What is Osteoarthritis?
Osteoarthritis describes degeneration of the joint surface or cartilage in a joint. This occurs due to an abnormal strain on a certain joint, often from a biomechanical fault over time. Joints that are commonly affected include the knees, hips, spine, shoulders, and hands. Osteoarthritis can also be present due to the aging process. Often, mild arthritis that are seen on X-rays are not causing any pain and are asymptomatic. When the joint degenerates over time, you may start to feel stiffness, soreness, and an inability to move the joint as well as you did in the past. As the symptoms start to impair your ability to carry out daily activities, physiotherapy can help minimize symptoms and slow down the progression of your osteoarthritis.
Osteoarthritis develops overtime with wear and tear of the joint. Cartilage that sits on the ends of the bones in the joint starts to degenerate due to trauma or overuse and becomes rough and frayed. Overtime, the joint becomes more inflamed and you start to experience pain, swelling and stiffness. There is no cure for osteoarthritis, but different treatments are present to help manage symptoms and delay joint replacement surgery.
Who does OA (Osteoarthritis) affect?
OA typically affects those over the age of 65 years, but it can occur in people of all age groups. According to the Arthritis Foundation, 1 in 2 adults will develop symptoms of knee OA in their lifetime, 1 in 4 adults will have symptoms of hip OA by age 85 and 1 in 12 people over the age of 60 have OA in their hands.
Heat or ice?
Many people ask us this question. The quick answer is, whichever you prefer. Try both and see which one you like more. The usual rule of thumb is ice for acute pain and injuries when inflammation is present. If you feel your joint is actively inflamed (ie. swollen and hot), then use ice. Otherwise, try heat and see if the heat calms down your muscles more.
Is walking good for my knee condition?
Yes, as long as it doesn’t hurt the knee and you’re not limping. Any mild limp you may have at the beginning of a walk will be exasperated by the end. As a result, you may end up experiencing pain in the low back or hips and feet as well if you continue to do long distance walks as exercises. Walking is a good form of cardio and a great exercise for general conditioning, but if you have specific pain in your knee, you need more specific exercises to directly strengthen the muscles around your knee. Book an appointment with a physiotherapist to get your gait assessed.
What can I do to relieve osteoarthritis pain?
Pain from osteoarthritis may come and go depending on the progression of the condition. To slow down the progression, stay active. However, you should avoid all high impact activities such as running, jumping, plyometrics, and contact sports. Moderate low body resistance training and exercises such as yoga, pilates, and Tai Chi are encouraged to maintain mobility, flexibility, and improve strength. Progression of strength training should be done slowly to reduce risk of flare ups from the arthritis. Use ice to reduce swelling and inflammation if irritated from exercises, then adjust your exercise intensity and duration accordingly.
Although OA is a chronic condition, there are many things that can be done to improve daily functioning. Physical activity is one of the most effective methods of conservative treatment for OA. Many studies suggest that the cartilage between your joints responds beneficially to the mechanical stimulation of exercise. However, if no stimulation occurs, further cartilage thinning can take place. In addition, exercise assists with body weight management which helps to reduce the pressure on our joints and decrease symptoms overtime.
After being cleared by your healthcare professional, various forms of exercise can be prescribed in order to decrease pain and swelling, improve strength, increase range of motion and maximize your functional performance. Recommended exercises for OA include low-impact aerobic activities such as walking, biking, swimming or other aquatic exercise programs. Research shows that aquatic-based activities (e.g. Aqua Fit) are preferred to land-based ones because the buoyancy of water helps to reduce knee and hip joint compression. Seated bicycling is another great option that allows you to move your knee joint within a large range while still maintaining knee stability and reducing high-impact forces. Joint-specific resistance training has also been shown to improve muscle strength, decrease pain and improve quality of life for those with OA. However, evidence has shown that strength training should be combined with range of motion, stretching, balance and functional training for optimal results.
It is important to consult a medical professional before beginning any new exercise program.
What can I do to prevent osteoarthritis?
