Many conditions lead to knee pain. However, osteoarthritis (OA) and patellar tendinopathy (PT) are the most common causes of knee pain in adults [1][2]. Symptoms go on for years and impact quality of life, participation in sports or leisure activities, and even work- related tasks. Put simply, knee pain impacts nearly every area of life.
Improving your symptoms, function and decreasing you pain requires addressing physiological factors like muscle strength as well as sensory & neuromuscular factors such as proprioception and neuromotor control [1][3].
In physical therapy treatment, protocols and treatment programs vary. Some care plans may include supervised exercises only, while some may include manual therapy and newer treatments such as dry needling (DN). Some evidence suggests that DN is not more effective than exercises alone for addressing patellar tendinopathy [4]. Other evidence suggests that manual therapy in conjunction with supervised exercise program is more effective than supervised exercises alone [2].
Here’s a quote from a recent research article on Dry Needling and knee pain:
“Dry Needling combined with an Eccentric Exercises (EE) program was not shown to be more effective than a program of only EE to improve disability and pain in patients with patellar tendinopathy.” [4]
What does that mean? It basically means that, according to the research, physical therapy treatment programs for knee pain should include some sort of manual therapy as well as supervised exercises. As we’ve mentioned here, to truly be effective, physical therapy treatment programs need to include more than just passive treatments, like manual therapy. We also need to include active treatments like exercises and other activities.
What types of rehabilitation interventions are recommended for patients experiencing knee pain?
Research shows that rehabilitation programs that use high, slow resistance and/or moderate, slow resistance exercise programs provide significant clinical outcomes in many measures and functional areas including numeric rating scales (NRS) for pain during running, squats, and NRS during athletic or participation in sports [1]. Basically, that means programs that use slow resistance exercises tend to have real effects and can help reduce pain, increase strength, and
Evidence also suggests that supervised eccentric exercise programs, provided through physical therapy, can also provide clinically significant outcomes [2]. These can also be completed in an aquatic therapy program.
Manual therapies, in combination with a supervised exercise protocol, were also found to be more effective than a supervised exercise protocol alone for improving pain and functional disability in patients with knee osteoarthritis [2].
What about patients undergoing a total knee arthroplasty (TKA) or other knee surgery?
Research suggests that progressive resistive exercise programs lead to higher ultimate strength in the post-surgical knee and are safe to perform, under the guidance of a qualified physiotherapist [3]. In plain English? If you work to strengthen your knee with resistive exercises (using something like a band), you can improve strength and stability in your knee joint.
When it comes to the type of resistive exercises you should look at, knee extension (quadriceps) exercises have been core components of therapeutic exercise programs for many years and are backed by a large body of scientific evidence. In fact, one study showed that eccentric quadriceps exercises helped exercise programs for many years and are backed by a large body of scientific decrease were shown to decrease knee pain and limitations [3]. A physical therapist can instruct you on the proper form and resistance to apply for these types of exercises.
Summary
In the end, research shows that using exercises to address knee pain can be effective. It also helps build up the strength and stability in the knee joint and surrounding muscles. While it may be tempting to try new, fancy techniques like Dry Needling, the research shows that some of these treatment techniques are no more effective than the tried and true techniques like exercises and manual stretches. In any case, it’s always a good idea to have a discussion about these techniques when developing your treatment plan with your therapist.
References
[1] Agergaard AS, Svensson RB, Malmgaard-Clausen NM, et al. Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial. Am J Sports Med. 2021 Mar;49(4):982-993. doi: 10.1177/0363546520988741. Epub 2021 Feb 22.
[2]Reza MK, Shaphe MA, Qasheesh M, et al. Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis. J Pain Res. 2021 Jan 26;14:127-138. doi: 10.2147/JPR.S285297. eCollection 2021.
[3] Liu H, Cong H, Chen L, et al. Efficacy and Safety of Lower Limb Progressive Resistance Exercise for Patients With Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2021 Mar;102(3):488-501. doi: 10.1016/j.apmr.2020.05.021. Epub 2020 Jun 20.
[4] López-Royo MP, Ríos-Díaz J, Galán-Díaz RM, Herrero P, Gómez-Trullén EM. A Comparative Study of Treatment Interventions for Patellar Tendinopathy: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2021 Feb 6:S0003- 9993(21)00141-6. doi: 10.1016/j.apmr.2021.01.073. Epub ahead of print. PMID: 33556350.
