As physical therapists, we can significantly influence how a patient feels about their knee osteoarthritis and their ability to attain relief from pain. Contrary to popular belief, the most impactful part of treatment may not be the exercise selection—and you might be missing key items that can increase adherence.
Sure, your patient probably needs a great deal of strength training, but as it turns out, your patient needs more than exercise to be successful with conservative treatment.
The Missing Link to Treatment
The mental and psychological impact of osteoarthritis can be even more significant than the physical disability itself. But this component of the condition is rarely discussed.
For example, a systematic review by Wallis, et al., found that “Participants in these studies reported a number of factors that contributed to their negative attitude and perception about their hip and/or knee osteoarthritis, such as their understanding of the pathology of osteoarthritis, the activity limitations they experienced, and their perceptions of other people’s beliefs toward their condition.”1
Consider the patient. They may not be able to move as well as they could before knee osteoarthritis. They may need a walker or other assistive device that might make them self-conscious around others. They may have to miss out on social gatherings. They likely fear what their future entails. Exercise alone may not be able to fix this.
Another important finding of this systematic review was that “participants who had negative experiences interacting with health professionals described their dissatisfaction with receiving limited information about their condition and the management options available including ways to avoid aggravating their condition, a sense of not being listened to.”
For these patients, there is so much power in feeling heard and understanding what osteoarthritis is beyond a superficial explanation such as “normal wear and tear.” So, how can we as clinicians incorporate this information into our treatments to empower patients with knee osteoarthritis?
Tips for Empowering and Motivating Patients with Knee Osteoarthritis
1. Explain what osteoarthritis is clearly and concisely.
My patients find it particularly helpful to have osteoarthritis explained in terms of inflammation. Your body collects inflammation from inactivity—the foods you eat, the amount of weight you carry, stress, poor sleep, and so forth. As this inflammation collects, it can wreak havoc in the joint. If we can reduce their inflammation, we can reduce their pain and irritation, as well! This framework helps them believe that relief from pain is possible, which is highly motivating.
Providing explanations like “wear and tear” can unintentionally—and incorrectly—lead a patient to believe there is nothing to be done about their pain. Research has shown that low-grade, chronic inflammation plays a vital role in osteoarthritis progression, which is promising news for those who hope to find relief.2
Although one cannot re-grow cartilage, we can reduce the irritation and instability that can lead to a patient experiencing a high level of pain, even in cases of severe osteoarthritis. I suggest doing additional research for further information that can aid in explaining osteoarthritis to patients in meaningful and motivating ways.
2. Explain what is possible.
Providing reasons why patients with chronic conditions can have hope can be incredibly powerful. Explaining that the possibility of relief is in sight and that surgery is not inevitable, is highly motivating. Most patients I talked with feel that they have been backed into a corner and that surgery is their only option for relief. This mentality leads to fear of movement, hesitation with other treatment options, and decreased quality of life.
With such patients, I like to share a story about another patient who was in a similar position and was able to find relief, or—even more specifically—was able to squat again without pain or go up and down the stairs. Hearing the successes of others who were once in a similar position can also be motivating to a patient who has lost hope.
3. Find ways to build confidence.
If you adhere to a cookie-cutter exercise program for all of your patients with knee osteoarthritis, you may be doing them a disservice. Not every patient will be ready for each exercise. You must find movements that do not flare up pain and that the patient is capable of performing.
Choosing movements that include moving sideways and backward can be great options when first starting patients on a home exercise program. If you can help a patient move in a new way that doesn’t flare up their pain, that is a big win for both of you. Building this confidence with the patient early on may prevent the sudden plummeting of adherence that you have probably seen in the past.
Another way to boost confidence is to explain exactly why you chose a particular exercise, rather than just providing the obvious goal of building strength. Explain that you are trying to support the joint and build muscle to absorb the force instead of overloading the joint with stress. This explanation allows the patient to visualize what you are attempting to create within their body and may lead to increased adherence.
Choosing exercises that are easy on the joints, as well as explaining why you have prescribed the set of exercises you have, are great ways to facilitate much-needed confidence.
Having these conversations is incredibly important and can help to improve outcomes, both subjectively and objectively. Building a patient’s confidence and understanding of what is going on in their joint can open many doors to what is possible
Treating clients with osteoarthritis is more than just the exercises you choose, more than just three sets of 10. Incorporating patient education and ongoing conversations about osteoarthritis, pain, and what is possible in your treatment plan can help increase adherence to and success with conservative measures.
For further information on osteoarthritis of the knee, MedBridge instructor Eric Robertson offers this course, which provides a deep understanding of knee osteoarthritis, including guidance for proper evaluation, and explores two cases of patients who present with complaints of pain and instability of the right knee.
- Wallis, J. A., Taylor, N. F., Bunzli, S., & Shields, N. (2019). Experience of living with knee osteoarthritis: A systematic review of qualitative studies. BMJ Open, 9(9). https://doi.org/10.1136/bmjopen-2019-030060
- Robinson, W. H., Lepus, C. M., Wang, Q., Raghu, H., Mao, R., Lindstrom, T. M., & Sokolove, J. (2016). Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nature Reviews. Rheumatology, 12(10), 580–592. https://doi.org/10.1038/nrrheum.2016.136