Osteoarthritis (OA) is the most common arthritis of the knee joint. It is also commonly known as Wear and Tear arthritis in which the natural cushioning between the joints, also known as cartilage, wears away. When this happens, the joint gets devoid of the optimum shock absorbing benefit of cartilage leading to the two bones – femur and tibia rubbing over each other and thus causing pain, swelling, stiffness, crepitus, reduced ability to move, bone spurs, and ultimately diminution of joint space and disability. Although age is the most common cause and a risk factor for the development of osteoarthritis owing to the progressive destruction of cartilage, its decreasing average age of prevalence and increasing scientific advancements have led to a conclusion that osteoarthritis likely represents a family of diseases that have a similar endpoint, but with multifactorial etiopathogenesis involving genetic, molecular, and environmental influences, particularly biomechanical stress. In fact, in many cases, biomechanical factors appear to play a critical role in the events that lead to the initiation and progression of osteoarthritis.
Clinical and animal studies of altered joint loading have provided strong evidence that abnormal loads can lead to alterations in the composition, structure, metabolism, and mechanical properties of articular cartilage and other joint tissues. Abnormal loading may be caused by a variety of factors such as obesity, immobilization, joint instability, overuse, or trauma. However, the most common biomechanical alteration in OA knee is Malalignment of the Femur over the tibia. Ideally both these bones should from a 180-degree alignment but if they are off by a few degrees, it can lead to abnormal load distribution due to the shifting of the center of pressure of the tibiofemoral force and thus resulting in increased stress and subsequent early degeneration of articular cartilage. Varus knee or bow legs is the commonest malalignment in knees which can cause or be a result of osteoarthritis. In this, the tibia, the larger bone in the shin, turns inward instead of aligning with the femur, the thigh bone which causes the knees to turn outward.
STT or SAAOL Traction Therapy is an amalgamation of the ancient Indian system of exercises and modern biomechanics. It helps in maintaining the mechanical axis at the intercondylar region, distributing the forces at both compartments, correcting Varus deformity, correcting hip and foot biomechanics, and maintaining the lumbar lordosis. All these biomechanical aspects are often overlooked in Osteoarthritis management and hence undervalued and under-treated leading to suboptimum results. STT involves the use of simple and trivial products and nylon ropes in form of loops with firm and tight knots and cotton belts with steel buckles at one end. These ropes and belts are used in particular forms and positions to achieve specific outcomes. Each position is maintained for 10 to 15 minutes and correction starts immediately and goes on as long as belts or ropes are tied in position. The lateral tilt of the patella (knee cap bone), lateral/outward tibial deviation or torsion, and medial/inward femoral deviation or torsion are principally corrected along with strengthening of the quadriceps (principally Vastus Medialis Oblique).
STT can be administered on patients with all 4 radiological grades of osteoarthritis knee on a wooden bench with dimensions of 7 × 2 × 2.5 ft. Patients should be comfortably seated with legs straight with shoulder distance between the feet, both hands below shoulders with fingers in front. All toes to spread. Ropes should be used with moderate force while belts at gentle force. Patients with redness, swelling, edema, and synovitis should not be given STT. Some of the commonly used stretches and positions include Peroneal Calf hamstring stretch (PCH stretch) which stretches the tight muscles and relieves pain, calf stretch which restores the plantar arches, double knot foot stretch which strengthens the foot muscles and ensures proper weight bearing by bringing talus to its key-stone position, Mild and fortified varus correction that corrects the tibiofemoral malalignment and ensures more central loading and thus relieving the medial compartment of knee and vertical leg stretch with lumbar traction for the distraction of knee joint forces which allows cartilage regeneration.
All these STT positions are given for a total of 40 to 50 minutes every day. This treatment in conjunction with medicines, exercises, electrotherapies like Ultrasonic therapy and TENS (Transcutaneous Electrical Nerve Stimulation), manual therapy, lifestyle modifications, proper diet and weight management, and foot pressure analysis and correction using customized soles go a long way in holistic and complete non-surgical management of Osteoarthritis Knee. STT is non-invasive and non-surgical. It is safe in patients with all age groups, co-morbidities, and grades of OA.
In a developing country like India, cases of osteoarthritis knee are increasing rapidly. However, awareness regarding its quick, prompt, holistic, and multidisciplinary management is still lacking. In the absence of a full understanding of the role of biomechanical factors or physics in the etiopathogenesis of osteoarthritis, very few treatment options are effective and available. Pharmacologic treatment is palliative and often based on analgesics or non-steroidal anti-inflammatory drugs, agents that may provide some symptomatic relief but are not disease-modifying and pose special hazards to older populations due to vascular side effects. Surgeries in Osteoarthritis are largely centered around total knee replacement, a major surgery in which the natural knee joint is amputated and a metal or plastic prosthesis is inserted. This surgery has high failure and complication rates with more than half of the patients requiring repeated revision surgeries. Therefore, in today’s era, there is an urgent need for a holistic, non-surgical, cost-effective, and multipronged approach to Knee OA treatment with proper identification, understanding, and management of biomechanical alterations. STT is proving to be an effective and natural way to preserve joint function and revert deformities.