Have you started noticing stiff and painful knees or hips? Are you experiencing swelling in your knee(s) after activity or running errands? Are you struggling to get out of bed due to joint pain and stiffness? Does your knee pain limit your ability to be physically active or restrict your job demands? These are all initial signs of osteoarthritis. As physiotherapists, we get a lot of people asking questions about osteoarthritis (OA), with over 20% of Canadians struggling with some sort of arthritic condition. In this blog we are going to break down the condition step by step and give you tips on how to manage it effectively.
What is Osteoarthritis?
Osteoarthritis, commonly referred to as OA, is the breakdown of joint cartilage (the tough material that covers bone), and changes to the underlying bone and surrounding joint structures.
The features of OA include:
Loss of articular cartilage with narrowing joint space
increased density and cysts of the underlying bone
stiffening of the joint capsule
degeneration of the meniscus, often with meniscus tears
osteophyte formations
The picture below shows the differences between a healthy knee joint and a knee joint with OA.
How does Osteoarthritis develop?
OA develops when the degradation of articular cartilage super-seeds the synthesis of healthy articular cartilage. Meaning, that cartilage covering your joint surface is disappearing faster than it is being reproduced.
We won't bore you with the underlying metabolic process that causes these changes but know that a lot of research has been done to show how this occurs. If you want to learn more about the science you can click here to read more.
Factors that cause cartilage degradation include:
Too much mechanical stimuli or use (i.e a previous trauma to the joint, too much use of the joint due to work or sport, joint mal-alignment or poor biomechanics, muscle weakness, and increased body weight)
Too little mechanical stimuli (i.e not enough use - living a sedentary lifestyle)
Inflammation mediators (body weight and genetics)
Basically, a joint must be used a healthy amount with good alignment to build and maintain healthy cartilage… think of Goldilocks, not too much, not too little, but just right.
What are the main risk factors for developing Osteoarthritis?
We often receive the question "What did I do to cause the osteoarthritis?" In some cases, there is nothing you could have done differently. Some people are more predisposed to developing osteoarthritis than others. Genetics, gender, and age play a significant role and are factors that cannot be changed. Below, we have categorized the risk factors for osteoarthritis into two groups: non-modifiable (things you can't or couldn't have changed) and modifiable (things that can or could be changed).
Non-Modifiable Risk Factors for OA
Age: Being over 40 years of age
Gender: Being Female
Genetics: Having a family history of OA
Modifiable Risk Factors for OA
Being Overweight
Having a prior joint injury
Having a hard physical occupation
Overuse of joints in spare time (i.e choosing a sport or hobby that is hard on your joints).
What can I do to prevent Osteoarthritis?
A consistent strength and cardiovascular routine can reduce the risk of developing OA. Canadian Physical Activity Guidelines recommend for the ages of 18-64 an accumulation of 150 minutes of moderate-vigorous physical activity per week and two strength training sessions using major muscle groups per week. If you are over 65, the recommendation is the same as above, with the addition of physical activities that challenge balance.
Strength training can help prevent osteoarthritis by building stronger muscles around a joint, providing better joint support and stability, reducing the load and stress on the joint, maintaining proper alignment, and reducing the risk of joint damage. Additionally, it can aid in weight management by building muscle mass and increasing your metabolic rate. Regular strength training also promotes the flow of synovial fluid, which nourishes the joint cartilage and keeps it healthy. This fluid also helps lubricate the joint, reducing friction and wear.
Cardiovascular activity is also important for joint health. Regular gentle cardio like running, swimming, and biking help to control your weight, keep your joints moving in a healthy way, can increase muscle strength, and help with circulation.
Overall, movement in the right amount with proper joint alignment is a key factor in reducing the risk of osteoarthritis.
How do I manage a diagnosis of Osteoarthritis?
here are various approaches to managing osteoarthritis, and the chosen pathway is usually based on the patient's prior treatments and the severity of the condition.
The first stage of OA treatment involves education, evidence-based exercises, and weight management. Education focuses on the development, signs and symptoms, management strategies, and treatment options for osteoarthritis. This helps patients understand the physiology of OA, what causes flare-ups, and what options are available to them. Education also empowers patient, helping them advocate for themselves and make informed decisions about their treatment. In addition to education, it is recommended to start an evidence-based exercise program targeting the muscles surrounding the affected joint, as well as implementing weight management strategies (such as nutrition plans).
If a patient is not showing signs of improvement in the first stage of treatment, pharmacological interventions are introduced. This would include pain medication, possible steroid injections, or weight management medications. In tandem, some patients will select to try an offloading brace (for knee OA) which can be prescribed by your physiotherapist or doctor and requires a custom fitting. Custom braces can be expensive but are typically covered by extended healthcare plans.
If a patient has tried education, evidence-based exercises, weight management, pain medication, possible injections and bracing and not managing well (i.e having difficulties at work, unable to perform daily tasks, or describing a lower quality of life), then joint replacement surgery becomes a viable option. In Canada, surgery is a final treatment option as it is the most invasive choice. Joint replacement surgery comes with risks like all surgical interventions and if this can be avoided with other conservative methods it is advised. Joint replacements typically only last 15-20 years, before needing a revision. Therefore, if a joint replacement is completed on a patient in their 40’s they may need two or three revisions in their lifetime. This is why a surgeon or doctor may ask a patient to wait until they are older before surgery is suitable.
Because of the complexity and frequency of osteoarthritis resources have been created to support patients on their journey with the condition. One of the best resources available is GLA:D Canada, there are online tutorials and education available, as well as in-person exercises and education programs around the country.
If you have been diagnosed with osteoarthritis or would like to learn more about the condition, reach out to your local physiotherapist. Physiotherapists can guide you through each stage of the process, assist with an evidence-based exercise program, discuss or prescribe bracing options, and provide you with education on the condition.
At Port Alberni Physiotherapy, we have physiotherapists with special post-graduate certifications in osteoarthritis management who would be happy to help you. To book an appointment, please visit our website www.portalberniphysiotherapy.ca or call us at 250-723-5112.