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Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

by | Apr 22, 2025 | Knee, Reformer Pilates

Knee osteoarthritis (OA) is one of the most common causes of chronic pain and mobility restriction in Australians over 45. Whether you’re a weekend warrior, an active grandparent, or someone just trying to keep up with the daily demands of life, OA can slowly erode your confidence in movement — long before X-rays show the full extent of joint degeneration.

At Praxis Physiotherapy, we take a forward-thinking, collaborative approach to managing knee OA. Working closely with renowned orthopaedic knee surgeon Dr. Kelly Macgroarty and drawing from our extensive experience with high-performance athletes and everyday patients alike, we believe the journey toward better knees starts well before surgery — and, for many, might even avoid or delay it altogether.

What is Knee Osteoarthritis?

Knee OA is a progressive condition involving the breakdown of joint cartilage and underlying bone, typically leading to:

  • Pain during or after activity

  • Morning stiffness or stiffness after rest

  • Swelling and inflammation

  • Loss of flexibility and range of motion

  • Difficulty with stairs, kneeling, or prolonged standing

Radiographic OA becomes more common with age, but symptoms often precede visible changes on X-ray. Up to 30% of people over 65 show radiographic OA, yet many remain functionally capable — highlighting the importance of early, movement-based interventions (Naja et al., 2021).

Why a Physio-Led Model Before Knee Replacement?

Surgery is not the first or only option. A large systematic review of 19 randomized controlled trials found that non-surgical interventions such as physiotherapy, platelet-rich plasma (PRP), and structured exercise were associated with meaningful improvements in pain and function over 12 months (Naja et al., 2021). Physiotherapy, in particular, is consistently supported by international guidelines as a first-line treatment (Fransen et al., 2015; Bennell et al., 2014).

Traditionally, knee OA rehab has emphasised quadriceps strengthening — and for good reason, as quadriceps weakness is strongly linked to OA-related pain and disability. However, more recent research suggests that focusing exclusively on the quadriceps may be too narrow. Programs that include hip (gluteal), hamstring, and calf muscle strengthening are now shown to be superior in improving functional outcomes, especially for activities like walking, stair climbing, and maintaining balance (Bennell et al., 2014). This broader approach addresses the full kinetic chain around the knee, optimises joint load distribution, and better supports long-term movement efficiency.

At Praxis, our physios:

  • Assess gait, strength, joint mobility, and function

  • Design individualised exercise programs targeting quadriceps, glutes, and calf strength

  • Implement manual therapy techniques to restore joint mobility

  • Provide pain education, load management advice, and real-world strategies

  • Monitor progress and adjust programs over time

This proactive approach not only builds resilience in the knee but also prepares the joint and surrounding muscles should surgery eventually be required.

Booster Sessions: Keeping Gains, Lowering Costs

An often-overlooked strategy is the use of booster physiotherapy sessions — structured follow-ups after an initial rehab program. Research by Bove et al. (2018) showed that exercise programs with booster sessions at 3, 6, and 12 months were not only more clinically effective but also more cost-effective over a two-year period compared to standard physiotherapy care.

At Praxis, we now embed these booster sessions into long-term OA management. They help patients:

  • Maintain strength and conditioning gains

  • Stay accountable with home programs

  • Troubleshoot new symptoms early

  • Reduce future health care costs and medication reliance

What About Injections and Other Adjuncts?

We often collaborate with GPs and orthopaedic specialists to incorporate adjunct treatments where the evidence supports it:

  • Platelet-rich plasma (PRP) injections showed significant long-term benefit for pain and function, with improvements of ~20 points on the WOMAC index. PRP ranked just behind stem cells as the most effective non-surgical treatment in a large 2021 network meta-analysis (Naja et al., 2021).

  • Hyaluronic acid (HA) injections have shown mixed results. A review of overlapping meta-analyses concluded that HA is likely safe and modestly effective, especially in early-stage OA, although guideline recommendations remain inconsistent (Xing et al., 2016).

Ultimately, our philosophy is to build strong knees first, and complement physiotherapy with interventions like PRP or HA only when clinically indicated and appropriately timed.

