Future Directions in Painful Knee Osteoarthritis: Harnessing Complexity in a Heterogeneous Population.
The diagnosis of osteoarthritis (OA) has evolved over the last decades and now is described as an intricate interwoven process involving the mechanical, biomechanical and structural processes in the knee joint. The main symptom of OA is pain, and many interventions seem futile in the managing of this pain.
A model is proposed in which pathological, psychological and neurophysiological factors are involved. Pathological factors include weakness in quadriceps, kinetics of the lower extremity, malalignment. Depression, pain catastrophising and fear of movement also influence pain. There is emerging evidence of pain centralisation as found in other chronic pain conditions.
Shifting the attention from pathophysiology towards a better understanding of the factors that may influence the knee may provide clinical diagnostics that not only take joint degeneration into consideration. An appreciation of how these factors may determine outcome and matching interventions to the specific patient´s pain experience, may lead to a solution in the future > From Kittelson et al. Phys Ther (2013) (Epub ahead of print). All rights reserved to The American Physiotherapy Association
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