Did therapy help your knee pain?
“Knee osteoarthritis (OA) is one of the leading causes of pain and disability worldwide”
This is an indication of how prevalent this condition is in the world. Arthritis is seen as a byproduct of aging, but this doesn’t mean that it directly causes pain.
“…exercise intervention has been shown to be efficacious and is recommended in multiple guidelines; however, its treatment effect has been reported to be modest.”
Everyone can benefit from exercise, but the extent of the benefit for patients with knee pain may not be that “miracle” that people expect.
“Although the statistical effectiveness of exercise for knee OA has been clearly demonstrated and may be equivalent or better than commonly prescribed medications, the effect on pain reduction and function remains modest.”
Exercise is a powerful tool or at least among the most powerful that we have now. In saying this though, it is not a magic elixir.
“The MDT approach has been extensively used to classify and treat patients with spinal pain. Studies have shown the MDT approach to be valid, reliable, able to successfully predict outcomes and associated with decreased lumbar surgery rates, pain, and disability.”
If this doesn’t sound great, then I don’t know what does! MDT (Mechanical Diagnosis and Therapy) is a specific assessment and treatment style that Is not taught in school. One must go through advanced courses and take a test to say that they are competent at using the method. Ask your therapist if they have taken any courses in the method and if they have achieved the certification through the Institute. This is the only way to determine if the therapist that you are seeing is competent to utilize the principles of the system.
“The most prevalent and well-studies MDT subgroup is the ‘derangement’ classification. This classification has been described in all joints and has been associated with a rapid response to specific end-range exericses…”
Would you like your symptoms to rapidly improve? Who wouldn’t? Roughly 40% of patients with knee pain may have symptoms that respond rapidly to a single exercise. Turning off pain doesn’t have to be difficult. In many patients, it only takes a single exercise to reduce or turn off the pain. This has to be followed-up with a constant assessment in order to determine which exercises the joint will tolerate at a specific point in time in order to ensure that the symptoms do not return when not in the clinic. There has been a lot of research in the medical world regarding Low Back Pain, but this article is the first that I have seen using the same principles for osteoarthritic knees.
“…significant treatment main effects were present for all primary outcomes. The MDT derangement subgroup had improved scores at 2 weeks and 3 months compared to the MDT nonresponder subgroup for all primary outcomes”
This is huge! This sentence essentially states that doing one exercise is more beneficial than doing many for a small subset of patients. Now for a little more information on a derangement. If there is one exercise that can greatly improve your pain, then there will be multiple exercises that either have no effect or make the pain worse. If your therapist is not at least looking for and ruling out this preferential exercise or direction of movement, you may be in therapy for a longer period with a longer list of home exercises. These exercises may or may not have a positive or negative effect on patient’s whose symptoms are rapidly reducible.
“The physical therapists were credentialed in the McKenzie system, and results may not be applicable to non-McKenzie-trained therapists.”
This sentence stands on its own. Anyone claiming to use a method should at least be trained and credentialed in using the method. In the Joliet area, there are only two of us endorsed by the McKenzie Institute to utilize this method.
In short, this study was performed on patients waiting to receive a total knee replacement, which means that they were shown to have severe arthritis on an X-ray. The patients receiving McKenzie-based treatment outperformed those receiving traditional evidence based guideline therapy and those that received no therapy. Seek out an MDT trained clinician if you are experiencing knee pain.
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