The Endocannabinoid System a Turning Point in Optimizing Physiotherapy Procedures in Knee Osteoarthritis

Ilie Onu, Ioana Buculei, Claudiu Gabriel Ionescu, Daniela Nicoleta Stanca, Bogdan Voicu, Daniel-Andrei Iordan


Introduction: Knee Osteoarthritis (KOA) is characterized by wear, tear, and it's a slowly progressive loss of cartilage, that becomes finally disabling. KOA is one of the most analyzed diseases by many medical specialties such as rheumatology, orthopedics, rehabilitation medicine, and physiotherapy. Major symptoms of KOA such as pain, dysfunction, and chronic low-grade inflammation will decrease the quality of life and eventually lead to locomotor disability. Since there are no effective ways to limit KOA progression, involvement of the endocannabinoid system (ECS) may be a non-pharmacological therapeutic alternative in the management of this disease. This study debate aspects of ways to modulate the ECS in KOA, using physiotherapeutic (PT) means such as TENS electroanalgesia, LASER biostimulation, and physical exercises with analgesic effects.

Materials and Methods: In the study, we included 82 sources, with the following keywords in the title: knee osteoarthritis, cannabidiol, endocannabinoid, inflammatory pain, analgesia, neuropathic pain, physiotherapy, electrotherapy, and LASER. To perform this review, we searched for the most relevant articles in the field of medicine and physiotherapy in 7 international databases applying inclusion and exclusion criteria.

Results: The application of TENS currents in certain doses and frequencies together with LASER biostimulation stimulates the production of endocannabinoids thus controlling pain, and stimulating the ECS. Physical exercise has an antioxidant, and anti-inflammatory role and stimulates the release of endogenous opioids.

Conclusions: The results obtained from this meta-analysis may contribute to paradigm shifts in clinical practice related to the treatment of pain by PT. TENS, LASER, and physical exercise are effective clinical tool that limits chronic inflammation and pain by involving the ECS. More studies are needed to understand endocannabinoid system involvements in KOA, and that will inspire medical doctors and physiotherapists to improve long-term treatment strategies.


Knee Osteoarthritis, endocannabinoid system, TENS, LASER, physical exercise.

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