Vital Care Medical and Chiro-Med Rehab Centre (Newmarket location) are now offering a joint collaboration for the management of OA Knee. An interdisciplinary approach combing medical and rehabilitative services allowing you to receive a truly integrated approach to management, in turn increasing your percentage of being symptom free and leading an active lifestyle. Our OA Knee Program may involve all of the below components or just some of the components depending on your symptoms, presentation and stage of osteoarthritis. Our program is evidence based, offering consultation / assessment & investigation, prescribed medications, joint injections, in-office supervised exercise program, kinesio-taping, detailed home exercise program, supportive knee bracing (custom and off-the-shelf) and patient education.

Osteoarthritis of the knee is a chronic condition where the cartilage in the knee joint gradually wears away, allowing the bones to rub against each other.

Risk Factors.13

  • Advancing age – 80% of people over age 55 have some radiographic evidence of this condition
  • Gender – females are 2 to 3 times more likely to develop OA
  • Obesity – weight loss may reduce this risk
  • Occupation – OA knee has been linked to occupations involving frequent squatting & kneeling
  • Sports – risk is increased for those who participate in wrestling, boxing, pitching in baseball, cycling, parachuting, cricket, gymnastics, ballet dancing, soccer & football

Symptoms.13

  • Pain
  • Morning stiffness
  • Swelling
  • Crackling or grating sensation
  • Bony outgrowths

Stages of knee osteoarthritis

If you are suffering from knee pain and experience any 3 of the following signs / symptoms below, our program may be of benefit for you:

  • Age greater than 50 years
  • Morning stiffness lasting less than 30 minutes
  • Crackling or grating sensation (crepitus)
  • Bony tenderness of the knee
  • Bony enlargement of the knee
  • No detectable warmth of the joint to the touch

Consultation

Consultation and assessment with a medical physician to confirm your diagnosis of osteoarthritis of the knee joint. Diagnostic interventions of x-ray, CT Scan and / or MRI may or may not be required. If you have any recent studies completed please feel free to bring them with you for review. Anti-inflammatory medications may be discussed and offered if you have not already tried a course of treatment.

Who would be a candidate for intra-articular injections?

  • Patients with severe inflammation or pain that prevents you from initiating an exercise program
  • Ineffectiveness of or contraindications of oral medications
  • Elderly patients for whom surgical treatments carry risk

Corticosteroids (Kenalog)

Corticosteroid injections provide short-term pain relief for OA of the knee by relieving inflammation.7 Duration of effects vary and have few side effects.8

Euflexxa® (Hyaluronic Acid)

Euflexxa (1% sodium hyaluronate) is a hyaluronic acid (HA) product that is manufactured from a natural source of HA. The non bird-derived substance is put through a precise, multistep cleansing and filtering process that creates a highly purified, gel-like HA fluid. Euflexxa is for injection into the knee to help replace your knee’s own HA.9,10 Hyaluronic acid functions as a thick, slippery fluid that helps cushion, lubricate and protect the bones and joint tissue. In patients with OA of the knee, the HA gets thinner over time and becomes less able to provide protection.11 It is proven to be effective complementary or alternative therapy for the treatment of the symptoms of osteoarthritis.

Euflexxa’s® primary method of action is the direct replenishment of a joint’s synovial fluid (HA), which works to lubricate and cushion the affected joint. Injections of Euflexxa allow for an increased range of motion with a decreased amount of pain.5 Viscosupplementation is a nonsurgical treatment that not only offers pain relief, but potentially provides protection of the cartilage in the knee.4 You can find further information at: http://www.euflexxa.com/ Knee Injection

Aerobic fitness and strengthening exercises are an essential component of managing OA Knee.3

How can exercise help you?1

  • Reduce pain
  • Improve joint stability
  • Improve flexibility
  • Promote synovial nutrition
  • Increase function and independence
  • Reduce weight

Supervised Clinic Exercise Program

An exercise program will be tailored to patient’s previous function, pain severity, muscle strength, and other symptoms or conditions.

