What is Osteoarthritis?
Osteoarthritis is the most common form of arthritis and most often affects the spine, hip, knee, hand and foot
Cartilage covers joint surfaces to reduce friction between the bones. In time the cartilage can become worn and the joint surfaces become rough and friction increases.
The subchondral/ underlying bone becomes exposed and reacts by producing more bone- this is where we see reduced joint space and osteophytes on xray.
The surrounding tissues also become more active- the capsule and ligaments thicken and more fluid is produced.
This is a fairly normal process and typically does not equal pain and symptoms- often we see osteoarthritic changes on xray, but the person has no pain and is fully active.
However, sometimes new bone formation can increase load in certain parts of the joint and this repair process becomes painful.
Osteoarthritis is typically characterized by pain, stiffness and altered function, which many patients come to us for help with.
There are a number of risk factors for osteoarthritis- age, previous injury, family history, being over weight, other conditions/ inflammatory diseases
So what can be done to help?
NICE guidelines recommend 3 core treatments: education and advice, exercise therapy and interventions to support weight loss, in addition to pharmacological treatments. Unfortunately pharmacological treatments are often favored and underlying problems are not being addressed.
Exercise- this is where the evidence is clear- strengthening the surrounding muscles improves stability and helps protect the joint. It also reduces pain and improves sleep. We understand that when you have pain the thought of doing exercise is not appealing- this is where physio can help to find the best exercise program for you, your symptoms and goals
Maintaining a healthy weight- weight bearing joints have to tolerate in excess of 6 times body weight with activities like stairs- therefore every 1kg makes a difference
Eating a healthy diet- there is some suggestion that symptoms of osteoarthritis are reduced in those that eat a Mediterranean diet
Painkillers- we always want to select the lower dose, with the smallest side effects, for the shortest amount of time, to provide the maximum benefit. It may be worth speaking to your GP about options
Other options may include:
Steroid injections- this can help reduce pain in mild to moderate osteoarthritis for several weeks, or even months. This can provide a nice window in which to strengthen around the knee without being limited by pain
Hyaluronic acid- this can help lubricate the joint. The evidence is limited but anecdotally we have seen some good results
Braces may be an option- usually if osteoarthritis is isolated to one part of the joint- to help offload that painful area
Apos therapy is a foot wear device with two pods places underneath in a position to redirect ground reaction forces away from the painful area. The pods are also unstable so encourage the muscles to contract and relax more naturally
Acupuncture- these is some evidence to support acupuncture for pain relief
Manual therapy- some people find some short term relief from joint mobilization and soft tissue massage. However this should not detract from exercise therapy, optimizing general health and weight management
Joint replacement surgery- this is reserved for cases where osteoarthritis is advanced and pain is impacting on quality of life and function. It is now a fairly routine operation in the UK and joints last approximately 15yr.
So if you suspect you have osteoarthritis, come and see us. We can confirm your diagnosis, address the core treatments and discuss what options might be appropriate for you.