Osteoarthritis (OA) & Physiotherapy

Author: Lisa McTaggart

Reading Time: 5 minutes

What is Osteoarthritis?

As we age, our bodies endure physiological changes that affect our joints. Osteoarthritis (OA) – often referred to as the blanket term “arthritis” – is characterized by a decrease in joint space. As the space between bones decreases, bone surfaces become more congruent and increased friction in the joint occurs. This process degrades cartilage/bone and eventually leads to the formation of new bone (called osteophytes). These physiological changes can cause pain and often impacts an individual’s ability to perform numerous activities of daily living.

OA is a common orthopedic condition that affects many individuals.

The joints most commonly affected by OA are the hip, knee, hand and foot, however, any joint in the can be affected by the condition. Symptoms associated with OA can be treated effectively with Physiotherapy in most cases. If a joint replacement is required, Physiotherapy (both pre-surgery and post-surgery) can speed the healing process for faster return to functional activities.

OA Treatment

Pain is the most common complaint in individuals with OA. The following treatments can improve symptoms related to OA.

#1 EXERCISE!!! – Research literature conducted by numerous studies recommends that “exercise is arguably the most important treatment for OA”1. As such, OA treatment should include a rehabilitation program that incorporates exercises guided by an experienced physiotherapist. Generally, strength gains are noticed after approximately 6 weeks – if exercises are performed diligently. (See FAQ “Why does my physiotherapist make me exercise?)

Manual Therapy – Physiotherapists are trained in specific manual techniques to improve symptoms associated with OA.

Modalities – Electrical modalities can assist in reducing pain levels temporarily.

Activity Modification – Modifications may be necessary to complete activities. For example, swimming is a great strengthening/endurance activity that places less strain on peripheral joints.

Medications – Some medications offer pain relief. Speak to your doctor or pharmacist regarding the options available.

Surgery/Joint Replacement – In severe cases, joint damage may require joint replacement for return to functional activities. In these circumstances, it is important to see a physiotherapist both before and after surgery. (See FAQ “I’m getting a knee/hip replacement – Why do I need to before and after the surgery?”) 

Osteoarthritis (OA) – Frequently Asked Questions

Am I at risk for developing OA?

Symptomatic OA is present in approximately 40% of men and 47% of women1. The incidence of OA increases, as certain factors are present. These include2, but are not limited to:

  • Overweight/Obesity
  • Increasing age
  • Gender
  • Previous Injury
  • Genetics
  • Specific Occupation/Activity

Why does my physiotherapist make me exercise?

As osteoarthritis commonly affects joints involved in weight bearing activities, most individuals experience pain while participating in activities that load the joint. Contrary to popular belief, “pain-free exercise does not appear to accelerate OA development, and has been postulated to have a protective effect”1. Exercise can strengthen joint structures, which increases joint stability1. Exercise can also improve metabolism in articular cartilage, increase endurance and facilitates weight loss (which places less load on the joint)1.

Although exercise is undoubtedly beneficial, it is important to discuss training regimens with your physiotherapist to ensure proper body mechanics. If exercises are performed incorrectly, increased strain on joints can lead to injury – which can actually increase the risk of developing OA2. Proper exercise techniques and training schedules are imperative.

What else can I do to decrease my pain?

As previously mentioned, exercise is one of the best methods to decrease your OA pain. Some discomfort during exercise and muscle aches post exercise are normal. Your exercises should be performed daily to see improvements in pain, strength and endurance. As previously mentioned, strength/endurance improvements are usually seen after 6 weeks of training during physiotherapy.

Changes to your diet can also help to decrease pain associated with OA. A healthy diet combined with exercise can expedite weight loss – which decreases stress on joints affected by OA.

Activity modifications can include choosing exercises that limit joint impact (swimming, elliptical, biking as opposed to running and jumping), scheduling appropriate rest periods in daily activities and training, and utilizing assistive devices to complete important tasks (gait aids, grip assisting devices, etc.).

Your doctor can prescribe medications to help with pain. However, it is important to address the underlying issues contributing to osteoarthritic pain. Medication should only be used as an adjunct to exercise and other conventional treatments.

What should I expect for healing timelines?

Healing timelines vary according to individual and the type of surgery performed. Factors such as overall health status, compliance (RE: precautions & exercise consistency), health habits, age and fitness level will impact healing timelines. Generally, strength/endurance changes can be seen within 6 weeks of attending physiotherapist sessions and participating in a daily rehabilitation program performed at home.

I’m getting a knee/hip replacement – Why do I need to see a physiotherapist and exercise before and after the surgery?

If you are receiving a joint replacement, you are more than likely currently struggling with some activities of daily living. Physiotherapy pre-surgery, especially with a focus on proper strengthening, has been shown to speed up the recovery process. In a joint replacement surgery, some muscles are cut to allow access to the joint. These muscles are usually sore post-surgery and muscle wasting is usually apparent (due to lack of use after surgery). Once sufficient healing time has passed, strengthening of these muscles can begin. By participating in an active strength/endurance program prior to joint replacement your baseline strength increases – which, in turn, allows you to return to activity faster. For example, pre-operative quadriceps strength is “a good predictor of physical performance 12 months after surgery”3.

Physiotherapy post-surgery is an important component to re-gaining functional activities. Initially following surgery, multiple factors are impacted such as increased pain/discomfort, asymmetrical weight bearing, inability to complete some activities, gait changes, muscle atrophy and difficulty with balance3. It is important to address these changes in physiotherapy to gain maximum function and prevent maladaptation at other joints.

 Can I return to activities that I used to do after having joint replacement?

Depending on your surgery, your surgeon may make specific recommendations regarding return to pre-surgery activities. Every surgery is different and it is important to discuss precautions and return to activities with both your surgeon and Physiotherapist. Typically, individuals with a total knee replacement (TKR) or total hip replacement (THP) are recommended to avoid activities that place extreme loads on the joint. For example, Lorenz and Salsbery recommended the following guidelines for return to activity in TKR and THR patients*:

Recommended: Bowling, Golf, Dancing, Walking, Swimming

Recommended with experience: Cycling, Hiking, Rowing, Cross-country skiing/stationary skiing, speed walking, doubles tennis, ice skating

Not recommended: Jogging, running, contact sports, racquetball/squash, singles tennis, baseball, martial arts, water skiing, handball, wall climbing, jumping activities

*Important: These are general recommendations. It is imperative that you discuss return to activity with your surgeon and physiotherapist as every individual will have different circumstances.

References

1.     FRIES, J.F., BRUCE, B. and SHOOR, S. Osteoarthritis, Exercise and Knee Replacement. The Journal of Rheumatology, volume 36 (no.4), p. 669-671. http://www.jrheum.org/content/39/4/669

2.     Neogi, T, and Zhang, Y. Epidemiology of Osteoarthritis. 2013. http://dx.doi.org/10.1016/j.rdc.2012.10.004

3.     Lorenz, D.S. and Salsbery, M.A. Return to High-Level Activity Following Knee Replacement. Topics in Geriatric Rehabilitation, volume 29 (no. 1), p. 46-54. DOI: 10.1097/TGR.0b013e318275c1fb

Lisa McTaggart, MScPT Student

 

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