Genetics is a contributing factor to developing osteoarthritis in the future. Previous joint injuries such as ACL or meniscus tears and high impact exercises can also contribute to osteoarthritis in the knee. However, continual exercises and gentle lower body and core strengthening can help support your joints. Proper alignment of the pelvis, hips and knees can reduce repetitive strain on certain parts of your joints.
There is no cure for OA but research has been done to determine what can help slow down the progression and manage the symptoms of osteoarthritis.
NSAIDs (Aspirin, Ibuprofen, Naproxen etc.) have been the used to help manage symptoms associated with OA but due to the adverse effects associated with long-term NSAIDs use, more and more people are opting to go the more natural route. But because there are so many different natural treatment options, it can be a little overwhelming. We’re going to try to break things down and make it easier for you to decide which approach will be most beneficial to you when it comes to OA management.
Glucosamine and/or Chondroitin Sulfate
Glucosamine is an amino sugar that stimulates your cells to produce a protein that is present in your body’s connective tissue. It has been shown to be effective in the management of OA by decreasing symptoms and preventing joint structure changes.
Chondroitin is a major component of the extracellular matrix of the connective tissue of your body. It helps maintain the viscosity in your joints, stimulates cartilage repair and it inhibits the enzymes that lead to the breakdown of cartilage. Like glucosamine sulfate, it also has been shown to prevent joint structure changes.
Glucosamine and Chondroitin sulfate are usually packaged together as a form of OA management. It has been shown that the combinations of the two are more effective in decreasing OA pains and delaying joint space narrowing.
Glucosamine and chondroitin sulfate are safe to consume. For those that have a shellfish allergy, it’s best to consult with your medical doctor before taking glucosamine and chondroitin sulfate as glucosamine is part of the structure that makes up the shell of the shellfish.
Hyaluronic acid is a carbohydrate that occurs naturally in all-living organisms. It binds to water giving it a consistency similar to Jello. It functions to bind to water and lubricate moveable parts of the body. It plays an important role in the development of cartilage, maintenance of synovial fluid and regeneration of tendons and it acts as joint lubrication and shock absorber. Hyaluronic acid is usually injected into the joint to help with symptoms of OA, but oral ingestion of hyaluronic acid has also been shown to decrease symptoms of pain and stiffness as well as improving activities of daily living and improving mobility.
Also known as methysulfonylmethane is a naturally occurring compound in green plants, fruits and vegetables. It stabilizes the cell membrane and slows down the leakage of inflammatory material when a cell is injured. Therefore, MSM has been shown to decrease inflammation and act as a pain reliever. It has not been shown to help minimize joint space narrowing. However, combination of MSM and glucosamine sulfate has been shown to decrease swelling, joint function, and walking time. It has also shown to improve joint mobility and overall function.
Because these approaches are all natural, it’s best to give your body about 3 months to see how it responds to these supplements. If after about three months, you don’t notice much difference, you can switch to another supplement or try a combination of different supplements to find what works best for you.
What are my treatment options for osteoarthritis?
With mild to moderate cases with osteoarthritis, physiotherapy and exercise are the best ways to reduce pain and maintain or increase functions and activities of daily living. As osteoarthritis is a progressive condition, when the osteoarthritis becomes more severe, or “bone-on-bone”, meaning the cartilage has degraded to nearly nothing, surgery is the last option. At this time, you may have significant restrictions with activities, including walking and climbing/descending stairs. Total joint replacement surgeries are commonly done in the hips and knees, and will require a full year of rehabilitation and physiotherapy afterwards.
How can physiotherapy help with my osteoarthritis?
Physiotherapy treatment for osteoarthritis includes patient education, pain management, manual therapy to maintain or increase your current level of movement in the joint, and exercise. Our physiotherapists will help you understand your specific condition and develop an individualized master health plan with the goal of providing you with strategies to manage your osteoarthritis on your own.
At Full Function, we often treat patients with osteoarthritis in all different stages. Physiotherapy treatments include education, manual therapy, and exercises to help reduce pain. If you have any further questions regarding osteoarthritis, feel free to contact one of our health practitioners at Full Function Rehab & Wellness
Written By: Danette Lam, MScPT