Well-tolerated strategies for managing knee osteoarthritis: a manual physical therapist approach to activity, exercise, and advice.

The orthopedic manual physical therapist approach to knee osteoarthritis (OA) is an effective, well-tolerated, and comprehensive strategy that provides a spectrum of intervention measures, which include guidance on activity selection, as well as selection of manual treatment and exercises to systematically address impairments and increase strength and movement in the knee and other related body regions. This approach integrates manually applied treatment while reinforcing exercise and functional activities that are tailored in scope and dose to each patient. Concepts used in the careful design of this exercise program include emphasizing minimal dosing, avoiding exacerbation, using exercises with multiple effects, effective functional positioning, emphasizing the importance of mid-range movements and end-range challenges, and strategic timing of exercises. Focusing on motion and strength gains through range of motion, along with functional or reinforcing activities, such as walking or biking to maintain motion and strength gains, are keys to long-term success. The overarching theme is that well-tolerated strategies using manual treatment, exercise, and activity require deliberate design and targeting of the most common impairments and functional limitations seen in the knee OA population and, more importantly, tailoring to the individual patient.