Should Patients with Osteoarthritis be Treated with Physical Therapy First?  A New Study Provides Evidence

Orthopaedic & Spine Center
Photo of Tom Toothaker, DPT

Tom Toothaker, DPT

A recent study published in Arthritis Care & Research posited that Physical Therapy seems to be underutilized when it comes to the treatment of Osteoarthritis (OA).  They looked at the treatments being provided to patients with OA who were participating in three clinical trials at Duke University Medical Center Primary Care, UNC – Chapel Hill and at the Durham VA Health Care System.

While approximately three-fourths of the patients were treated with oral analgesics, at least half had injections and about a third had topical pain creams, only about 39-52% had Physical Therapy as a treatment.  Researchers found this to be significant because OA Clinical Practice Guidelines recommend the use of non-pharmaceutical treatments (weight-loss, PT or activity) as the first line of treatment or for these to be utilized in conjunction with drug therapy.

While there were some differences in demographics and clinical factors, there continues to be a trend for treating OA with pharmacologic agents (analgesics, steroids and even opioids, which is higher among the VA population), instead of using Physical Therapy. Based on this finding, researchers believe that the use of Physical Therapy is “a key area for improvement” in the treatment of OA and that better adherence to its use, per Clinical Guidelines, could greatly improve pain and increase function for OA sufferers.

Dr. Tom Toothaker, Clinical Director and Physical Therapist at Orthopaedic and Spine Center, frequently treats patients who suffer from OA.  Here are his comments about the study and how it correlates with what he observes in his PT practice. “Physical Therapy is definitely an underutilized service in the management of patients with OA, along with many other musculoskeletal impairments. OA can create joint stiffness and pain which then leads to decreased activity.  Decreased activity can then lead to more joint and muscle stiffness and decreased strength. Studies have shown a course of Physical Therapy prior to surgical intervention can improve post-operative outcomes, as well.”

Dr. Toothaker adds, “Every human being should know how to perform basic maintenance on themselves, but they don’t. Skilled Physical Therapy (which is therapy you cannot do at home and without the direction of a skilled Physical Therapist) is commonly prescribed following many orthopaedic surgeries. It is the ideal environment in which to learn appropriate movement patterns and functional exercises to improve strength and mobility, as well as learning how to better manage your OA symptoms.”