Knee Osteoarthritis

Exercise Physiology Brisbane - 12 September 2017

Osteoarthritis (OA) is a common degenerative disorder that affects many people and can cause significant pain and disability. There can be many causes for the onset of OA including general wear and tear, age, obesity and injury. Despite how common this is across the population, the exact mechanism for how it begins remains poorly understood. The condition itself is characterised by a degradation of articular cartilage, which through various complex mechanisms, leads to alterations to the joint structure and ultimately causing pain and loss of function. The most common site for OA to appear is in the knee, and the most common symptom reported by people seeking treatment for knee OA is pain. This combination can lead to significant reduction of function if no treatment is received.

 Due to just how common OA is, along with the presence of pain and loss of function associated, there is great interest in better understanding this condition. There are some recent studies that have explored the possibility that some of the pain being felt by suffers is myofascial is nature, which is known as myofascial pain. The reason this is being explored as a possible source of the pain is because there tends to be a discrepancy between radiographic findings and the reports of pain form sufferers. Myofascial pain is defined as “the complex of sensory, motor and autonomic symptoms causes by myofascial trigger points”. These trigger points are often in the form of small nodules in the muscle itself that can cause pain if pressed. They also have the potential to cause referred pain in surrounding areas and movement dysfunction. There are two main types of trigger points that have been identified. The first is known as an Active Trigger Point and is associated with spontaneous bouts of pain and discomfort. The second is known is a Latent Trigger Point which is not associated with spontaneous pain, but can have pain elicited by compression and are thought to cause a reduction in range of motion. While trigger points have generally been accepted as being real, the mechanism behind their presence is not well understood at all. What we do know anecdotally is there can be significant pain reduction by releasing these trigger points.

 A recent critical review examined several studies in order to determine if there are any benefits of using different release techniques on the trigger points. They looked at four studies to first look at how commonly occurring these trigger points in patients with knee OA are. All of the studies they looked at showed there was a higher occurrence of trigger points in those that suffered from OA when compared to people that do not. The muscles that were most commonly affected were the rectus femoris, gastrocnemius, vastus medialis and adductors. There was also a group of 6 studies that looked at the benefits of myofascial release through various techniques on the pain levels of OA sufferers. Some of the interesting findings of these studies included:

  • myofascial trigger point injections reduced the intensity of pain and improved mobility
  • myofascial release techniques improved ROM and significantly reduced pain levels
  • Dry needling’s improved function and pain scores
  • Spray and stretching techniques improved pain ratings
  • Lidocaine injections improved ROM, reduced pain and increased function,
  • ITB myofascial release improved ITB flexibility, patella alignment and pressure pain threshold. 

 So, what does this all mean? Simply put, there is sufficient evidence outlined in these studies to include the release of the myofascial trigger points for someone who is experiencing pain from knee OA. And while there isn’t one specific method that has been shown to be the most effective, they are all beneficial in some way. Of particular note in that impressive list of improvements is myofascial release techniques, which can be achieved with a massage ball, and ITB release through the use of a roller. Both of these techniques are ones that we use in our practice and that can be relatively easy to be implemented to your home program.

 ITB rollouts are a very simple and easy release technique that can easily be achieved at home. It simply requires a roller and some space. A video outlining the technique in order to achieve this method can be found here. The idea is to simply lie on your side with the lateral aspect of the quads on the foam roller and slowly make your way down, slowing down at any point that seems particularly tender and spending a small amount of time on that location until the sensation has diminished.

 The second technique highlighted is self-myofascial release (SMR). SMR techniques are more general and can be achieved using many different implements such as a massage ball and foam roller, whilst being applied to any number of areas. The specific muscles that these studies highlighted as important are rectus femoris, gastrocnemius, vastus medialis and adductors. If this is something you’re looking to include in your program, click on the links of each of the muscle names to view a video that can help demonstrate the techniques and areas for that particular muscle. The idea for this technique is similar to that of the ITB in that you want to target the tender areas until the strong sensation associated subsides, even if only a little bit.

These techniques are all relatively safe to implement at home, and can have significant result as outlined in the studies mentioned in this article. It is important to not over-use them though, as this can cause more pain and muscular tension. A few minutes at a time is plenty to elicit some results. If you have any questions about these techniques, please get in contact with one of the staff members for more information.

 Anthony Markey
Student Exercise Physiology (EPB Prac Student)