What is the treatment for a hand on knee gait?

Treatment for Hand on Knee Gait

Tibiofemoral knee braces are strongly recommended for patients with hand on knee gait due to knee osteoarthritis, as they provide significant improvement in ambulation, joint stability, and pain relief. 1

Understanding Hand on Knee Gait

Hand on knee gait is a compensatory walking pattern where patients place their hand on their knee during the stance phase to:

• Provide additional stability to an unstable knee joint 2
• Compensate for quadriceps weakness or paralysis 2
• Reduce pain during weight-bearing 3

This gait pattern is commonly seen in patients with knee osteoarthritis or other conditions causing knee instability and quadriceps weakness.

Primary Treatment Options

Bracing and Support Devices

• Tibiofemoral knee braces: Strongly recommended for patients whose knee instability is causing significant impact on ambulation, requiring hand support during gait 1
• Patellofemoral braces: Conditionally recommended for patients with patellofemoral knee OA contributing to the hand on knee gait pattern 1
• Kinesiotaping: Conditionally recommended as it permits range of motion while providing some stability 1

Exercise Therapy

• Strengthening exercises: Focus on quadriceps and hamstring strengthening to improve knee stability during gait 1
• Aerobic and aquatic exercises: Strongly recommended to improve overall function and reduce pain that may be contributing to compensatory gait patterns 1
• Gait training: Specific gait modification techniques have shown clinically significant effects on knee pain and function 4

Assistive Devices

• Walking aids: Conditionally recommended to reduce load on the affected knee and improve stability, potentially eliminating the need for hand-on-knee support 1
• Evaluation for assistive devices: All patients should be evaluated by a healthcare professional for their ability to perform activities of daily living and receive appropriate assistive devices 1

Additional Interventions

Pain Management

• Topical NSAIDs: Conditionally recommended, especially for patients aged ≥75 years 1
• Oral NSAIDs: Conditionally recommended for younger patients without contraindications 1
• Thermal interventions: Conditionally recommended for pain relief, including locally applied heat or cold 1

Joint Protection Techniques

• Instruction in joint protection: Conditionally recommended to reduce stress on affected joints 1
• Weight reduction: Strongly recommended for overweight patients to reduce knee joint loading 5

Treatment Algorithm

1. Initial Assessment:

   • Evaluate severity of knee instability and quadriceps weakness 1
   • Assess pain patterns and location (medial vs. anterior knee pain may require different approaches) 3
   • Consider radiographic evaluation to determine underlying pathology 5

2. First-line Interventions:

   • Prescribe appropriate knee brace (tibiofemoral or patellofemoral) 1
   • Initiate exercise program focusing on quadriceps strengthening 1
   • Provide instruction in joint protection techniques 1

3. Adjunctive Therapies:

   • Add thermal modalities for pain relief 1
   • Consider appropriate pain medications (topical or oral NSAIDs) 1
   • Evaluate need for walking aids 1

4. Advanced Interventions (if inadequate response):

   • Consider specialized gait training with physical therapist 4
   • Evaluate for intra-articular corticosteroid injections if inflammation is present 5
   • Address both limbs, as contralateral limb weakness can contribute to gait asymmetry 6

Common Pitfalls to Avoid

• Focusing only on the symptomatic knee: Contralateral knee problems may contribute to gait asymmetry and ipsilateral pain 6
• Overlooking non-pharmacological interventions: Exercise and bracing should be primary interventions before relying solely on medications 1
• Improper brace fitting: Optimal management with knee bracing requires expertise in fitting the braces and coordination between primary care providers, specialists, and brace providers 1
• Neglecting underlying pathology: Hand on knee gait may be a symptom of various conditions requiring specific treatment approaches 7