Osteoarthritis (OA) affects up to 3.6% of the global population and is characterised as a condition that causes damage to the cartilage that lines the ends of the bones. As this gets more severe, it can lead to pain, swelling, stiffness and reduced function. As it progresses it can affect other structures around the joint such as the sub-chondral bone, ligaments, capsule, and other soft tissues around the joints.
Patients suffering from OA will often complain of stiffness and some pain in the morning that improves with movement after a few minutes. They may also find that if they exercise for prolonged periods, they can become uncomfortable or if they are inactive for a while it takes them some time to get moving again. It may also be associated with some stiffness around the joints, but this often improves a little with movement and exercise.
The joints may also swell and remain swelled. This is often not a bad thing as it is just the joint trying to protect itself and will commonly improve with movement. If the joint looks red and feels hot to touch, it could be a sign of infection or acute inflammation and you may want to discuss this with your doctor.
If your pain is waking you up in the night, or it is taking more than one hour for the pain and stiffness to subside in the morning, this could be a sign of an inflammatory feature of a different type of arthritis. Your Physiotherapist may ask you as part of your assessment if you have any other medical problems such as psoriasis, any eye or stomach problems, swollen fingers, history of tendon problems such as tennis elbow or a family history of any of the above. This will help guide any treatment and management plan and whether the Physiotherapist may need to liaise with your GP.
Only a relatively small amount of the population suffers from arthritis and it is important to separate this from the normal ageing process of our bones, joints and soft tissues. Often, patients will have X-rays where they are told they have “degenerative changes” and this is commonly misunderstood to be arthritis.
As we age, our bones and joints age with us and can show some extra bone growth (osteophytes) or hardening of the bone (sclerosis). This is purely the bones and joints adapting to age and making themselves more robust. So, the presence of these is often a good sign and very rarely do they cause any concern or symptoms.
Risk factors for developing OA include age, genetics, female gender, obesity, muscle weakness and the previous injury (secondary arthritis). Obesity has been shown to be a significant pre-determining factor for development of OA. Many patients will say they find it hard to exercise or are worried about exercising for fear of making their symptoms worse. It is a myth that exercising will make the joints wear out quicker. We at Pure Physiotherapy prefer the phrase “wear and repair” to the misleading “wear and tear” phrase.
Your assessment will begin with your Physiotherapist inviting you to give a history of your symptoms. This will provide the clinician with information that can help identify relevant factors which may make OA a probable diagnosis. Your Physio will then perform a full physical examination to facilitate a rapid and accurate diagnosis, ensuring that the most appropriate and effective treatment can be implemented.
X-rays can be useful to help diagnose any OA but a good assessment from your Physiotherapist will be a far better way to help with the diagnosis and to give you a better understanding. Very rarely are patients sent for X-rays unless there is significant concern about the joint and the symptoms. All x-rays expose the patient to a dose of radiation, and this is higher for joints closer to the torso (i.e. hips and shoulders). Spinal x-rays are rarely carried out, again because of the significant amount of radiation given.
Physiotherapists at Pure can refer you for a private X-ray with our colleagues at Global Diagnostics in Norwich. We may write to your GP also if we felt there may be a need for you to be referred, although this is very rare.
Your Physiotherapist will discuss lifestyle modifications that may help you be more active, lose weight and get a better understanding and control of your symptoms associated with OA. A recently published study showed that if patients with OA lost 10% of their body weight, their pain improved by over 50%. Exercise for patients with OA does not have to be about running, cycling or swimming for miles and this is something your Physiotherapist can assist with – finding the most enjoyable and suitable exercise for you.
It is a common myth that moving joints will cause them to wear out. In fact, it is quite the opposite with movement of the joint important for preventing progression of the arthritis. Inside your cartilage is a substance called synovial fluid. This is the lubricant and shock absorber in your joints. If it is kept moving and has regular load applied through it, it can keep moving. If joints are kept still, this fluid can stick and become stagnant. This can then cause a chemical reaction leading to an inflammatory episode which could result in the joint becoming more stiff and painful. Your physiotherapist may use the phrase “motion is lotion” which is a nice way of explaining the benefits of getting the joints moving. Possessing this knowledge should give you the reassurance to know that keeping yourself active won’t cause further damage.
Exercise has been shown to be the single most effective way of managing OA and if someone is given a diagnosis of OA, it is important that that person then works to strengthen the joint and help to achieve optimal mobility. Through regular re-assessment, your Physiotherapist can track your progress and ensure that your exercise plan remains challenging with optimal stimulus for positive adaptation to occur.
In a recent study, people with mild to moderate OA who undertook a strength-based exercise programme for a number of weeks, showed an improvement in their OA on X-ray findings on completion of the exercise programme. Building strength is important and your Physiotherapist at Pure will set you up on a bespoke exercise programme to help you build up that strength so you are more able to do those tasks you previously found difficult such as climbing stairs, getting out of a chair or overhead tasks. Please find the patient resources section of our website where we have created a series of recommended exercise programmes. We advise consulting with your Physiotherapist prior to trying any of these exercises.
Your Physiotherapist at Pure may also use modalities such as manual therapy and acupuncture to help with your pain alongside your exercise programme. We also strive to provide our patients with ongoing advice and support to effectively manage symptoms long-term and to reduce slow the progression of these changes.