Altered knee joint biomechanics and too much joint loading have long been considered as important contributors to the development and progression of knee osteoarthritis (OA). For this reason, a greater understanding of how different treatment options influence the loading environment of the knee joint could have practical implications for devising more effective physical therapy management strategies. The authors aim in this clinical commentary was to review the pertinent biomechanical evidence supporting the use of treatment options intended to provide protection against excessive joint loading while providing symptomatic relief and functional improvements for better long-term management of patients with knee OA. The biomechanical and clinical evidence regarding the effectiveness of knee joint offloading strategies including contralateral cane use, laterally wedged shoe insoles, variable stiffness shoes, valgus knee bracing, and gait modification strategies within the context of effective disease management are discussed. In addition, the potential role of therapeutic exercise and neuromuscular training in improving the mechanical environment of the knee joint are considered. Management strategies for treatment of joint instability and patellofemoral compartment disease are also mentioned.
Based on the evidence presented as part of this clinical commentary, the author argues that special considerations for the role of knee joint biomechanics and excessive joint loading are necessary in designing effective short and long-term management strategies for treatment of patients with knee OA.