You may have seen a recent article posted on CBC titled Why Canada is Wasting Millions on Useless Knee Surgeries. The article, which you can read here, sheds light on the latest research that suggests arthroscopic surgical repair may not be the best option for patients with degenerative knee diseases like osteoarthritis. This evidence and the recommended guidelines developed by Siemieniuk, R. A et al. ( 2017) have only just been published, meaning many patients may still be recommended for this surgery. If you have a degenerative knee disease and read this article, you may be left wondering “do I really need arthroscopic knee surgery?” To answer the question, we talked to Ashlin Chamberlin, physiotherapist, and Clinic Team Manager at Sherwood Park Physiotherapy – pt Health.
How do you find out if you really need arthroscopic knee surgery?
The authors of this study suggest that no one with knee osteoarthritis (mild or severe) have arthroscopic surgery. So, if you know you have knee osteoarthritis, you might want to follow the suggested guidelines and try non-operative or conservative management first.
What is non-operative or conservative management?
Like the CBC article says, there is no easy answer for chronic knee pain. However, less invasive treatment options (also known as non-operative or conservative management) like physical therapy, massage therapy, chiropractic care, oral or topical anti-inflammatory medications can help.
Not only are these treatments less invasive, but they also help empower patients to take control of their situation and actively work towards improving their knee mobility and strength. It’s important to remember that you don’t need to be in pain, oral or topical anti-inflammatory medications may be prescribed by your physician to help you with pain management. If pain continues to be hindering a variety of intra-articular injections may also be used.
How can physical therapy help?
As a physical therapist, I can tell you that physio can help you return to your usual activities by improving mobility and strength. The use of physical therapy is supported by the Siemieniuk et al. (2017) clinical practice guideline previously mentioned. But, other research groups have also recommended physical therapy as an effective way to manage and treat knee pain. For instance, earlier studies show that an 8-12 week exercise program for patients with knee osteoarthritis provided:
- Pain reduction
- Improved knee function
- Decreased depression
- Reduced anxiety
What kinds of treatment can I expect if I seek physical therapy?
As mentioned above, you may be prescribed an exercise program. If you are, it should include these exercises to be effective (Herllan et al. 2007, Osteros et al. 2012, Far et al. 2012):
- Resistance training
- Mobility exercises
- Balance exercises
These are all exercises that a physical therapist can prescribe, modify and coach to the level that best suits each patient individually. Physical therapists may also use manual therapy techniques to assist in improving joint mobility, decrease pain and stiffness in addition to an exercise program.
Are there other therapies that can be used along with physio to reduce chronic knee pain?
Other therapies that may be used along physical therapy to reduce chronic knee pain include:
- Massage Therapy
- Chiropractic
- Acupuncture
- Aquatic Therapy
- Bracing
The CBC article states there likely is no long term benefit to this surgery, is there a long-term benefit from physical therapy?
Current research studies only follow patients for 6 to 9 months after physical therapy, so there isn’t a lot of published evidence showing long-term benefits. But, in my clinic, I do see patients successfully managing their condition for years with conservative treatments that include physical therapy, pain management with their physician and supplementing in other therapies like Acupuncture, massage, chiropractic or aquatic therapy.
How can I talk to my doctor about alternatives to surgery?
The Arthritis Society of Canada has an excellent guide on how to have effective conversations with your physician. This can be found on their website (http://education.arthritis.ca/TalkToYourHealthCareProvider/story_html5.html).
Know that you’re not alone, your physical therapist can also assist in advocating on your behalf by contacting your doctor to discuss your specific case and how medical management between the two professions will improve your care and symptom improvement.
We hope this has helped you better understand your treatment options. Book an assessment today, if you’re experiencing knee pain and would like to speak with a physiotherapist about non-operative treatment options.
About the Physical Therapist
Ashlin Chamberlain, PT
Ashlin completed her science degree from the Augustana Faculty at the University of Alberta in 2010 and went on to complete her Masters of Science in Physical Therapy from the University of Alberta in 2012. Ashlin has completed post-graduate courses including a Certificate of Vestibular Rehabilitation from Emory University, Bernard Tonks introduction to Vestibular Rehabilitation, Medical Acupuncture, Orthopedic Manual Therapy Level 3 Lower/Upper quadrants. Ashlin enjoys treating a wide variety of conditions at
Sources
Arthritis Society of Canada. (2017). Arthritis Society. Retrieved from http://arthritis.ca/home.
CBC News. (May 11, 2017). Why Canada is wasting millions of dollars on useless knee surgeries. Retrieved from http://www.cbc.ca/beta/news/health/arthroscopic-surgery-useless-1.4110569
Farr, J.N., Going, S.B., McKnight, P.E., Kasle, S., Cussler, E.C., & Cornett, M. (2010). Resistance training in patients with early knee OA lead to improved Physical activity. Phys Ther. Mar;90(3); 356-66. Retrieved from https://myorthoevidence.com/acereports/report/159/resistance-training-in-patients-with-early-knee-oa-lead-to-improved-physical-activity.
Hinman, RS; Heywood, S.E & Day, A.R (2007). Aquatic Physiotherapy reduces hip and knee osteoarthritis pain. Phys Ther. Jan; 87(1): 32-43. Retrieved from: https://myorthoevidence.com/acereports/report/863/aquatic-physiotherapy-reduces-hip-and-knee-osteoarthritis-pain
Osteras, H., Osteras, B., & Torstensen (2012). Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury. J Body Mov Ther. Oct;16(4):456-63. doi: 10.1016/j.jbmt.2012.04.003.
Herrlin, S; Wagne, P; Weidenhielm L, Werner S (2007). Exercise therapy alone similar to arhtorscopy plus exercise for degenrative mensical tear. Knee Surg Sports Traumatol Arhrosc. April; 15(4) 393-401. Retrieved from: https://myorthoevidence.com/acereports/report/5937/exercise-therapy-alone-similar-to-arthroscopy-plus-exercise-for-degenerative-mensical-tear
Siemieniuk, R., Harria, I.A; Agoritsas, T.; Poolman, R;l Brignardello- Petersen, R;l Van de Velde, S; Buchbinder, R; Englund, M; Lytvyn, L; Quinlan, C; Helsingen, L; Knusten, G; Olsen, N; Macdonald, H; Hailey, L; Wilson, H; Lydiatt, A; Kristiansen A. ( 2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017; 357. doi: https://doi.org/10.1136/bmj.j1982