Knee Osteoarthritis: Physical Therapy vs Steroid Injection for Pain Relief

MedicalResearch.com Interview with:
Dr. Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT
Professor with Baylor University Graduate School 

Dr. Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT
Professor with Baylor University Graduate School

Study authors in addition to Gail Deyle are Chris Allen, Stephen Allison, Norman Gill, Benjamin
Hando, Evan Petersen, Douglas Dusenberry, and Daniel Rhon

Summary:

Physical therapy is superior to glucocorticoid (steroid) injections for stiff and aching knees says Dr Gail Deyle, a physical therapist specializing in orthopaedics and manual physical therapy. A study recently published in the New England Journal of Medicine directly compared physical therapy with glucocorticoid injections to determine which was better primarily at one year but also in the short term.

The research was a collaborative effort of providers from physical therapy, orthopaedics, and
rheumatology at two Army Medical Centers. Dr Deyle, who is a professor with Baylor University Graduate School, and the senior author of the study, states, our results leave no doubt that physical therapy should be strongly considered for patients with knee osteoarthritis. They will clearly benefit from a physical therapist’s hands-on treatment and decision making for exercise and activity selection.

Osteoarthritis of the knee is common world-wide and is a leading cause of disability, accounting for substantial healthcare costs. While osteoarthritis of the knee is primarily a chronic disorder associated with aching and stiffness, it can clinically present with acute episodes leading patients to visit primary care and emergency department physicians for timely relief and perhaps requesting advanced imaging to determine what is wrong inside their knee. Providers commonly use gluccocorticoid injections to help patients through this acute phase. This is an important point to guide patients to a physical therapist, says Dr Deyle.

These injections may provide short-term relief but they also increase the risk of infection and
accelerated aging of the joint, including fractures of the joint surfaces. If the patient is also sent to see an orthopaedic surgeon, they may receive an MRI and perhaps be told that they are “bone on bone” leading patients to believe that there is little hope with treatment options
other than more injections and eventual total knee replacement.

Throughout this process, most patients are not sent for consultation with a physical therapist.
In fact, only 10% percent of patients with knee osteoarthritis receive treatment from a physical
therapist for their knee osteoarthritis prior to total knee replacement. Physical therapy is simply not offered as often as glucocorticoid injections despite study findings over the past 20 years that physical therapy treatment strategies reduce pain, improve function, reduce medication use including opioids, and reduce the incidence of surgery for patients with knee osteoarthritis.