Quadriceps femoris muscle weakness is correlated with knee pain and functional disability in knee osteoarthritis.2 Research has shown that the size of vastus medialis is imperative to the reduction of knee OA progression.6 Rehabilitation will focus on strengthening the quadriceps, with focus on the vastus medialis muscle; a typical program may be similar as the one outlined below:

  • Warm-up with walking on a treadmill or cycling at low intensities
  • Aerobic exercise on treadmill or bicycle
  • Strengthen quadriceps with focus on vastus medialis muscle
  • Improve proprioception with weight-bearing exercises
  • Stretching routine

Home Exercise Program

Patients will receive prescribed exercises and stretches to maintain the therapeutic gains of their supervised exercise program. Studies have shown stronger gains as well as therapeutic benefits related to OA Knee are more likely to be maintained in the supervised clinical setting.12 Research has shown that exercises such as resistance training, walking, cycling, aquatic exercise, Tai Chi and balance and agility training are beneficial for persons with knee osteoarthritis. These exercises help by reducing symptoms and improving function.1

Custom DonJoy Knee Bracing – Custom Adjustable OA Defiance®

The Custom DonJoy Brace can be customized to offload stress on any compartment of the knee joint, resulting in reduced inflammation, less pain and preventing any further deterioration in the knee joint. The custom knee brace can be worn in conjunction with other treatment options, such as joint injections.14

Off-The-Shelf Bracing – OA Reaction Web™ Knee Brace

The REACTION WEB is a responsive, webbed approach to knee pain that gives you a distinct alternative to the basic knee sleeve. The elastomeric web is an innovative solution that absorbs shock, disperses energy and shifts pain away from your knee. This comfortable solution is easy to apply. It takes the shape of your knee, with an improved design engineered for better fit and comfort. 15

Goals of our Program

  • Reduce Symptoms
  • Reduce rate of OA progression
  • Improve your function
  • Educate you, regarding your responsibilities

  1. Smith, T., Kirby, E., & Davies, L. (2014). A systematic review to determine the optimal type and dosage of land-based exercises for treating knee osteoarthritis. Physical Therapy Reviews, 19(2), 105-113 9p. doi:10.1179/1743288X13Y.0000000108
  2. Seong Hoon, P., & Gak, H. (2015). Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis. Journal Of Physical Therapy Science, 27(3), 729-731 3p. doi:10.1589/jpts.27.729
  3. Roddy E, Zhang W, Doherty M, et al.: Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus. Rheumatology (Oxford), 2005, 44: 67–73.
  4. Stitik, T. (2001). Viscosupplementation for osteoarthritis. Physical Medicine & Rehabilitation, 15(1), 117-145 29p.
  5. http://www.alvedapharma.com/suplasyn.html
  6. Wang, Y., Wluka, A. E., Berry, P. A., Siew, T., Teichtahl, A. J., Urquhart, D. M., & … Cicuttini, F. M. (2012). Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis & Rheumatism, 64(12), 3917-3925 9p. doi:10.1002/art.34681
  7. O’Connor, M. I., MD. (2004). Nonoperative management of knee arthritis: A little bit of this, a little bit of that. Orthopedics, 27(9), 971-972. Retrieved from http://search.proquest.com/docview/203912548?accountid=6180
  8. Bellamy N, Campbell J, Robinson V, et al. Intraarticular corti-costeroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;2:CD005328.
  9. Date on file. Bio-Technology General (Israel) Ltd.
  10. EUFLEXXA [package insert]. Parsippany, NJ: Ferring Pharmaceuticals Inc; 2014.
  11. Benke M, Shaffer B. Viscosupplementation treatment of arthritis pain. Curr Pain Headache Rep. 2009; 13(6):440-446.
  12. Kalunian, K. C., Tugwell, P., Curtis, M. R., (2015) Nonpharmacologic therapy of osteoarthritis – www.uptodate.com
  13. Kalunian, K. C., Tugwell, P., Curtis, M. R., (2015) What is OA Knee – www.uptodate.com
  14. http://www.djoglobal.com/products/donjoy/custom-adjustable-oa-defiance
  15. http://www.djoglobal.com/products/donjoy/oa-reaction-web?landingpage=false