Vital Care Medical and Chiro-Med Rehab Centre (Newmarket location) are now oﬀering a joint collaboration for the management of OA Knee. This is an integrated approach to management combining both medical and rehabilitative services to optimize the treatment of OA knee. The program uses the best current practices and evidence in medicine and rehabilitation to optimize the management of OA knee in order to reduce its impact on your day to day life. Our goals are simple: reduce pain, improve joint function and slow the rate of progression; allowing you to get back to being active again.
Our OA knee program is comprehensive and is tailored to you based on your assessment, stage of progression and your personal goals. After your initial consultation/assessment and investigations (if required) by our Medical Physician and Rehabilitation team the treatment of your OA knee is then individualized using a combination of the following management components:
- Oral Medications
- Joint injections (kenalog, hyaluronic acid)
- In-clinic supervised exercise program
- Detailed home exercise program
- Supportive knee bracing (custom and off-the-shelf)
Osteoarthritis of the knee is a chronic condition where the cartilage in the knee joint gradually wears away, allowing the bones to rub against each other causing pain and aﬀecting knee joint function.
- Advancing age – 80% of people over age 55 have some radiographic evidence of this condition
- Gender – Females are 2 to 3 times more likely to develop OA
- Obesity – weight loss may reduce this risk
- Occupation – OA knee has been linked to occupations involving frequent squatting & kneeling
- Sports – Risk is increased for those who participate in wrestling, boxing, pitching in baseball, cycling, parachuting, cricket, gymnastics, ballet dancing, soccer & football
- Morning stiffness
- Crackling or grating sensation
- Bony outgrowths
Anyone suﬀering from knee pain and experience any 3 of the following signs / symptoms below:
- Age greater than 50 years
- Morning stiﬀness lasting less than 30 minutes
- Crackling or grating sensation (crepitus)
- Bony tenderness of the knee
- Bony enlargement of the knee
- No detectable warmth of the joint to the touch
Additionally, anyone with progressed OA knee awaiting joint replacement
Medical Consultation (OHIP covered)
The initial consultation and assessment is with a medical physician to conﬁrm your diagnosis of osteoarthritis of the knee joint. Diagnostic interventions may include x-rays, CT scan, MRI (Note: reports from any recent investigations completed are encouraged to be brought to your initial assessment)
Medical management options of your OA knee will then be discussed.
WHO WOULD BE A CANDIDATE FOR INTRA-ARTICULAR INJECTIONS?
- Patients with severe inﬂammation or pain that prevents you from initiating an exercise program
- Ineﬀectiveness of or contraindications of oral medications
- Elderly patients for whom surgical treatments carry risk
Corticosteroid injections provide short-term pain relief for OA of the knee by relieving inﬂammation.7 Duration of eﬀects can last several weeks to months and have few side-eﬀects. It can be repeated multiple times yearly if required and deemed appropriate.
EUFLEXXA® (HYALURONIC ACID)
Euﬂexxa (1% sodium hyaluronate) is a hyaluronic acid (HA) product that is manufactured from a natural sources of HA. The nonbird-derived substance is put through a precise, multistep cleansing and ﬁltering process that creates a highly puriﬁed, gel-like HA ﬂuid. Euﬂexxa is for injection into the knee to help replace your knee’s own HA.9,10 Hyaluronic acid functions as a thick, slippery ﬂuid that helps cushion, lubricate and protect the bones and joint tissue. In patients with OA of the knee, the HA gets thinner over time and becomes less able to provide protection.11 It is proven to be eﬀective complementary or alternative therapy for the treatment of the symptoms of osteoarthritis.
Euﬂexxa’s® primary method of action is the direct replenishment of a joint’s synovial ﬂuid (HA), which works to lubricate and cushion the aﬀected joint. Injections of Euﬂexxa allow for an increased range of motion with a decreased amount of pain.5
Viscosupplementation is a nonsurgical treatment that not only oﬀers pain relief, but potentially provides protection of the cartilage in the knee.4
You can ﬁnd further information at:
Aerobic fitness and strengthening exercises are an essential component of managing OA Knee.3
How can exercise help you?1
- Reduce pain
- Improve joint stability
- Improve flexibility
- Promote synovial nutrition
- Increase function and independence
- Reduce weight
Supervised Clinic Exercise Program
An exercise program will be tailored to you based on your personal activity goals, pain severity, muscle strength, and other symptoms or conditions.
