Both Thai exercise combined with Thai massage and strengthening exercise combined with Swedish massage brought benefits to people with knee osteoarthritis, but the Thai program yielded more significant and longer-lasting results, according to recent research.

The study, “The effectiveness of Thai exercise with traditional massage on the pain, walking ability and QOL of older people with knee osteoarthritis: a randomized controlled trial in the community,” involved 31 people with knee osteoarthritis. The study participants ranged in age from 50 to 85 and were randomly assigned to either a Thai physical therapy (TPT) group or a standard physical therapy (SPT) group.

Both the TPT and SPT programs consisted of two phases. Phase one was supervised class-based TPT and SPT, which took place three days a week for eight weeks. During this same phase, participants were instructed to follow the program at home at least two days per week as well.

The second phase was the home-based TPT or SPT alone. Subjects were instructed to perform the program at least three times a week for 12 months. During this second phase, they received a “booster session” once a month for the first three months. The booster sessions were designed to increase education and awareness about movement, exercise planning and other relevant issues.

For the TPT, there were six assigned exercises, all involving a wand. The exercises focused on concentric and eccentric isotonic contraction of the quadriceps and hamstrings in different positions. To start, the exercises were performed five times per session, two sets per day. This increased every two weeks until reaching 40 times per session.

For the Thai massage portion of the TPT, pressure was applied to the “muscle lines” of the quadriceps, hamstrings, tibialis anticus and calves. One or two finger pads or the side of an elbow tip was used to deliver deep pressure as necessary. Also, heat was applied to the upper and lower leg muscles, as well as the knees, using a bag filled with Thai herbs.

For the SPT program, subjects were instructed to perform six progressive strengthening exercises for the quadriceps and hamstrings. The exercises were performed 10 times per session, two sets per day, with the resistance increasing every two weeks. For the Swedish massage portion of the SPT, the protocol involved superficial and deep stroking, along with kneading or stroking, of the upper and lower leg muscles, as well as the use of a hot-water bag on the legs and knees.

The main outcome measure for this study was the six-minute walk test (6MWT). This test evaluates a person’s capacity for walking by measuring how far they walk in six minutes. A secondary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which evaluates pain, stiffness and function. Quality of life (QOL), as measured by Short Form-36 (SF-36), was a secondary outcome measure as well. These outcomes were assessed at baseline and then at two, five, eight and 14 months.

Results of the research revealed significant improvements in both groups on all outcome measures at the two-month mark, but the improvements were greater in the TPT group, especially in terms of the 6MWT. Distances on the 6MWT were improved by about 20 percent in the TPT group versus about 9 percent in the SPT group at the two-month mark. After one year, only the score for the 6MWT remained greater in the TPT group as compared to the SPT group.

“The main findings of this study are that the TPT group showed improvement in the 6MWT, WOMAC and SF-36 scores after two months of treatment and lower detraining effects on the 6MWT distance at one year after TPT as compared to the SPT group,” stated the study’s authors.

Authors: Punnee Peungsuwan, Phawinee Sermcheep, Papatsara Harnmontree, Wichai Eungpinichpong, Rungthip Puntumetakul, Uraiwan Chatchawan and Junichiro Yamauchi.

Sources: School of Physical Therapy and Back, Neck and Other Joint Pain Research Group, Khon Kaen University, Thailand; Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan; and Future Institute for Sport Sciences, Japan. Originally published in 2014 in the Journal of Physical Therapy Science, 26(1), 139-144.