PHYSIOTHERAPY

MANAGEMENT FOR
KNEE OSTEOARTHRITIS
By- Dr. Mayuri Zanwar
Content
• Electrotherapeutic Modalities
• Therapeutic Exercises
• Manual Therapy
• Taping,
Electrotherapeutic Modalities

• Trancutaneous Electrical Nerve Stimulation

• Ultrasound
• LASER
• Interferential Current
• PHONOPHORESIS(US+PAIN RELIVING OINMENT)
Transcutaneous Electrical Nerve
Stimulation

Patient Position: Supine Lying Technique:

TENS device under the patella of the symptomatic knee, with the knee flexed at
90.Base = 90Hz
Sweep = 1 to 250 Hz
pulse width = 60 ms Quadripolar / Two channel
Duration = 10-20 minutes
Pulse= symmetrical biphasic
The intensity was gradually increased during the intervention, as sensation decreases
owing to habituation.
Ultrasound

• Patient Position: Supine Lying Technique

• US treatment head to be applied over the site of maximum pain of the affected knee joint.
• US dose: Frequency = 1 MHZ
• Intensity = 1.5W/cm2,
• Mode = continuous
• duty cycle=100%
• Duration = 10 minutes
Laser therapy:

• Patient Position: patients in supine lying position.

• Treatments will be delivered with a diode laser
• wavelength =830 nm, continuous wave, power= 50 mW)
• Dose :skin contact at a dose of 6 J/point.
• Duration:per point are in the range of 30 seconds to 1 minute. eight
points were irradiated per session.
Interferential therapy

• Patient Position: Supine Lying Technique:

• Four interferential pad electrodes will be placed around the affected knee joint. The patient will be explained
that he will feel a tingling sensation which should not be unpleasant. Interferential dose: Frequency = 4000 Hz

• Base = 90Hz

• Sweep = 50Hz

• Beat Frequency = 90-130 Hz

• Quadripolar / Two channel Duration = 10-20 minutes

• IFT will be turned on (parameters as above) Gradually the IFT output intensity will be increased until the
`normal' tingling is encountered by the patient.
Phonophoresis

• Patient Position: Patient Position: supine position with a roller under the affected knee to maintain flexion at
90°

• The ultrasound device was held over the tibiofemoral joint medial to the patellar tendon to enhance energy
penetration into the joint space. Gel containing 1.16% diclofenac diethylamonium was applied by an us device
to the superomedial, inferomedial and lateral sides of the knee in circular movements.

• Frequency = 1 MHZ

• Intensity = 1.5W/cm2,

• Mode = continuous

• duty cycle=100%

• Duration = 10 minutes
Electrotherapeutic Modalities

• Trancutaneous Electrical Nerve Stimulation

• US
• LASER
• IFT
• PHONOPHORESIS(US+PAIN RELIVING OINMENT)
 Quadriceps muscle strength exercises
• supine position:

 In this situation, a pillow is placed underneath a knee and it is flexed for a

15-degree angle.
 the patient has to completely extend his knee and lift it up off the ground.
 The same process is repeated for the other knee. In this situation, the patient
should directly lift up his calf off the ground in an extended position.
 The same process is repeated for the other knee. In this situation, the normal
knee is bent while the involved knee is relaxed straight on the ground.
Then, the involved knee is hoisted higher than the bent knee’s level and it is
kept in that position for 5 seconds and it will be allowed to go down
smoothly.
 In supine status, 2 knees are on the fixed surface and the patient should
move her two legs down and keep them contracted and, then, relaxed.
• sitting position
• At the start of exercise, first, the knee is flexed to
above 90 degrees and, then, flattened to 180 degrees
that are kept contracted, and knee muscle contraction
should be in a painless state and, then, slacked.

• Duration
• Quadriceps muscle strength training was done in 3 sets and each set with 10 repetitions (30 repetitions in
total) with low intensity.
• The treatment was 5 sessions per week for 3 weeks and each session took 35 minutes
Dynamic-type strengthening exercise

• In their home, with a volume of 3 sets of 15 unilateral repetitions, with extension and flexion movement for
both knees (2-s duration per movement), with a frequency of twice a day.
• For calculation of 1-repetition maximum (1rm), a red, green, or blue band test (theraband) was performed,
requesting that the patient perform at least 10 repetitions of extension.
• the band was tied to a belt worn by the participant, which that would aid in stabilizing the exercise.
• The participant leaned against a wall, sitting on the floor with both knees in extension. They were asked to
flex and adjust the elastic band to generate tension against the extension of the knee.
• Rest intervals between each series where 30 s. Frequency of execution was 3 days per week. The patient was
also asked to perform stretching exercises for quadriceps and hamstring muscles, lasting 15 s per muscle
group, twice a day and 6 days which lasted a week.
Hip strengthening:

• Hip muscle strengthening: The intensity/dosage of the exercise varies from 50% to 80% of either 1 RM or 10
RM for 2 to 3 sets of 8 to 20 repetitions and the frequency ranges from 3 to 5 times per week
• Hip abduction and adduction in side-lying (weight cuffs)
• Isometric hip abduction (towel squeeze placed between the thighs)
• Standing hip flexion and extension
• Side-lying clam
• Seated internal and external rotation

• b b b.
Resistance training:

• The most common regimens prescribed are 2 to 3 sets of 8 to 12 repetitions, starting at a

resistance maximum of 50% to 60% with a progressive scale for 3 supervised sessions per
week, for an average of 27 weeks.
• Session may include 20 minutes of seated quad strengthening; 30 and 50 minutes of high-
resistance and low-resistance full knee flexion/extension exercises, respectively
• Exercises include: seated quad strengthening, high-resistance and low-resistance full knee
flexion/extension exercises, quad strengthening consisting of leg extension, leg press, and
forward lunges.
closed kinetic chain and open kinetic chain exercises

Hot Packs (20 minutes)

1. Quadriceps Setting exercise
2. Straight-Leg raise exercise
3. Short-Arc Terminal Knee Extension exercise
4. Full-Arc Knee Extension exercise
5. Rowing machine exercise
6. Standing wall slides
7. Lunges
8. Step up-step down exercise
• Each exercise was done in 3 sets of 10 repetitions
•L
Retro walking (Backward Walking):

• 10 min of supervised retro walking training with 5-min

warm-up and cool-down sessions 3 days a week for 6
weeks at their comfortable walking speed.
• The participants were instructed to gradually increase
their walking time up to 30 min over the 6-week period.
• In the warm-up and cool-down sessions, the subjects were
instructed to perform heel raise exercises, ankle toe
movements, and gastrocnemius-soleus and hamstring
stretches.
MANUAL THERAPY
• Movement With Mobilization
• Maitland Mobilization
Movement With Mobilization(MWM)
Glide Patient Position Procedure
Knee Flexion MWM: Side Glide with Belt Supine lying Mobilization: Medial or lateral glide of tibia
Assistance through mobilization belt
  Movement: Knee flexion

Knee Extension MWM: Side Glide in Open Supine lying Mobilization: Side glide of tibia on stabilized
Chain femur Movement: Knee extension
   
 
 Maitland Mobilization
Glide Patient Position Procedure
Knee Distraction Patients were supine. Grasp around the distal leg, proximal to the
malleoli with both hands. Pull on the long axis of
  the tibla to separate the joint surfaces.
 
 

Knee Dorsal Glide. Patients were supine The guiding hand supported the lower limb from
the anterior side of the distal femur. The
mobilization hand was positioned over the
anterior surface of the proximal tibia, and the
tibia was moved in the posterior direction

Knee Ventral Glide patient in supine and knees in resting position (The knee is flexed 25 The guiding hand supported the lower limb from
degree, the anterior side of the distal tibia. The
  mobilization hand was positioned over the
posterior surface of the proximal tibia, and the
  tibia was moved in the anterior direction.

Patellar glides Patients were placed in a side-lying position knee supported using a knee supported using a wedge and slightly flexed
wedge and slightly flexed to a degree that allowed a vertical to a degree that allowed a vertical gravitational
gravitational glide of the patella in a lateral to medial direction. glide of the patella in a lateral to medial direction.
   
TAPING
• Before application of Kinesiotaping , the area to be treated was cleaned and checked. All the patients who were eligible
to this study were taken allergic test to Kinesiotaping.
• In this taping method, it consists of 3 strips (Two "Y" strips and one "I' strip).
• The anchor portion of the tape is about 4 cm in length. The length of "Y" strip is about 13 cm and "I" strip is about
11 cm.
• All bases of stripes and ends of stripes were applied with paper off tension. The desire tension is applied between the
bases and ends (Middle portion).
• The patient was positioned in supine lying. The first "Y" strip represent of
• Quadriceps and the tails wrap the patella medially and laterally with 50% tension with maximum knee flexion. For the
second strip "Y" strip was applied between tibial tuberosity and inferior pole of the patella with 90˚of knee flexion.

• The tails wrap the patella medially and laterally with 50% tension. For the third "I" strip was applied to patella
mediolateral with 50% tension in the position of 30˚ knee flexion.
• The Kinesiotaping application was kept for 3 days.
• After three day interval, Kinesiotaping was replaced. The patient was renewed Kinesiotaping in cases the tape had
separated.
• Received Kinesio tape application to knee with 2 times per week for 3 weeks
Others
• Taping
• Bracing&Orthosis
QUADRICEPS MUSCLE
STRENGTHEINING:
• Patient position:
• Technique:
• Duration:
• Reps:
• photo:
tens
• Patient position:
• Technique:
• Duration:
• Parameters:
• Intensity:photo