Quadriceps femoris (quad) muscle weakness is correlated with knee pain and functional disability in knee osteoarthirits.2 Research has shown that the size of vastus medialis is imperative to the reduction of knee OA progression.6 Rehabilitation will focus on strengthening the quadriceps, with focus on the vastus medialis muscle; a typical program may be similar as the one outlined below:
- Warm-up with walking on a treadmill or cycling at low intensities
- Aerobic exercise on treadmill or bicycle
- Strengthen quadriceps with focus on vastus medialis muscle
- Improve proprioception with weight-bearing exercises
- Stretching routine
Home Exercise Program
Patients will receive prescribed exercises and stretches to maintain the therapeutic gains of their supervised exercise program. Studies have shown stronger gains as well as therapeutic beneﬁts related to OA Knee are more likely to be maintained in the supervised clinical seting.12
Research has shown that exercises such as resistance training, walking, cycling, aquatic exercise, Tai Chi and balance and agility training are beneﬁcial for persons with knee osteoarthritis. These exercises help by reducing symptoms and improving function.1
Custom DonJoy Knee Bracing – Custom Adjustable OA Defiance®
The Custom DonJoy Brace can be customized to oﬄoad stress on any compartment of the knee joint, resulting in reduced inﬂammation, less pain and preventing any further deterioration in the knee joint. The custom knee brace can be worn in conjunction with other treatment options, such as joint injections.14
Off-The-Shelf Bracing – OA Reaction Web™ Knee Brace
The REACTION WEB is a responsive, webbed approach to knee pain that gives you a distinct alternative to the basic knee sleeve. The elastomeric web is an innovative solution that absorbs shock, disperses energy and shifts pain away from your knee. This comfortable solution is easy to apply. It takes the shape of your knee, with an improved design engineered for beter ﬁt and comfort. 15
Goals of our Program
- Reduce Symptoms
- Reduce rate of OA progressiont
- Improve your function
- Educate you, regarding your responsibilities
- Smith, T., Kirby, E., & Davies, L. (2014). A systematic review to determine the optimal type and dosage of land-based exercises for treating knee osteoarthritis. Physical Therapy Reviews, 19(2), 105-113 9p. doi:10.1179/1743288X13Y.0000000108
- Seong Hoon, P., & Gak, H. (2015). Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis. Journal Of Physical Therapy Science, 27(3), 729-731 3p. doi:10.1589/jpts.27.729
- Roddy E, Zhang W, Doherty M, et al.: Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus. Rheumatology (Oxford), 2005, 44: 67–73.
- Stitik, T. (2001). Viscosupplementation for osteoarthritis. Physical Medicine & Rehabilitation, 15(1), 117-145 29p.
- Wang, Y., Wluka, A. E., Berry, P. A., Siew, T., Teichtahl, A. J., Urquhart, D. M., & … Cicuttini, F. M. (2012). Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis & Rheumatism, 64(12), 3917-3925 9p. doi:10.1002/art.34681
- O’Connor, M. I., MD. (2004). Nonoperative management of knee arthritis: A little bit of this, a little bit of that. Orthopedics, 27(9), 971-972. Retrieved from http://search.proquest.com/docview/203912548?accountid=6180
- Bellamy N, Campbell J, Robinson V, et al. Intraarticular corti- costeroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;2:CD005328.
- Date on file. Bio-Technology General (Israel) Ltd.
- EUFLEXXA [package insert]. Parsippany, NJ: Ferring Pharmaceuticals Inc; 2014.
- Benke M, Shaffer B. Viscosupplementation treatment of arthritis pain. Curr Pain Headache Rep. 2009; 13(6):440-446.
- Kalunian, K. C., Tugwell, P., Curtis, M. R., (2015) Nonpharmacologic therapy of osteoarthritis – www.uptodate.com
- Kalunian, K. C., Tugwell, P., Curtis, M. R., (2015) What is OA Knee – www.uptodate.com