Knee Osteoarthritis: Physical Therapy vs Steroid Injection for Pain Relief

In this study, the researchers found that physical therapy provided short term benefit that was
equal to the higher risk steroid injection with substantially greater benefit from physical
therapy at one year. Patients receiving physical therapy had overall less pain and stiffness and
performed better on functional tests. All patients who received surgery during the study period, 1 arthroscopic surgery and 3 total knee replacements, were in the injection group, even though patients in the physical therapy group had more severe arthritis at enrollment. Total healthcare costs for both groups over the one-year period were equivalent.

The physical therapy strategy used in this study consisted of manual physical therapy with
reinforcing exercise including ongoing guidance to help patients find appropriate types and
amounts of physical activity. The hands-on manual treatment facilitated painless performance
of reinforcing exercises, translating quickly to less pain with daily activity and home exercise.
Patients typically left the initial physical therapy treatment session feeling less pain and
stiffness in their knee while injection patients needed several days of rest and strategies for
pain control from the injection.

When physical therapy offers better outcomes with less risk, it is comparable to an investment
strategy that provides higher return with less risk. The question becomes “why not” rather than
“why” says Dr Deyle.

While this is the third clinical trial on patients with knee osteoarthritis performed at this
treatment center with remarkably similar results, future research should continue to explore
innovative noninvasive methods to treat the spectrum of impairments related to osteoarthritis
with the goal of keeping patients moving and functional with minimal symptoms.

Citation:

Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee

Gail D. Deyle, D.Sc., Chris S. Allen, D.Sc., Stephen C. Allison, Ph.D., Norman W. Gill, D.Sc., Benjamin R. Hando, D.Sc., Evan J. Petersen, D.Sc., Douglas I. Dusenberry, M.S., and Daniel I. Rhon, D.Sc.
April 9, 2020
N Engl J Med 2020; 382:1420-1429
DOI: 10.1056/NEJMoa1905877

https://www.nejm.org/doi/full/10.1056/NEJMoa1905877