Case Study: Physiotherapy Rehabilitation of Knee Osteoarthritis in a 58-Year-Old Female

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Clinical Experience (2010–2012 – Outpatient Setting)

Presenting Complaint:

A 58-year-old female, a housewife by occupation, presented to the physiotherapy outpatient department with chronic bilateral knee pain, more pronounced on the right. She had been experiencing discomfort and stiffness for several years, particularly aggravated by prolonged standing, stair climbing, and squatting. Her primary goal was to reduce pain and improve her ability to perform daily household activities independently.

History and Background:

The patient had been diagnosed with osteoarthritis (OA) of the knee, confirmed radiologically. She had no history of trauma or surgery but reported gradual worsening of symptoms over time. Despite the chronicity, she remained active and highly cooperative, expressing a strong desire to follow all prescribed therapy and home exercise regimens.

Assessment:

Initial clinical evaluation revealed the following:

• Observation:

- Mild genu varus deformity

- Joint swelling and muscle wasting around the knee (especially quadriceps)

• Palpation:

- Tenderness at the medial joint line

- Crepitus felt during knee flexion and extension

• Range of Motion (ROM):

- Knee flexion restricted to 110° with discomfort

- Full but painful extension

• Strength:

- Quadriceps and hamstrings: 3+/5 (manual muscle testing)

• Gait:

- Slow, guarded gait with reduced stance time on the affected side

• Functional Limitations:

- Difficulty squatting, kneeling, and prolonged walking

- Frequent rest breaks needed during chores

Treatment Plan:

A focused 14-day physiotherapy intervention was implemented to address pain, stiffness, and muscle weakness, with sessions conducted in a clinical outpatient setting.

Interventions Included:

1. Electrotherapy Modalities:

  • Interferential Therapy (IFT): 15 minutes per session for pain relief and muscle relaxation
  • Hot Packs: Applied prior to exercise sessions to reduce stiffness

2. Stretching Exercises:

  • Hamstring and calf stretches—held for 20–30 seconds, repeated in sets
  • Gentle quadriceps and iliotibial band stretching
  • Stretching was particularly effective in relieving postural tightness and discomfort

3. Strengthening Program:

  • Isometric Quadriceps Sets: Early focus on static contractions without aggravating pain
  • Straight Leg Raises (SLR): With ankle weights as tolerated
  • Closed Kinetic Chain Exercises: Mini squats, step-ups, and wall slides in later sessions

4. ROM and Mobility Work:

  • Active-assisted and active knee flexion-extension exercises
  • Supported gait training to build confidence and proper loading patterns

5. Education and Home Exercise Program:

  • Advised on posture during household work, stair climbing techniques
  • Taught how to modify activities to reduce joint stress
  • A take-home program was provided and regularly reviewed

Outcome Measures:

• Pain: Reduced from 7/10 to 2–3/10 by end of therapy

• ROM: Improved to near full flexion without discomfort

• Strength: Noticeable improvement in quadriceps tone and control

• Function: Able to climb stairs with less effort, complete kitchen tasks with fewer breaks

• Satisfaction: Patient expressed significant relief and appreciation for the structured program

Prognosis:

With her consistent attendance, cooperative nature, and adherence to the home program, the patient showed excellent improvement over the 14-day period. Her prognosis remained positive with continued exercise and weight management.

“Managing osteoarthritis requires a balance between pain relief and functional strengthening. In this case, hands-on care, progressive exercises, and simple lifestyle education brought significant change. It reinforced my belief in patient-centered physiotherapy that adapts to the individual’s pace and needs—especially in long-term degenerative conditions.”


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