Surgical Collaboration 

In more advanced cases, where conservative management fails, we work closely with Dr. Kelly Macgroarty, one of Queensland’s leading knee surgeons. Our relationship allows:

  • Streamlined triage for surgical consultation

  • Shared prehabilitation planning to improve surgical outcomes

  • Integrated post-operative rehab, using in-clinic gym equipment and reformer Pilates to accelerate return to function

This continuity ensures you’re never left navigating knee OA alone — whether your journey stays entirely within physio care or progresses to surgical management.

Why Praxis Physiotherapy?

At Praxis, we’ve built our care model around best-practice guidelines, decades of elite sport and private practice experience, and a shared goal of keeping our patients active, independent, and thriving.

Our Teneriffe, Carseldine and Buranda clinics offer:

  • In-clinic rehab gyms

  • Reformer Pilates for joint-friendly loading

  • Real-time strength testing technology

  • Physios with elite sports and post-surgical rehab experience

Take the First Step

If you or someone you love has been told you’re “heading for a knee replacement,” don’t wait. There is so much we can do to reduce pain, improve function, and build confidence in your knees — surgery or not.

Book an appointment today at one of our Brisbane clinics and start your journey to stronger, more resilient knees.

Interested in ACL specific rehab? Check our guide on return to sport after ACL injury

Until next time, Praxis What You Preach!

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

  • Bove, A. M., Smith, K. J., Bise, C. G., et al. (2018). Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial. Physical Therapy, 98(1), 16–27.

  • Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554–1557.

  • Bennell, K. L., Dobson, F., & Hinman, R. S. (2014). Exercise in osteoarthritis: moving from prescription to adherence. Best Practice & Research Clinical Rheumatology, 28(1), 93–117.

  • Naja, M., Fernandez De Grado, G., Favreau, H., et al. (2021). Comparative effectiveness of non-surgical interventions in the treatment of patients with knee osteoarthritis: a PRISMA-compliant systematic review and network meta-analysis. Medicine, 100(49), 

  • Xing, D., Wang, B., Liu, Q., et al. (2016). Intra-articular hyaluronic acid in treating knee osteoarthritis: a PRISMA-compliant systematic review of overlapping meta-analyses. Scientific Reports, 6, 32790.

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The Benefits of Remedial Massage

The Benefits of Remedial Massage

by | Jan 5, 2024 | Massage, Recovery

Remedial Massage — Indulgence or Evidence-Based Care?

We all enjoy the occasional indulgence — a moment to switch off, slow down, or reward ourselves after a busy week. For many people, massage falls into this category. It is often seen as a “luxury” rather than a legitimate health intervention.

The good news is that, unlike many indulgences, massage is associated with a range of reported health benefits. In fact, as wellness interventions go, it is relatively affordable, low risk, and widely accessible. But as always, it’s worth looking beyond the feel-good factor and asking — what does the evidence actually show?

Massage has long been a popular treatment among athletes, coaches, and sports physiotherapists. It is frequently used to assist recovery, manage muscle soreness, and promote relaxation. However, despite its widespread use, the scientific evidence remains mixed. While many people report meaningful benefits, research suggests that the physiological effects of massage are complex and not always consistent across studies (Arroyo-Morales et al., 2011).

What actually happens during a massage?

Massage therapy involves applying manual pressure, kneading, and movement to the muscles and surrounding soft tissues — including tendons, ligaments, and fascia. It is a form of manual therapy that aims to influence both local tissue behaviour and the broader nervous system.

Weerapong and colleagues (2005) proposed four key mechanisms through which massage may affect the body. Three of the most relevant are outlined below.

1. Biomechanical effects

Mechanical pressure from massage can influence the physical properties of muscle and surrounding tissues. Research suggests that massage may:

  • Improve muscle compliance (flexibility of the muscle)

  • Reduce passive muscle stiffness

  • Reduce active muscle tension

  • Increase joint range of motion

  • Enhance local blood flow through increased arteriolar pressure

  • Raise muscle temperature via friction and movement

These effects help explain why people often feel “looser,” warmer, and less stiff after a treatment (Hopper et al., 2004).

2. Neurological effects

Massage does not only act on muscles — it also influences the nervous system.

One way this occurs is through changes in neural excitability, which can be measured using the Hoffman reflex (H-reflex). This reflex provides insight into how responsive the spinal motor neurons are — in simple terms, how “switched on” a muscle is.

