Osteoarthritis (OA) is a frequent source of pain and stiffness
that brings clients into healthcare offices.
In fact, it is the most common type of arthritis, affecting 1 in 10 Canadian
adults. It occurs when the cartilage
that covers and protects bones breaks down and wears away, narrowing the joint
and making it less smooth. Eventually,
this may lead to the formation of bone spurs, ligament laxity, and weakening of
the muscles around the joint. It is most
common in the weight-bearing joints of the hips, knees, low back, neck, big
toes, as well as the fingers and thumbs.
Also known as degenerative joint disease or degenerative
disc disease (specifically in reference to OA of the inter-vertebral spaces in
the spine), its prevalence increases with age, with a notable increase after
age 70. Other risk factors include a
family history of OA, being overweight, or a previous joint injury (e.g. knee
ligament injuries).
The diagnosis of OA is made via a combination of a patient's
history and symptoms (e.g. morning stiffness lasting 15-20 minutes), physical
examination of the joint, and by obtaining an x-ray of the involved area. It is important to note that x-ray findings
and symptoms don't always go hand in hand, where a greater degree of degeneration
does not always equal more pain. As a
result, it is important to treat the patient and their unique clinical
presentation versus the x-ray findings alone.
This illustrates the complexity involved in the "experience"
of pain as structural changes are not the only factor.
When it comes to managing OA the goals of treatment are to
control pain and maintain function. You
cannot conservatively reverse the structural changes that are already present
but you can work toward slowing its progression and the need for more invasive
treatments.
Daily
range of motion exercises compete with the progressive stiffness of OA and
strengthening exercises are important to maintain muscle tone and active
stability around the joint. Together, these
activities serve to improve joint loading patterns to minimize stress on the
affected joint(s). Aerobic exercises are
also valuable as they increase energy and assist with weight management. Furthermore, all forms of exercise have the
added benefit of releasing endorphins which have a pain-blocking effect on the
nervous system.
Making
lifestyle modifications, such as pacing strenuous activities, using assistive
devices as needed, and making healthier dietary choices goes a long way. As stated, excess weight is a risk factor and
losing even 10 pounds can create a noticeable change in symptoms. 80-90% of hip and knee replacement patients
are either overweight or obese so controlling weight deserves attention.
Manual
therapies including soft tissue techniques, joint mobilization and/or
manipulation, therapeutic modalities, and acupuncture may assist with
decreasing pain and stiffness.
Medications, particularly painkillers and anti-inflammatories, are also
commonly used to manage the symptoms of OA.
Each of these approaches should be discussed with a healthcare
practitioner so you are informed of the risks and benefits of the therapy.
If your
pain and function due to OA is not being successfully managed by the above
options, a referral to an orthopaedic surgeon may be necessary to discuss more
invasive treatment options, such as joint injections and surgery.
With
OA, the concepts of "motion is lotion" and "move it or lose
it" hold true.
Seek professional advice if needed to learn your limits and develop a
management plan. This article is for
general information purposes only and is not to be taken as professional
medical advice.
