Osteoarthritis and Joint Pain

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Osteoarthritis

What is Osteoarthritis (OA) and how common is it?
Osteoarthritis is a lifelong disease, which can start for no obvious reason. Osteoarthritis affects the whole joint and is the most common cause of physical inactivity in the ageing population. With OA, the cartilage on the ends of bones changes and can thin over time. Other structures in and around the joint, such as the joint capsule, ligaments, muscles and underlying bone, can also be affected. Osteoarthritis is more than just a joint condition and is influenced by a number of tissue-based, immune and individual factors. 

 

Osteoarthritis is more common than high blood pressure and diabetes and is the most common lifestyle disease in people older than 65 years. More than 2 million Australians have hip or knee osteoarthritis and 30% of people aged 50 and over report hip and/or knee pain. 

 

Osteoarthritis is often described as a “wear and tear disease” or “bone on bone”. These phrases sound really scary and can actually lead many people to think that they should and cannot be physically active. We know that this is wrong and that cartilage actually needs moderate load through activity/movement to be able to regenerate itself. 

 

Who gets OA? 

As mentioned, OA is the most common lifestyle disease in those aged over 65. OA is more common in women and women are more likely to have OA of the hands and knee, whereas men are more likely to have OA of the hip. During middle age men are more likely than women to have OA. 

 

While structures can be involved in the symptoms of OA there are a number of factors (the majority being modifiable) that can have a negative impact on your experience with osteoarthritis. These include: 

  • Weight

  • Stress

  • Trauma

  • Muscle weakness

  • Physical inactivity (your joints/tissues need stimulus to regenerate and be strong)

  • Stress, depression and feeling isolated 

  • Sporting injuries/doing too much 

  • Lifestyle factors such as poor sleep 

  • Age (non-modifiable) 

  • Sex (non-modifiable) 


Common symptoms? 

  • Morning stiffness and pain 

  • Pain with activity and weight bearing, even sometimes at rest 

  • Swelling/hot joints 

  • Crepitus

  • Reduced range of motion 

  • Functional limitations e.g difficulty getting out of a chair 

  • A sense of giving way 

  • A sense of giving way/feeling unstable 

  • Location of pain can vary for each joint 

  • Visible structural change e.g. knocked knees 


How can Physio help? 

Your Physiotherapist will conduct a thorough assessment to confirm your diagnosis of OA - this is done by taking a thorough history (which includes typical pain behaviour, functional limitations, risk factors, symptoms etc.) and assessment (range of movement, strength testing and other relevant functional tests). Imaging is not needed to diagnose OA and it is always the patients symptoms and not imaging findings that guide the choice of treatment. Scans are important in the case of a traumatic injury or if something more sinister is suspected and will be required for the small proportion of people who do require joint replacement surgery.  

 

We know that OA is irreversible but the symptoms can be reduced and even disappear with the right approach and treatment plan. The three key components of OA management are education, exercise and reducing inflammation. Research has shown that exercise and education can prolong and in some cases even prevent the need for joint replacement surgery. Your Physiotherapist will work with you to create an individualised treatment plan to achieve your goals and improve your function and pain. Treatment is not just about exercise, but establishing a baseline and monitoring symptoms before, during and after exercise. It is really important to get the dosage of activity right in order to get the best possible outcome. 

 

Weight loss is something that can be achieved by exercise and other lifestyle changes like diet, but it can be hard to do on your own. This is where seeing a dietician can be extremely beneficial. Research shows that only a 5% reduction in weight is needed to have a positive impact on pain and inflammation. Your Physiotherapist can discuss what other Allied Health services could be beneficial to you in managing your OA.