Knee osteoarthritis

Hi I have a 75year old patient who has been diagnosed with osteo artritis of the knee.She has been Immobile for 2years now because of the pain.The right knee only flexes till 20 degrees and herleft till 70.As of right now i am giving her mobility exercises but they are not making much difference.IF anyone as any suggestions on how to reduce the pain and increase her range pls reply.
Thankyou.

[alophysio]

Hi Bhani,

Good luck - 2 years is a long time to be immobile. I wouldn't expect too much to happen too quickly.

Can your patient do hydrotherapy? The warm water and taking weight off the joint will help.

Otherwise, i would be doing pain-free weightbearing closed chain exercises to develop co-contraction strength and work into their lack of ROM.

I would also be looking at the whole lower limb kinetic chain for problems as being immobile has its drawbacks!

I hope this helps!

hi,

You have to find out his x-ray findings & other investigation reports of both knee joint & patellofemoral joint.

You can try contract-relax method to improve the joint mobility, before that u should assess completely to get a clear picture of his problem.

I think, he suits for knee replacement surgery.

good luck.

Hello!
Try using surge faradism to quads.I tried and found it quite helpful in reducing pain.Later syncronize it with active knee extension....It helps in reducing pain
Regards
Sana

Hello ,
Since she is immobile from past 2 years start with wax therapy and proceed to isometric of quadriceps, then mobility exercises.

If this lady has been immobile for 2 years I have a suggestion. What motivates her? What really makes her happy? Does she read, paint, do knitting, does she socialise? I would begin to wonder if this lady was depressed and to have lost the will to move. In cases like this I look for the highest form of emotional motivation, that process which will help her overcome the discomfort it will possibly cause her to get back to where she was. Let her lead. If you show her activities with her wrists, arms, hips, and she demonstartes that she is compliant then maybe she will try working on the area which is problematic. To stand she will need pliable hips and lumbar spine. She will need strong arms for a frame, she will need inner stength as well. If she has good family and frinds she will move is she is motivated. However family can often do to much, or a residential home may simply be giving her the gentle love and care she has never had. In which case why should she change? I find that a sitting class with a group outside the hospital setting works well.

Hi,

look for bone density since the patient is bedridden for 2 years

[bikefixr]

Have you tried a Bionicare unit yet? Don't know if it is available in Europe yet, but it just got it's FDA and Medicare approvals in the US. It started as an attempt to stimulate bone, but research found that changing waveforms could stimulate hyaline cartilage. The unit uses a low-level electric field to generate a negative charge in the knee joint, identical to the charge present in a healthy knee. Cartilage is aneural and avascular, so the chondrocytes rely on a neg charge to trigger regeneration. The cartilage doesn't know or care where the field comes from. Bottom line is that the unit has impeccable science behind it from Johns-Hopkins and is being prescribed by many of the top knee doctors in the US. The clinical results are impressive in restoring function and reducing pain. It takes a motivated patient becuase therapy is 6-8 hrs / day for several months. It took years to create the problem, it takes months to restore it. This is not for the patient who is waiting for a cure in a pill or a magic wand.

[sdkashif]

Have a look over some useful articles regarding the physiotherapy management of Knee OA.

Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis.

Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial

EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT)

[davidjack]

hi u hav not given detailed assesment result.ok then,u say her flexion is restricted.Is it fexion r flexion to extnsion.Becoz in o.a knee mostly in chronic patient like urs develop FFD(fixed flexion deformity)i.e extnsion will be affected. u say the reverse.
Regarding Rx go for waxbath/ IFT,short arc knee exs.try this out