Deyle et al in 2000 did a research trial looking at the effect of combining hands on physical therapy with exercise for knee osteoarthritis (OA). They compared the results to a placebo group. The physical therapy group received hands on treatment that consisted of soft tissue mobilization, stretching and joint mobilization to the knee. Similar treatments were applied to the low back, hip or ankle if those areas were thought to be contributing to the knee problem. The exercises consisted of stretching exercises for the knee joint and muscles of the lower limb, muscle strengthening for the hip and knee and riding a stationary bicycle. The exercises were done such that they caused no pain or minimal pain. The treatment lasted for 8 sessions, and then patients were to continue a home exercise program.
After 8 weeks, the physical therapy group showed improvement on a questionnaire asking about their perceived pain, stiffness and functional ability. As well, they were tested on the distance they were able to walk in 6 minutes, and this measure showed improvement.
At 1 year after enrollment in the study, the treatment group still showed most of the improvement that they showed at 8 weeks.
One of the key findings in the study is that at 1 year after the start of the study, 20% of the placebo group had undergone total knee replacement surgery, but only 5% of the treatment group had undergone knee replacement surgery. As well 15% of patients in the placebo group had received injections while only 5% of the treatment group had received injections.
This study concluded that a combination of hands on physical therapy and exercise was more effective than no treatment for improving timed walking distance as well as patient perceived pain, stiffness and functional ability in patients with knee OA. This treatment may defer the need for surgery.
Deyle G, Henderson N. Effectiveness of manual physical therapy and exercise in osteoarhritis of the knee. Annals Of Internal Medicine. February 2000;132(3):173-181.