Knee joint instability is one important factor in the etiopathogenesis of knee OA and exercises that strengthen the quadriceps muscle (main knee stabilizer) may be beneficial. As for the chondromalacia parellae, the situation differs in the need for reducing the retropatellar pressure when exercises are performed. Taping of patella proprium ligament is recommended. Exercises could be performed by the patient himself/herself but the best results are achieved when quidance  and control by experienced kinesitherapist is available. 

Thank you Dr Tanchev

Tailored-fit-Taping+ isometric exercise for Quads 

Ideally a personalized program by a physiotherapist but much of the work can be done at home by the patient (depending on motivation, etc). Pat-fem taping may be beneficial with chondromalacia but often unnecessary (depends on the PT's training)  In general best to think functional in terms of exercise prescription.

Thank you

Hi everyone,

I agree above the statement about the O.A and chondromalacia  patella treatment. This started with PT evaluation and diagnosis.If soft tissues needs stretching then start with low grade and if needs stability then isomatric with low grad and more recruitment of fibers and ligaments .start with concentric muscle work to isomatric then eccentric with proper angle of movement to lower the compact forces on joint and more soft tissue work.For best results physical therapist to perform all exercises in his or her supervision and for chondromalacia patella taping is more beneficial and also at 10 to 15 degrees knee flexion ,compression and decompression of patella is also helpfull manually in supine position.

considering that the knee is a joint load , and subject to gravity , any exercise based on the eccentric will be favorable elongation .

whether to recommend boosting , inner coarser usually the most affected by the loss of strength.

the patient , if you get involved , you can make active treatment at home, always under constant evaluation by a specialist .

Generally speaking, exercises that strengthen the quadriceps muscle (main knee stabilizer) may be beneficial.Ideally a personalized program.

I agree with the above comments also. Regardless of the underlying condition, treatment must be based on a thorough bio-mechanical assessment. As a treatment adjunct, if appropriate (and it usually is) the patient should be provided with very clear instructions for a very limited number of specific exercises. Too many and they don't do any! They should practice the exercies with you in the clinic so that you can give them feedback to ensure correct performance, and that they are not aggravating their pain. The number of repetitions and sessions per day should be specific, to help patients engage with the self management process.

For further reading, you may be interested in the publications listed here: http://mcconnell-institute.com/resources.html

Jenny McConnell is a fellow of the Australian College of Physiotherapy, and has been involved in the research and treatment of patellofemoral problems for many years.

@Jacquelin Capell: I agree entirely with you. 

Thank you Jacquelin Capell. 

Hi there,

good talk so far. I see taping as not helpful. If there are stiffness and tightness, than adress it not merely by stretching, add other treatment options. Here is an application for acupuncture. For shock wave, for massage/ manuel thearpy. Other as well, e.g. put a small ball on top of the tight structure (tractus, pat. lig., ankle, feet) and by hitting the ball a couple of times you apply pressure to the tight structures and there will loosen. Repeat it daily. Use a blackroll regularly as well.

Concerning quadriceps- this is not the only muscle responsible for knee action or patellar hypercompression. Hamstrings too short? Quadriceps must then overcome these thigt hamstrings by generating more power. Gluteals to tight? Femur/ notch gets externally rotated, thus medial hypercompression of patellafacet. Gluteals to weak? too much internal rotation of the femoral notch- lateral hypercompression. How is the tibial rotation? Patellar ligament will be tense, thus mostly distal patellar pain- wheather accompanied by chondromalcia or not. So look for the foot- does cause a flat foot more internal rotation of the tibia? What do you recommend than? And pes cavus? If using insoles, think how long insoles exist- these are mainly passive acting insoles by bedding the feet. But they do not train the feet muscles. So after a time the feet flatten more an more, thus the insoles must be adapted to prevent further pain  Active insoles are different in perhaps activating the footmusculature, thus this might be a better way in the long run preventing detoriation.

Nice day to you all, JE

Hi 

We are practicing to use Physical therapy before exercises (Sonophoresis, iontoforesis, interferential current, and specially in subacute stage LLLT) before exercises you can use electro stimulation of Quadriceps) .I have practice to use taiping after physical therapy and to do correction of pattela position. Making exercises with taiping band is optimal, and less of pain too. Generally exercises must be applaing in chronic stage. The comorbуdity is key for that how you can load patient, static cycling is good also. 

Nice discussion up to now. I believe that we need to know what factors are causing this particular Knee Osteoarthritis in every single case. Only after the definition of this, we can advise for exercises. Everybody above is right but the most clear answer, which is creating a lot of questions is Jean's. Jacqueline is also putting the same approach in a different way, as she is mentioning the biomechanical assessment. So in a very simplistic answer to the original question; Yes, the physiotherapist has to carry on the exercises. Reason. Physiotherapists have to assess and advise and maybe change the regime. Reason for change. Misreading of the original findings or condition changed picture. The most of the times though we are treating using empirical methods and I believe this is due to time spent with the patient. More time, less pressure, better treatment due to better understanding of the patient's needs. I have had the experience working in environment where even a gait analysis was performed to help the formation of a global picture of patient's needs. Time per patient; 1.5 hours of study. And this is before the consultation and the regime application. There is no such time available for everybody. Sorry to be Cassandra but treatment of knee arthritis is not scientific, not because we do not know but because we do not have time.

All the muscles that present themselves weakened.

I agree with Dr. George Zafiropoulos. I'm doing scoping of literature on Knee OA for my PhD study. Specific and tailored exercises should be provided. Additionally, you must also consider a lot of risk factors. 

100% agree with Jean Edelstein

i agree totally with jacuellin capell

I would agree with above comments.

I am suggesting patients to do static quadriceps exercises and later dynamic quadriceps exercises. This has helped alot in OA patients.

 As a rule of thumb I totally agree with dr Sunku. This way ie, by reinforcing quads, you alleviate pain by taking off some load from the osteoarthritic knee.

Dr. Sunku, I agree.

Thank you everyone for your answers. They're quite helpful.

I think isometric quadriceps strengthening exercises are most appropriate. 

I think we should also consider the coordination between quadricepses and hamstring, in open and close circle, depending of ROM of knee with out pain 

i think  elongation quadriceps as isquiotibiliales elongation . in any case agonist antagonist balance.

The quadriceps femoris muscle provides stability for the knee joint; optimizing the strength of the muscle is important in the rehabilitation of patients with knee OA. We must not also overlook its antagonist - the hamstring to prevent biomechanical imbalance.

Hello Gaza,

With regard to knee osteoarthritis, all muscle groups need to be strengthened in harmony. As there are symptoms, we opted to isometric exercises.

It's different for those with chondromalacia patella? No, we follow the same protocol.

The patient can do the exercises on their own, or they need to be performed by a physical therapist? In our service, we always recommend professional guidance

Regarding osteoarthritis of the knee, which muscle groups need to be strengthened and what exercises can help to do that? We follow the suggested protocol since it does not arise for such impossibilities

Thanks a lot for your answers.

In addition to all contributions above, without underestimating the importance of bio-mechanical assessment of the client, strengthening exercises targeting the abductors and the hip extensor of the ipsilateral LL is significantly helpful, both close and open chain exercises in many KNEE OA clients.

I totally agree with all the above comments and the concept of chain exercises to strength neighbor muscle group 

Definitely strengthening of quads will help the patient in getting pain relief. Other muscle like abductors, adductors, and extensors  of hip should also be strengthened.