But...with established flexion contracture, night pain, substantial loss of range and function, and > 12/12 Hx of pain it can be challenging to get good conservative outcomes without complete patient commitment to a difficult rehab program. 5/
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1. Educate. In detail. To succeed, patients with moderate/advanced knee OA need to embark on a fairly demanding rehab program. So they need to understand their condition and the reasoning behind everything they'll be doing. 6/
2. Medication: 1/12 course of Naproxen. Oddly, had not tried NSAID’s previously. Immediately helped his night pain. Sleep is important for many reasons, but it’s particularly important during intensive rehab, and can help break a pain cycle. 7/
3. Cycling: He bought an exercise bike. 🚴♂️ for 20-30 minutes. Every. Single. Day. Good evidence that lubricant secreting cells in synovial joints respond well to cyclical movement. But also a great exercise for restoring belief in the legs, and modulating his knee pain. 8/
4. Restore extension: poor extension = poor result. We used *manual therapy* to help. 😬. Twice/week. 😬🤯. For 6 weeks..FFD’s can be hard to change, so he was pushed pretty hard. Patient needs to stretch. A lot. Multiple times daily for at least 5 minutes per time. 9/
5. The physio sessions weren’t just ‘hands-on’. Also a combination of coaching and motivation. It’s important for patients to see incremental ‘wins’ to help sustain them through a long rehab. In the initial stages progress can be slow, so in person sessions are invaluable. 10/
6. Strengthening: *Controversially* we used open chain resistance.🤯.an exercise demonised like few others. But they can be invaluable in patients with atrophied quads who struggle with WB load. Used sensibly they’re fine, and offer a step to heavier WB load. 11/
Comments
1. Educate. In detail. To succeed, patients with moderate/advanced knee OA need to embark on a fairly demanding rehab program. So they need to understand their condition and the reasoning behind everything they'll be doing. 6/