A study on calf massage (Morelli et al., 1990) demonstrated that massage could reduce spinal motor neuron excitability. Practically, this suggests massage may promote muscle relaxation in a similar way to gentle stretching or sustained pressure techniques.

This neurological effect may help explain why massage can reduce perceived muscle tightness, improve comfort, and support recovery even when structural tissue changes are minimal.

Photo from the Praxis Physiotherapy article: The Benefits of Remedial Massage

3. Physiological effects

Massage has also been shown to influence the autonomic nervous system — the system that regulates stress and relaxation in the body.

Studies demonstrate changes in:

  • Heart rate

  • Blood pressure

  • Heart rate variability (a marker of stress regulation)

  • Cortisol levels (a stress hormone)

Together, these changes reflect an increase in parasympathetic (rest-and-digest) activity, creating a genuine relaxation response rather than just a subjective feeling of calm.

4. Psychological effects

Beyond physical changes, massage can have meaningful psychological benefits.

Research has shown that massage can reduce anxiety and improve mood state. In sporting contexts, pre-performance massage has even been associated with lower performance anxiety, helping athletes feel calmer and more focused before competition (Arroyo-Morales et al., 2011). 

 

 

 

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FACT OR FICTION FRIDAY || I’m too old to lift weights!

FACT OR FICTION FRIDAY || I’m too old to lift weights!

by | Dec 13, 2019 | Gym and Strength, Osteoarthritis

Answer: FICTION 🙊 Progressive strength training in the elderly (>60 years) is efficient, even with higher intensities, to improve bone health, pack on muscle and retain function. And not surprisingly, side effects are rare! Strength training increases muscle strength by increasing muscle mass, and by improving the recruitment of motor units, and increasing their firing rate. This is no different between younger and older gym goers.
Mid Potion Achilles Tendinopathy Location

It all comes down to how you train! Training with higher loads generally provokes marginally larger gains in muscle size. Intensity corresponding above 85% of the individual maximum voluntary strength can also illicit improved rate of force development compared to 60-80%. This is imperative for reducing frailty as we age.

It is now recommended that healthy old people should train 3 or 4 times weekly for the best results; persons with poor performance at the outset can achieve improvement even with less frequent training.

Photo from the Praxis Physiotherapy article: FACT OR FICTION FRIDAY || I'm too old to lift weights!

So if you are using age as an excuse – STOP! Don’t let your age be a barrier to trying new things or feeling strong. We are here to help with supervised sessions, a great network of PTs as well as our clinical reformer pilates classes which are a great way to start (or return) to strength training!

To book for a clinical pilates 1:1 session or to chat with a physio about how strength training can help you, head to our booking page or give us a call on (07) 3102 3337

PREVENT | PREPARE | PERFORM

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References:

Mayer, F., Scharhag-Rosenberger, F., Carlsohn, A., Cassel, M., Müller, S., & Scharhag, J. (2011). The intensity and effects of strength training in the elderly. Deutsches Ärzteblatt International, 108(21), 359.

Lopez, P., Pinto, R. S., Radaelli, R., Rech, A., Grazioli, R., Izquierdo, M., & Cadore, E. L. (2018). Benefits of resistance training in physically frail elderly: a systematic review. Aging clinical and experimental research, 30(8), 889-899.

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Is running bad for your knees?

Is running bad for your knees?

by | Nov 28, 2018 | Knee, Pain, Return to Sport, Running Injuries, Sports Injury

Running. Probably one of the most maligned exercises when it comes to knees and overuse injuries. The thought that running ‘wears’ out your knees and causes osteoarthritis (a chronic disease often associated with joint pain and stiffness, reduced mobility and reduced quality of life) is one of the most common comments I hear as a physiotherapist – typically by non-runners. But do we have it right? Is running actually bad for your knees?

I recently attended the University of Queensland Sports Masters presentation day. The keynote speaker was a Dr Jean-Francois Esculier, a Postdoctoral Fellow at the University of British Columbia on the topics of running and knee osteoarthritis. Originally trained as a physiotherapist, Dr Esculier gave us an excellent overview of his latest research his take on whether or not running is detrimental to knee health.

First, there was an acknowledgement that echoed the sentiments in the opening paragraph. A study in which Dr Esculier undertook attempted to ascertain the perception about running and the knee joint health among the public and health care professionals. The results suggested that many non-runners perceived running as detrimental to knee health. Understandably, with no clear guidelines, health care professionals displayed high rates of uncertainty regarding running as a risk factor to develop knee osteoarthritis (KOA), and about the appropriateness of running with pre-existing KOA [1].

