Osteoarthritis (OA) is a condition which affects middle aged to elderly people (45 years and older). The 2017-18 National Health Survey shows about 2.2 million Australians currently live with OA, with numbers expected to skyrocket to 3.1 million by 2030.
Healthy cartilage covers the ends of the bone surface ensuring a smooth surface for bone to move nice and smoothly, however OA occurs this cartilage breaks down. Not only is the cartilage affected, so too is the entire joint resulting in bony changes whereby extra bone is laid down, ligament and tendon changes, inflammation the joint and changes to the surrounding muscles.
With no current cure for OA, often people believe surgery is the only ‘fix’ however with strong evidence for management of OA through physiotherapy and exercise, a non-surgical approach should be trialled first.
Two of the biggest modifiable factors for osteoarthritis which I will talk about below include exercise and weight management.
Do I have OA?
Symptoms of OA can vary slightly depending on the level of severity. Often it presents as joint pain, joint stiffness, swelling of the joint, reduced range of motion, crepitus or grinding, feeling of ‘giving way’ and muscle weakness. The more severe OA, the more likely everyday function and activities of daily living may be impacted.
So, what can I do for OA?
Exercise helps to increase range of movement, flexibility and strengthen muscles around the hip and knee. It also helps to minimise and slow down the OA process by improving cartilage nutrition, increasing blood flow, decreases the swelling and improves muscle strength.
Often other factors such as fatigue, depression and poor sleep can be associated with OA, however exercise can help to address these factors. Patients suffering from knee OA have a huge lack in strength of muscles around the knee (specifically the quadriceps) and similarly patients with hip OA have weakness of muscles around the hip including the gluteal muscles. Therefore, a major part for rehabilitation is strengthening surrounding muscles to ensure increased stability to the joint which therefore will help improve pain levels. Current guidelines suggest strong evidence for land-based exercises for both knee and hip osteoarthritis and recommend exercises to include walking, muscle strengthening, Tai Chi and stationary bike for those with OA.
Obesity is a huge risk factor for OA and can increase the OA process. Physiotherapy can assist with management of obesity through exercise and education. There are currently strong recommendations for weight management for hip and knee OA. Think about the amount of weight-bearing forces that go through the hip and knee when we do everyday activities! It’s a lot…This only increases when you are carrying excessive weight. Increased weight increases the load on the joint which increases pain. Whilst education regarding weight loss may be a sensitive topic for some, addressing this is vital in management of osteoarthritis. So much so that a loss of at least 10 percent of body weight has been associated with a 50 percent reduction in pain scores, now that’s pretty OAwesome!
Written by William Lewis (Physiotherapist)