Gary Smith


The purpose of this paper is to present a case study of a female masters’ level triathlete/runner with severe medial knee osteoarthritis, a history of multiple lower limb stress fractures and knee pain of 6 months duration who has been treated by a titled sports chiropractor (Australasian Institute of Chiropractic Education; AICE) using current multimodal evidenced-based management protocols. The overall burden of osteoarthritis and its management to the individual and to society is also discussed.

Clinical features: a female master’s level triathlete/runner aged 51 years who is highly competitive in her age group category at local, regional and state level events. The athlete presented to a sports and exercise chiropractor with knee pain which had prevented her from running over the previous 6 months. MRI imaging revealed severe medial knee osteoarthritis, subchondral oedema at the medial femoral condyle and full thickness chondral loss, indicating Grade 4 on the Kellgren-Lawrence classification scale.

Intervention and outcome: management consisted of 6 weeks running gait retraining, specific corrective exercise prescription and monitoring and gradual progression of exercises and running load. No manual therapy was provided during this study. At the end of 6 weeks the athlete reported subjective improvements in knee pain and running capacity. Objectively there were improvements in orthopaedic resisted muscle grading testing, joint range of motion and The Knee Injury and Osteoarthritis Outcome Score (KOOS).

Conclusion: diagnosed with severe medial knee osteoarthritic deterioration and pain, the athlete had subjective and objective improvements in function and symptoms following this six-week evidenced based intervention. Further research involving larger sample sizes, longer term follow-up, males, non/binary or transgender subjects and alternative exercise protocols would assist in clarifying the optimum management in a variety of situations.


Case Reports