Osteoarthritis of the knee

Paul Creamer and Marc Hochberg

rightly highlight the important role of physical therapy in the management of osteoarthritis. In case of osteoarthritis of the knee, walking or jogging is not recommended as an exercise because such activity tends to increase joint loading.

Exercises to strengthen the quadriceps—for example, quadriceps-setting exercise and straight-leg raises—are effective in reducing pain and improving function in patients with knee osteoarthritis.

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But patients may not continue to exercise regularly. It has been noted that the frequency of regular exercise among patients with osteoarthritis is proportional to the amount of instruction and follow-up provided for the exercise regimen.

I would like to relate our experience of a bicycle ergometer in the management of knee osteoarthritis.

A 67-year-old woman had symptoms due to osteoarthritis of her knees which had lasted 5 years. She had been given intra-articular steroid injections twice and been advised quadriceps-strengthening exercises together with the use of paracetamol. But she was not doing her exercises regularly, and continued to have knee pain. Meanwhile, diabetes was detected. Apart from diet, she was advised to exercise regularly on the bicycle ergometer on minimum of resistance, initially for 5 min daily, which was gradually increased to 30–45 min daily. Within a few weeks after starting to exercise, her knee pain and use of paracetamol decreased. 6 months later, she had no pain and did not require paracetamol. During the past 2 months, five other patients with knee osteoarthritis have been put on gradually increasing exercise with a bicycle ergometer, two of whom are feeling better with reduced use of analgesics. The beneficial effects of exercise with a bicycle ergometer in patients who have osteoarthritis of the knee deserves further investigation.