Only a few “physical therapy” interventions appear to help people with painful knee osteoarthritis, or OA, according to a review article recently published in the Annals of Internal Medicine.

Researchers in Minnesota examined the results of 193 clinical trials on 13 common nondrug, nonsurgical approaches to managing knee OA:

  • patient education programs
  • proprioception exercises (motor control)
  • aerobic exercises
  • aquatic exercises
  • strengthening exercises
  • tai chi
  • massage
  • orthotics
  • taping
  • electrical stimulation
  • pulsed electromagnetic fields
  • ultrasonography (using sound waves to penetrate tissues)
  • diathermy (deep tissue heat treatment)

Although the study referred to these as physical therapy interventions, some do not require a physical therapist’s expertise.

What worked? Aerobic and aquatic exercise helped improve disability. And aerobic and strengthening exercises, as well as ultrasonography, were shown to reduce pain and improve function.

“We expected that these core physical therapy interventions helped adults with knee OA. Exercise programs that are specifically designed for knee OA patients are the first things physical therapists recommend,” explains study co-author Tatyana A. Shamliyan, MD, a senior research associate with the Minnesota Evidence-based Practice Center, School of Public Health, University of Minnesota in Minneapolis.

The review found that some interventions – specifically diathermy, orthotics and magnetic stimulation – provided no relief. Electrical stimulation reduced pain in the short-term but made pain worse over time. A few single studies showed some improvement with tai chi, but its sustained benefits need to be confirmed with future studies, Dr. Shamliyan says.