Mid Potion Achilles Tendinopathy Location

Osteoarthritis often results in cartilage loss, in bone rubbing on bone, which can cause inflammation, pain, stiffness, reduced mobility and reduced quality of life [7].

The paucity of clear training parameters for runners also has a knock on effect with a staggering 75% of runners report being injured whilst running each year with the knee being the most common region of complaint [2]. From my experience as a clinician, the factor that is most often associated with an injury are training errors. Too much too quick. Boom bust. No physical preparation. No listening to your body or allowing adequate recovery time. No periodisation or plan – just run and run.

The remainder of the talk that covered many interesting relatable topics (that will likely be areas for future blogs) but the information that most interested me and should answer the question as to whether running is bad for your knees was the following:

Cartilage change with running:

With the improvements in MRI scanning, more papers are looking at the cartilage volume of knees immediately after a long distance run. According to current evidence [3], cartilage may exhibit short-term decreases in thickness, volume and cartilage water flow (T2 relaxation time) secondary to temporary loss of fluid following repeated compressions associated with running. However, cartilage size tends to return to baseline within hours suggesting that cartilage may well tolerate mechanical loading sustained during running and adapt to repeated exposure.

The response of cartilage to longitudinal load is exactly what Van Ginckel et al [4] investigated. After providing a 10 week “Start To Run” program to novice runners, the reserachers looked at the glycosaminoglycan (GAG) content before and after the running intervention and compared to sedentary controls, who did no running. For those of you (like me) who had no idea what glycosaminoglycan / GAG content is, it is essentially a surrogate marker for cartilage quality (specifically, GAG is an important structural matrix compound in regulating the cartilage tissue’s endosmotic swelling pressure and thus, the tissue’s compressive strength).

The results suggested that a gradually built up running scheme appears to positively effect GAG content, and thus cartilage quality. In fact, running appears to be a chondroprotective effect on the knee when compared to a sedentary lifestyle in a female asymptomatic subjects. The author’s went onto say that running schemes like this might be considered a valuable tool in osteoarthritis prevention strategies [4].

Photo from the Praxis Physiotherapy article: Is running bad for your knees?

Osteoarthritis (OA) rates in competitive vs recreational vs non-runners:

The body’s ability to adapt to considered and appropriate load is likely explanation as to why when we look at the rates of lower limb osteoarthritis (OA) across the population, we find some interesting results. A systematic review [5] of the literature looked at the association of recreational and competitive running with hip and knee OA. The overall prevalence of hip and knee OA was 13.3% in competitive runners, 3.5% in recreational runners, and 10.2% in controls. Exposure to running of less than 15 years was associated with a lower association with hip and/or knee OA compared with non-runners.

Recreational runners had a lower occurrence of OA compared with competitive runners and controls. These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee OA. However, it was not possible to determine whether these associations were causative or confounded by other risk factors, such as previous injury [5].

SUMMARY

Running appears not to cause osteoarthritis in your knees unless you are a competitive long distance runner. Even then, you are only slightly above the average for non-runners but enjoy the myriad of other benefits that exercise brings. Further, increased mileage in recreational runners appears to be actually protective for your knees and reduces your risk of needing a knee replacement [6]. Caution however must be taken to monitor detailed training parameters such as frequency, speed and distance, so that an optimal dosage for knee joint health tailored to the individual patients with knee osteoarthritis.

So the next time someone tells you that you shouldn’t be running because you’ll get OA, or if your health expert recommends to stop all activity because you have been diagnosed with mild / moderate osteoarthritis of the knee, we can help! As always, we at Praxis are more than happy to help you navigate your way back to performing – whatever that may look like! Give us a call (07) 3102 3337 or book online www.praxisphysio.com.au today

Praxis logo

There is no need to accept knee pain as ‘normal’. Call us now on (07) 3102 3337 or book online to have one of our physios develop a plan to reduce your pain and restore your function!

To read more about how running can help your knees (that’s right – running!) check out our related posts on running written by our published principal physio, Stephen.

Team Praxis,

PREVENT | PREPARE | PERFORM

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

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