 63.

Now, groundbreaking research conducted by United States Army medical researchers indicates manual therapy, in conjunction with proper home exercise prescribed by a physical therapist, is a potent drug and surgery-free treatment for osteoarthritis of the knee.

Sufferers of the disease now have more options, according to Erika Jacob, a licensed physical therapist and geriatric specialist at Denver Physical Therapy (DPT), Denver, Colo., a unique practice that focuses on holistic, natural approaches to physical ailments. "What this study does is support that our treatment is a potent one for osteoarthritis and very attractive to those who want a cost-effective and non-invasive method of dealing with the disease," says Jacob.

"Causes for osteoarthritis are not always known, but it's felt that they are bio-mechanical in nature," she adds. "Erosion of joint cartilage causes it to become rough and even disappear completely, so the effect is bone rubbing on cartilage instead of cartilage rubbing on cartilage. The effect is much like sandpaper. And in really severe cases, we see bone rubbing on bone."

"Clinically, we see pain and swelling in and around the joint. The pain is substantially worse if it is a weight-bearing joint such as the knee," says Jacob. "The pain improves with rest but the joint can become very stiff when immobilized. Stiffness causes more rubbing which can create a no-win situation."

Prescription for healing

Those suffering from osteoarthritis of the knee may experience tenderness, swelling, grinding and popping with motion, and mild to severe limitation of joint motion. Jacob's prescription for osteoarthritis is a combination of hands-on physical therapy and a custom-tailored home exercise program. Physical therapy treatment is designed to stretch the tight muscles and strengthen the weak ones. This treatment, followed by a prescribed home-exercise program, significantly reduces pain, and while it won't reverse degeneration of the tissue surrounding the knee, it will slow its progression.

"When degeneration occurs and normal activities continue, inflammation and varying levels of pain begin," says Jacob. "Naturally, when we have pain, we tend to stay away from activities and motions that hurt. However, when we stop using an area, it gets stiff, the surrounding muscles begin to weaken, and the capsule around the joint tightens. Manual therapy can improve the symptoms of osteoarthritis by increasing joint mobility with mobilization. Active range of motion lubricates the joint and passive range of motion stretches the capsule and soft tissue."

Once mobility and range of motion improve, strength training is started with the idea of giving more support to the joint and removing stress from the bone and cartilage. According to Jacob, physical therapists may suggest ending activities that put too much stress on the joint, but usually offer alternative activities.

"A combination of manual physical therapy and prescribed home exercise is very effective in slowing further degeneration of the disease, but it doesn't preclude common sense practices. We don't advise patients to take up running, necessarily," says Jacob.

A revealing study

A study published in the Annals of Internal Medicine indicates that after only one to two months of physical therapy, patients show increased mobility and more than a 55 percent improvement in tests measuring pain, function and joint stiffness.

Typically, osteoarthritis is treated with nonsteroidal anti-inflammatory drugs (NSAIDS). Long-term use of NSAIDS, however, can lead to gastric complications, increased risk for hospitalization and perhaps death.

"Osteoarthritis of the knee is one of the most common problems that otherwise healthy patients present," says Dr. Yani Zinis, physical medicine specialist at Denver Orthopedic Associates (located at Rose Hospital in Denver). "And although we can't correct the disease-state of osteoarthritis without replacement surgery, we can recommend treatment that may potentially slow the progression of the disease while dramatically improving the patient's function and lifestyle."

"I'm a big advocate of physical therapy as treatment for osteoarthritis of the knee," says Zinis, who is also an assistant team physician for the Colorado Avalanche and the Denver Nuggets. "I see professional athletes at the age of 22 or 23 with moderate levels of osteoarthritis of the knee. The benefits of physical therapy as an effective treatment of the disease are meaningful, even to those at a young age."

In the past, sufferers of osteoarthritis of the knee were forced to turn to drug therapy or opt for a new pair of knees. However, new knees are only replacement parts that tend to wear out after about a decade. The operation typically isn't feasible for extremely old patients, so doctors and their patients must look to alternatives.