For many, a diagnosis of osteoarthritis is quite an upset. It is often perceived to be a condition that will only worsen, that the damage is done and you may as well get used to a life of struggling along from day-to-day. However, unsurprisingly, I am here to explain how this is a misconception.
Before we go any further, let me briefly explain what osteoarthritis (OA) is and how it can affect you. It is a mechanical disorder that results in damage to the cartilage on the joint surface resulting in excessive growth of the underlying bone. The most commonly affected joints are the knees and hips. These joint changes are mostly age-related but can develop earlier in life as a result of a significant injury to a joint (e.g ACL rupture) or if you are unlucky enough to have a genetic predisposition.
The signs and symptoms of OA can affect people differently but there are common trends that do occur. These include:
- Joint stiffness lasting less than 30 minutes in the morning
- Crepitus (clicking/grating sounds) on active movement
- Reduced range of movement
- Pain at end-range of movement
- Intermittent or sporadic pain, constant pain, or activity-related pain
- Painful, swollen joints
For those suffering from these symptoms, it is the pain and associated frustration and anxiety from the loss of function that often bothers them the most. This is why it is important for OA sufferers to be made aware that there is a lot that they can do to help manage the condition.
An accurate diagnosis can be made following a thorough assessment by a physiotherapist or physician. An X-ray or other imaging can be useful to confirm, or to get a baseline measurement but it is not essential. As with any injury or condition, we will always look at the risk factors of the patient. These risk factors can be split up into either modifiable (e.g. weight, strength) or non-modifiable categories (e.g age, genetics). While we always acknowledge the non-modifiable factors, as physios we get excited about the modifiable ones as it provides us with a real opportunity to help patients treat whatever condition or injury they have. For sufferers of OA, joint overload and the function and strength of the surrounding muscles are the two main modifiable risk factors. If targeted they can play a large role in improving daily function and quality of life in those suffering from OA. Yes, you’ve guessed it correctly – lose weight and get stronger!
Although our approach in the clinic certainly has a bias towards using exercise as a treatment, there is a vast amount of research that supports the use of exercise along with weight-management and patient education as the three core principles of effective OA treatment.
It is important to note that exercise does not just need to be part of a rehabilitation programme following a knee or hip replacement linked with OA. If used appropriately, evidence suggests that you can significantly delay or even prevent the need for joint replacement 1.
Considering the population that is usually affected by OA, the most important measures that can be improved with appropriate treatment and management are long-term function 2, health-related quality of life 3, and psychosocial benefits 4.
There are some simple rules to follow when prescribing exercise for those with OA. Needless to say, anything that exacerbates the symptoms greatly should be avoided. Typically, for those with knee or hip OA, you should avoid repetitive, high-impact exercises such as running. Strengthening the muscles that support the knee and hip can reduce some of the excessive joint forces that drive the painful symptoms, over time reducing pain and improving mobility and weight bearing capacity.
Don’t get me wrong; I am not suggesting that all we have to do to reverse OA is to hit up the gym and do a few squats. The physical changes to the joint will not be reversed. However, we have observed those benefits and positive changes that I mentioned previously with appropriate, progressive exercise.
If you suspect that you do have OA, get a full assessment by a Chartered Physiotherapist and get ready for some structured exercise in your life. We tend to be very fond of getting people stronger, fitter, and ultimately healthier.
- Svege, I., Nordsletten, L., Fernandes, L. and Risberg, M. (2013). Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Annals of the Rheumatic Diseases, 74(1), pp.164-169.
- Hurley, M., Walsh, N., Mitchell, H., Nicholas, J. and Patel, A. (2012). Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial. Arthritis Care Res, 64(2), pp.238-247.
- Hurley, M., Walsh, N., Bhavnani, V., Britten, N. and Stevenson, F. (2010). Health beliefs before and after participation on an exercised-based rehabilitation programme for chronic knee pain: Doing is believing. BMC Musculoskeletal Disorders, 11(1), p.31.
- Hurley, M., Mitchell, H. and Walsh, N. (2003). In Osteoarthritis, the Psychosocial Benefits of Exercise Are as Important as Physiological Improvements. Exercise and Sport Sciences Reviews, 31(3), pp.138-143.