OSTEOARTHRITIS
At Aspire physiotherapy in Liverpool, we treat many clients who have osteoarthritis. Below is a summary of what the evidence says and how we help our clients.
What is Osteoarthritis?
At Osteoarthritis is a very common problem. Osteoarthritis affects the whole joint including the articular cartilage (the cartilage covering the ends of the bones), subchondral bone, menisci, ligaments, and muscles.
Osteoarthritis is the most common cause of difficulties with mobility and disability in older people. It is also common the in younger and middle-aged people. Approximately 5% of people between 35 and 54 years of age have osteoarthritis. Many of these people have injured their joint earlier in life. Approximately 30% of the population between 50 and 70 years of age have problems related to osteoarthritis and the percentage increases in older age groups.
The Healthy Joint
A joint is a connection between two bones. The ends of bones are covered with cartilage, which create a smooth surface for the bones. An articular capsule surrounds the joint. This capsule secures the joint and contains synovial fluid (a lubricant providing nutrition to the cartilage). Muscles and ligaments surround the joint and help to secure it (Figure 1).
The cartilage surface is smooth and allows the bones to slide easily when moving. Cartilage is solid, but flexible. It absorbs shock and spreads loads over its surface. As far as we know, cartilage has no pain sensors and so it cannot ‘hurt’. The cartilage has no blood vessels. Nutrients are brought to the cartilage by the synovial fluid.
Changes in the Joint with Osteoarthritis
You may have heard osteoarthritis described as ‘wear and tear’ of the joint. This statement is incorrect because loads are still needed to keep cartilage healthy. In a healthy joint, there is a balance between the regeneration and degeneration of cartilage. Osteoarthritis occurs when there is more degeneration (breakdown) than regeneration of cartilage. This causes cartilage to thin, crack, and maybe disappear. Bones can then start to rub against each other. However, cartilage needs a certain amount of load to regenerate. This is why healthy loads need to be applied on joints for cartilage recovery.
Three Joints that are Often Affected by Osteoarthritis
Knee:
- You may feel (or hear):
- Pain with weight-bearing
- Stiff and unstable leg
- Knee giving out
- Crunching or clicking noises
- It might be hard to walk up and down stairs, or get from sitting to standing
- Occurs with deformities like knock-knees or bowleg
Hip
- Pain can be located:
- Often outside the hip or deep in the groin
- Inside, outside, or down the thigh
- Sometimes not in the hip, but instead pain on the inside of the knee
- Hip osteoarthritis often leads to reduced range of motion in the joint. This can lead to trouble getting in and out of a car, putting on socks, picking things up from the floor
- Often, your step length will often get shorter when walking. It may be hard for you to straighten your hips, so you may tend to bend forward when walking.
Hands
- Most commonly affects the end of fingers and the base of the thumb
- Fingers may feel stiff or tender. They may look ‘lumpy’ and have minor deformities
- It is common for the muscles in the hands to feel weak. It can be hard to clench your hands into a fist, carry something heavy, write or use scissors
Why do you get Osteoarthritis?
There are a number of factors that raise your chance of getting osteoarthritis.
There are some factors we cannot affect, such as:
- Age
- Gender – more common in women
- Heredity
Factors that we can change to reduce the risk of osteoarthritis:
- Obesity
- Physical inactivity
- Muscle weakness
- Sports related joint injury
- Work or leisure time related joint injury
How do you know you have Osteoarthritis?
X-rays
At later stages, osteoarthritis can be seen on an x-ray. It will show a smaller joint space, osteophytes (extra bone growth), cysts (liquid-containing cavities) in the bone, and sclerosis (hardening) of the bone under the cartilage. Magnetic Resonance Imaging (MRI) or arthroscopic surgery can also show these changes. Despite seeing these changes, a person may not feel any symptoms. On the other hand, symptoms can be felt for 10-15 years before changes show up on an x-ray or MRI. This is why diagnosis for osteoarthritis is done based on symptoms (something you feel that tells us about a problem).
