Exercise recommendations in athletes with early osteoarthritis of the knee.

Osteoarthritis of the knee is a common condition that afflicts millions of individuals annually. The benefits of exercise are self evident as athletes and middle-aged individuals grow older, and the focus has centered on pain-free participation in their sports and activities. In the past, medical treatment has primarily relied on oral medications to manage symptoms, without the incorporation of therapeutic exercise. Consequently, as the osteoarthritis progresses, patients are offered surgical management and eventual joint replacement. A goal-oriented progressive rehabilitation programme that incorporates medical management in the initial stages would allow patients a greater ability to participate in sports, thereby obtaining the numerous benefits of exercise and perhaps delaying surgery. A progressive rehabilitation programme consists of five stages (I to V). Medical management is primarily reserved for stage I: protected mobilisation and pain control. It entails the use of pain medications, nonsteroidal anti-inflammatory drugs, with or without the use of chondroprotective agents such as glucosamine. Injection therapy is usually incorporated at this stage with intra-articular injections of corticosteroids or viscosupplementation, either of which may be combined with minimally invasive single-needle closed joint lavage procedure. Stages II and III introduce open kinetic-chain nonweightbearing exercises to the affected joint, with progression to closed kinetic-chain exercises. Stage IV focuses on return to sporting activities, with continued closed kinetic-chain exercises. There is also the incorporation of sport-specific exercises to improve neuromuscular coordination, timing and protect against future injury. Finally, stage V, or the maintenance phase, is primarily aimed at educating the patient on how to reduce the risk of re-injury and optimise their current exercise programme. Medical management of knee osteoarthritis within the framework of a progressive rehabilitation programme that includes active therapeutic exercise may delay the progression of this disease and allow patients years of greater pain-free activity and improved quality of life.