Looking for a creativity bubble from you | Sharing clinical tips on knee OA

I have just been stung to the tune of nearly $400 for using a low-resolution picture in 2015 on a blog post by an organisation called PictRights. Nearly 10 years ago I wasn't thinking of ownership rights of such low-quality pictures, but beware. These companies trawl websites looking for any pictures used without a licence and bingo you are in their crosshairs!

Anyway, I went through my blog posts for the past 15 years and have hopefully culled out any pictures used without a licence. Some have over 150K views and I thought others were of interest to review.

What do you call a group of Physios?

In English, collective nouns referring to groups of animals are often colourful and unusual; for example, a school of whales, hover of trout, murder of crows, or my favourite, a parliament of owls.

This has led many writers to invent their collective nouns for humans, such as a gaggle of girls but what about a collective noun for a group of physios? I think it is time we grabbed this opportunity and create collective noun history.

My 10 cents to start the ball rolling is a 'movement of physios'. A movement representing a body of related individuals with similar goals (e.g., health and wellbeing through a combination of hands-on skills, education and exercise programming) but also a wordplay on our common central tenement of 'move well, stay well'. I will put this on our Blog site and you can add your suggestions below. After a few weeks, I will report back with the top 5 for an iterative narrowing-down process.

Knee - OA Management

The following blog post was written in 2015 and remains in most still relevant. However, I wanted to add a couple of more recent takes based on anecdata/personal experience.

When I see a client with a long-term 'problem' one of my first questions asked is "How long do you plan on living?" Now this certainly raises eyebrows, cuts through the general malaise around exercise and accountability and opens up an interesting honesty in regards to management. Usually, the response is a curious "Why?" and that provides a beautiful opportunity to pitch long-term strategy, over just simple short-term pain relief. Try it next time.

The other aspect I wanted to mention was the Ossur UnloaderOne brace (no affiliate link!). A well-aimed cow kick a decade ago left me minus most of my medial meniscus and resulted in medial compartment OA. I limited irritation and cross-trained in swimming. However, over the past 12 months, I have returned to a passion of mine in hiking/rucking. Long story short, even with a lot of gym work, and using hiking poles, the result was aggravation, frustration and casting around for a solution. Thanks, Xander! One of our dry-needling instructors had this weird brace and on discussion and doing some research, I realised there was a biomechanical brace with potential. I have now been using it for the past 4 months, just hiked 7 days on the Bib Track with 16kg and it was great. Gym of course continues, poles are used at times, but my knee is happy 95% of the time. So, if you have active clients with either medial or lateral knee isolated compartment symptoms, I would encourage you to explore the possibility of the UnloaderOne knee brace.

"Knee osteoarthritis (OA) affects more than 250 million people around the world and is an important factor contributing to a loss of early lifestyle and later independence. In 2013, arthritis and musculoskeletal conditions were national health priority areas in Australia. In association with knee OA, meniscal tears are very prevalent, with the medial compartment most commonly affected.

Arthroscopic knee procedures are common in Australia with over 100,000 performed annually. These are predominately to address meniscal and arthritic problems.

Katz et al 2013 (1) examined 351 symptomatic patients, 45 years of age or older with a meniscal tear and imaging evidence of mild-to-moderate knee osteoarthritis. The primary outcome measure was the physical-function scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The study was randomized and conducted over seven centres.

Participants were allocated to surgery and physiotherapy (called physical therapy in the USA) program or only a physiotherapy program, usually of 6 weeks duration. The three-stage structured physiotherapy program was designed to address inflammation, range of motion, concentric and eccentric muscle strength, muscle-length restrictions, aerobic conditioning (e.g., with the use of a bicycle, or elliptical machine), functional mobility and proprioception.

The study was designed as a crossover and 30% of patients initially assigned to the physiotherapy group crossed over to the surgery in the first 6 months. This was because of insufficient initial improvement. The other 70% completed the study with no significant difference in outcome measures measured at 6 months, compared to those of the surgery group.

The paper concluded, "There were no significant differences in the magnitude of improvement in functional status and pain after 6 and 12 months between patients assigned to arthroscopic partial meniscectomy with postoperative physical therapy and patients assigned to a standardized physical therapy regimen."

This study strengthens the evidence-based protocol for clients with a degenerative meniscal tear and mild to moderate OA, that the first line of management offered should be a 6-week structured exercise program, and if there is insufficient improvement a surgical review is appropriate.

Reference: 1. Katz JN, Brophy RH, Chaisson CE, et al Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine 368: 1675-1684, 2013."