Symptoms
A clinical diagnosis for osteoarthritis is done based on symptoms. Osteoarthritis often affects one joint and symptoms often progress slowly. Symptoms can start for no apparent reason. For some people, symptoms stop fully. For others, symptoms quickly turn into more serious problems and spread to other joints. Symptoms can come and go. Early symptoms are more commonly felt in the morning for long periods of time. These include:
Pain when moving or loading the joint. In time, pain can happen at rest or at night.
- Joint stiffness <30 minutes and problems starting your day.
- Less range of motion.
- Heat and swelling at the joint.
- Muscle tightness.
- Difficulty moving around.
How can you treat Osteoarthritis?
Currently, there is no known way of curing cartilage loss. Treatment is used to reduce symptoms (i.e such as reducing pain) and improve function of the joint. Learning about osteoarthritis is part of the treatment. Special exercises can be done to relieve pain and boost joint function. When function improves, the next step is to get more active. Being physically active can help maintain weight loss and improve overall health. These things should be done as early as possible by people who have osteoarthritis. The usual treatment for osteoarthritis is outlined by the pyramid in Figure 2. Below are explanations of each line of treatment organised by colour.
Figure 2. The treatment of osteoarthritis can be shown by this pyramid. The lower part is education, exercise and weight loss (if necessary). This should be offered to anyone with osteoarthritis right away. The middle part should be offered to those who did not improve with education and exercise. Surgery (typically joint replacement) should only be offered when no other treatment has worked.
The benefits from Exercise for Osteoarthritis
Exercising has added benefit for people with osteoarthritis.
- Nutrients are pumped in and out of the cartilage when it is loaded and unloaded. This promotes growth and reformation of the cartilage which boosts its strength.
- Exercising will have your joints moving through their range of motion. This will make it easier to do everyday things you used to have trouble with (putting on socks, climbing stairs, getting in and out of the car).
- Exercise helps build stronger muscles, which helps make daily activities easier by supporting the joint.
- Exercising will train your coordination; the ability to use the right muscles at the right time with the right amount of force. This will make it easier to control movements like walking on uneven ground.
The benefits of exercise disappear when you stop exercising. To keep the effects of exercise, you have to keep exercising regularly and consistently. This is why it’s important to do exercises that you enjoy. This will help make exercise part of your daily routine. Examples of exercises that might work well are: walking, Nordic pole walking, aquatic (water) exercises, dancing, cycling, and strength training.
Exercise Recommendations (based on current evidence)
- Everyone, regardless of injury, illness or age should aim to be physically active for 30 minutes a day.
- These 30 minutes can be done in 10 minute bouts. At least twice a week, these bouts should be 20 minutes long and either maintain or increase in intensity.
- These activities should be slightly difficult and be done on top of your normal everyday activities. This is needed to maintain good health and prevent diseases (e.g. diabetes, certain types of cancer, high blood pressure among others).
These recommendations apply to people with osteoarthritis. The ideal type and amount of exercise depends on the person’s age, abilities, functional limitations, and health status. If you have not been physically active in the past, it may be a good idea to start slowly. See how you feel, and then gently increase the intensity.
Aspire Physiotherapy’s method
Self-management is the most important treatment method for osteoarthritis. Self- management is the ability to care for yourself through your own behaviours.
You may find that you need a little extra help to get active. At Aspire Physiotherapy in Liverpool we are trained and professional in the understanding of body movement and function.
Our skilled Physiotherapists can help with:
• Assessment – A physiotherapist can assess your joint difficulties, your function and your level of activity. This will help them find a treatment that fits you best.
• Exercise – At Aspire physiotherapist we can help you find what you are currently capable are in terms of exercise, we teach the right ways to exercise and adjust the exercises to your needs.
• Knowledge – You can get advice if you’re unsure of how to exercise or how it should feel when exercising.
• Pain relief – At Aspire Physiotherapy our physiotherapists has tools that can ease your joint pain so that you can proceed with your exercises
• Walking Aids – If needed, the physiotherapist can help you get a walking aid if your joint is painful and needs relief.
- Inspiration and motivation – It can be hard to get started if you haven’t exercised for a while or if you are in pain. Starting with a physiotherapist for 6-8 weeks can help you shift into an active lifestyle.
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