Everyone has heard of osteoarthritis (OA) but not everyone knows what it is. Although it is the most common chronic condition of the joints, most of the time it is not the cause of ones symptoms. This article will better equip you with the knowledge of OA and how to best manage it.
What is osteoarthritis?
In a healthy joint, there is a layer of cartilage that covers the end of the joint that provides lubrication, support and cushioning between the bony surfaces. In OA, the cartilage surface starts to degrade and break down, which begins to cause pain, swelling and stiffness.
As OA progresses, bones also break down and develop growths called bony spurs. This occurs as the body tries to fight and lay new bone and cartilage down but can often lead to increased discomfort and pain. The body also starts an inflammatory process and develop enzymes that further leads to cartilage damage.
In the final stages of OA, the cartilage is worn away leading to bone on bone contact causing joint damage and severe pain. OA can affect any joint, but it occurs most often in the fingers, toes, neck, lower back, hips and knees.
The first stages can be conservatively managed with physiotherapy, medication and lifestyle changes, while stage four is typically an indication for surgery.
Here are some statistics of OA:
- Affects approximately 3.6% of the worlds population
- 11th most debilitating disease in the world
- Causes moderate to severe disability in 43 million people
- 1 in 5 Australians (21%) over the age of 45 have OA
- 35% of adults aged 80 years and older have OA
Why does it happen?
There are several risk factors for developing OA and these are:
- Female gender
- Anatomical factors
- Muscle weakness
- Joint injury via sports or occupation
There are two types of OA:
Primary OA occurs in people aged 55 to 60 years old, where cartilage degeneration occurs. There is always a natural progression of cartilage breakdown as you get older, however for some people it may be more severe due to various risk factors.
The second type of OA is an increase in cartilage degeneration due to a specific cause. These can include:
- Obesity. This is one of the largest causes of OA as cartilage is placed under excessive load, therefore increasing the rate of wear and tear. The Arthritis Foundation found that every 1kg of extra body weight equates to extra 5kg of pressure on the hips and 3kg on the knees.
- Genetics. OA can be hereditary, therefore increasing your risk if it is common in your family.
- Injuries. Studies have found that fractures, joint damage and poor biomechanics can increase the risk of OA.
- Inactivity. Having a sedentary lifestyle is also a big cause of OA as joints are not exposed to adequate movement, lubrication and appropriate load to allow cartilage and bone to grow and remodel.
- Inflammatory diseases. Inflammation such as Perthes’, Lyme, rheumatoid arthritis, gout and other chronic forms of arthritis are also causes of OA.
- Other diseases and health conditions.
Do I have osteoarthritis?
OA symptoms often develop over time. The signs and symptoms of OA include:
- Pain. Affected joints can be painful at particular times of the day or with movement. Pain can depend on the severity of the OA.
- Stiffness. Joint stiffness can occur for 30 minutes after waking or after prolonged inactivity. Stiffness can often improve once moving and warmed up.
- Swelling. Caused by soft tissue inflammation around the joint.
- Poor flexibility. You may not be able to move your joint through its full range of motion.
- Crepitus. Grating, popping and crackling sounds when moving joints.
- Change in joint appearance. Bony spurs and joint space narrowing can occur. The body attempts to form new bone in response to wear and tear around the joint. This can often form hard lumps around the joints and change joint appearance.
How do I manage it?
There are several ways to manage OA but there is currently no treatment that can cure it. The two methods of managing OA include physiotherapy or for more severe circumstances, surgery. Lifestyle changes and medication are also important considerations in OA management.
One of the most effective ways to manage OA is changing your lifestyle. Being more active, eating healthier, having adequate sleep and keeping your general health in check can make a huge impact on preventing or maintaining your condition. Joining a gym, going for walks or attending an exercise class are excellent ways to increase your physical activity. Seeking advice from a dietitian or nutritionist can point you in the right direction to eating healthier. Ensure you have regular check ups with your doctor, this will ensure your general health is on track and your vitals are in normal range. The combination of lifestyle factors alone can prevent OA or significantly improve your symptoms.
Physiotherapy is an integral part of OA management and is typically the first point of call. A physiotherapist will be able to improve your physical and psychological function.
Rolls of a physiotherapy include:
- Goal setting
- Improve range of motion and flexibility
- Improving strength and balance
- Improve cardiovascular fitness
- Providing education, advice and tips on OA management
A large component of a physiotherapists work includes falls prevention. Individuals who are affected by OA, especially the elderly have poor mobility, reduced strength and impaired balance which put them at greater risk of falling. Studies have shown that individuals with OA are 30% more susceptible to falls and have a 20% greater risk of fractures. Additionally, side effects such as dizziness, drowsiness and nausea from medications can also contribute to falls.
A physiotherapist will equip you with a home exercise program for self management and provide in-clinic treatment such as soft tissue therapy, manual therapy, cardiovascular exercises, gym exercises and hydrotherapy. Combined, this can drastically improve a person’s well-being and quality of life.
If a joint is severely damaged, or a conservative approach has shown no improvement, the path towards surgery can be chosen. This involves the repair or replacement of the damaged joint. A doctor will refer an eligible patient to an orthopaedic surgeon to perform the procedure.
Osteoarthritis can be a debilitating condition but if managed appropriately and with the right help, people can improve their quality of life and continue to perform activities they love and enjoy. If you believe you may have osteoarthritis, or require more information, please contact us to see one of our physiotherapists. We will be able to point you in the right direction.