Osteoarthritis (OA) is a degenerative joint disease not only affecting the joints but the structures around and inside the joints too(1). The ageing process is already accompanied by balance issues (2,3), but the presence of knee OA speeds up the deterioration of balance system, impairing the balance further and increases the chances of fall and re-occurrence of knee pain(4).
Till date traditional physiotherapy treatment is focused on reducing knee pain, increasing knee ROM and strengthening exercises but lacked in balance and proprioceptive training.
Why Is Balance/Proprioceptive Training necessary in such cases?
A high prevalence of falls is one important factor that contributes to the mobility limitations and difficulties with activities of daily living in such condition. Researches found that 50% of adults with knee OA has experience fall in one year span and they require help with activities of daily living after the fall and will expect to need help for next 6 months (5). Thus focusing on balance is essential apart from traditional Physiotherapy treatment.
Which Training Program Works?
Amal. et al, invested the effect of two physiotherapy programs.
1) Traditional physiotherapy program – consisting of ROM, stretching and strengthening exercises and
2) Sensorimotor (balance) program – consisting of static and dynamic balance exercise and functional exercises.
on Pain, function and disability in population with Knee OA.
He found that sensorimotor training produced significant improvement of all balance measurements, while a traditional exercise program produced non-significant improvement in all the balance measures.
It was suggested that the sensorimotor training increased coordination between muscle groups and improved the response to sensorial information. In sensorimotor training, the patient progresses through exercises in different postures, base of support, and challenges to their center of gravity. So, each exercise elicits automatic and reflexive muscular stabilization demanding the patient to maintain postural control under a variety of situations.
Off-course, Traditional physiotherapy program needs to be continued where we focus on ROM, stretching, strengthening and mobility exercises but incorporating balance exercises (both static and dynamic) is very much important with clients with joint issues and older age. Make sure to assess the balance first and intervene accordingly.
- D.T. FelsonDevelopments in the clinical understanding of osteoarthritis. Arthritis Res Ther, 11 (1) (2009), pp. 203-224
- C.W. SlemendaThe epidemiology of osteoarthritis of the knee. Curr Opin Rheumatol, 4 (4) (1992), pp. 546-551
- R. Whipple, L. Wolfson, C. Derby, D. Singh, J. TobinAltered sensory function and balance in older persons. J Gerontol, 48 (1993)
- N. Verzijl, R.A. Bank, J.M. TeKoppele, J. DeGrootAGEing and osteoarthritis: a different perspective. Curr Opin Rheumatol, 15 (5) (2003), pp. 616-622
- 5. Levinger P, Menz HB, Wee E, et al. Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg Sports Traumatol Arthrosc. 2011;19:1082–1089.
- 6. Amal F. et al. Effect of sensorimotor training on balance in elderly patients with knee osteoarthritis. Journal of Advance research, Oct 2011, Volume 2.
Dr. Mansi Parikh
Co-Founder EndoRush App