A degenerative process (see “Why does a joint become osteoarthritic?”) of the knee joint, which is often gradual in onset, chronic knee swelling and pain with occasional episodes of increased pain, which is often stiff first thing in the morning and later in the day.

Diagnosis

Diagnosis of knee osteoarthritis is derived from the patient’s history and physical exam with an unremarkable neurological exam and no indicators of potentially serious pathology.

Chiropractors perform a thorough history of complaint and examination (orthopaedic, neurological and chiropractic testing). Assessment may also include the use of diagnostic imaging including X-ray and MRI.

Imaging studies are confirmatory for diagnoses of moderate or severe osteoarthritis [109,110].

Evidence based summary for manual therapy [53]

There is moderate quality evidence (on a scale of low, moderate and high) that manual therapy of the knee and/or full kinetic chain (pelvis to foot) combined with multimodal or exercise therapy is effective for the symptoms of knee osteoarthritis [108, 116, 117].

Other effective non-invasive physical treatments or patient education [53]

Exercise therapy, advice about weight loss, appropriate footwear, pulsed electromagnetic field therapy, acupuncture, and TENS [110 -115].

Back-in-Action Clinical Comment

Chiropractic treatment of knee osteoarthritic problems are initially based on reducing inflammation and improving the movement, position and stability of the knee and surrounding structures in order to reduce the risk of stress and further tissue damage.

Self help recommendations of using ice or heat is often given in the acute stage and limiting of aggravating activities. Rest, elevation and support may also be recommended. Nutritional approaches can be beneficial to help support soft tissue healing. Chiropractic adjusting techniques (manipulation) and mobilisation may be applied to improve the function of the knee joint itself and other functionally related joints in the lower back and leg. Various muscle release techniques may be applied. An emphasis is placed on self help exercise which might include self mobilisation, stretching, strengthening and balance training. Core stability exercise often is useful for improving the position of the low back, pelvis and hip. Areas of severe muscle spasm may also benefit from massage or acupuncture. Foot orthotics, heel lifts, sitting advice and other ways to improve postural problems affecting the knee may be suggested. Functional neurological treatment and exercises can be helpful.

Severe cases of osteoarthritis usually benefit more from surgical interventions.