Key Facts about arthritis

It’s a condition that can be debilitating and affects a large portion of the population, especially those over the age of 70. And unfortunately, once arthritis is there, we can’t reverse it.

It’s a condition that is characterised by pain, reduced mobility and a feeling of being overly stiff or tight in your muscles and joints.

Due to the nature of the condition, it can occur in people who have had a previous injury, have worked in labour specific jobs, have played large volumes of sport or are over the age of 65.

Osteoarthritis is essentially the “wearing out” of cartilage and bone within a joint. This damage opens nerve endings in the bone that causes pain during movement. Osteoarthritis is degenerative in nature, meaning that once is has occurred, we can’t reverse the damage done.

However, research has shown that the more active someone is, the lower pain they report with everyday tasks. It has also shown that completing regular activity has better outcomes post-surgery for those that require a joint replacement.

Below are some facts about osteoarthritis in Australia.

  • Osteoarthritis is the leading cause of pain and disability in the elderly.
  • It affects over 4 million people in Australia (that’s 1 in 6 people).
  • Osteoarthritis is the third leading cause of life-years lost due to disability in the elderly.
  • Arthritis is the second most leading cause of early retirement, causing a loss of $7.8 billion in GDP.
  • Around 2 million Australians who are within the working age (15-64) have arthritis
  • There are over 100 types of arthritis, with osteoarthritis, rheumatoid arthritis and gout being the main three types.
  • Osteoarthritis isn’t able to be reversed.
  • You have to use it or lose it! Rest can make pain and other symptoms much worse.

In Healthcare

Arthritis costs the country an approximate $5.5 billion in 2015, and this is expected to rise to $7.8 billion by 2030.

By improving our education of what arthritis is and the best forms of management to people, this will have a flow on affect, and hopefully reduce the financial burden placed on the healthcare system for arthritis related health issues.

In the body

Arthritis can affect any joint in the body, but research has shown the major load bearing joints (knee, hip, lumbar spine, cervical spine and shoulders) tend to be the joints with the biggest prevalence of arthritis.

Take Home Message

Arthritis is a health condition that has a lot of information written about it. What is important to know is that there are many different types of arthritis, and management of these different types will all be slightly different.

It is also important to know that the symptoms that you may feel due to arthritis may be completely different to someone with the same type of arthritis in the same joint.

There are multiple factors to consider when learning to manage symptoms of arthritis, and this blog will hopefully answer any and all questions you might have, specifically regarding osteoarthritis, the most prevalent type of arthritis in our society.

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The Three main types of arthritis

As mentioned earlier, osteoarthritis, rheumatoid arthritis and gout are the three main types of arthritis that affect Australian Society. All three types of arthritis can cause swelling, pain, reduced joint range of motion and associated reduced function, but each of them are slightly different to the other.

But what does this mean? How did I get arthritis? And what are the best ways to help manage my symptoms and avoid flare ups?

Osteoarthritis

Now, before we get into what Osteoarthritis (OA) is, it is important to know and reinforce a few things throughout;

  • OA is a natural process that occurs within the body.
  • If you scanned every person over the age of 70, you will find some sort of degeneration in some part of their body irrespective of pain.
  • As much as OA can have symptoms of pain, swelling and loss of range, you can also have OA without any symptoms.
  • Think of joint degeneration as wrinkles on the inside of your body. Everybody has wrinkles as you age, but it doesn’t necessarily mean anything is wrong. It just means you’ve lived a great life.

Osteoarthritis (OA) is a degenerative condition that can affect any joint, but mainly occurs in lower back, knees, hips, neck, small joints of the fingers and the bases of the thumb and big toe.

A joint in your body usually has a spongy, rubber type tissue called cartilage that protects the ends of bones, and helps them connect to form a joint. The cartilage is usually smooth and provides a cushion for the bones so that they don’t hit together and cause damage.

For example, think about a rubber stopper behind a door. If the two bits of wood (door and skirting board) where to bang against each other all day, there would be damage. The stopper helps to soften to impact of the door to avoid damage occurring.

With OA, the cartilage can first become more brittle, and henceforth start to break down. This can cause significant swelling, pain and reduced range of motion within the joint. As OA progresses (it is a degenerative condition), the cartilage may completely wear away, exposing the bone beneath that can also start to wear away. Small pieces of cartilage and bone that have broken off may then stay and float around within the joint (this is a normal process, and one you shouldn’t be worried about).

The body then starts an inflammation response to try and help repair the damage within the joint, but this can cause bony spurs and can also further damage the lining of the cartilage. Once the cartilage has worn away, bone may start hitting against bone. This happens in the final stage of OA and can be quite painful.

Now this all sounds very bad, but it is important to know that OA is a natural occurrence within the body, and one that occurs as we age, and if you scanned every person over the age of 70, they will have some level of OA in some part of their body, with or without pain.

Imagine our door analysis again, but your knee is the hinge of the door. Now, imagine that you open and close that door thousands of times throughout the day, every day, for many years.

The hinge will eventually wear away if you don’t take proper care of it. But even with proper care, it would be silly to think the hinge will be in the same condition 40-50 years on that it was when it first was put on the door.

OA is much the same. And much like that door hinge, if you didn’t use the door adequately for many years, it will begin to become stiff and hard to move.

This is also true of our aging process. So as much as simply using your joints may start the process of OA, not using them can start that process a lot quicker.

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an auto-immune disease where your body starts attacking the lining of your joints, causing inflammation and swelling. RA tends to affect the smaller joints in your body such as hands and feet, however larger joints such as your knees and hips can also be affected.

Because RA is an auto-immune disease, it is important to talk with your GP or specialist about possible management of this condition.

You will most likely have to take some sort of medication to help reduce swelling/inflammation and pain, and depending on the severity of your RA, may also have to take a disease modifying anti-rheumatic drug (DMARDs).

It is very rare for RA to go into remission without the use of medication.

Gout

Gout is a form of arthritis that is characterised by an excessive amount of uric acid being present in the blood stream. This uric acid then forms crystals in the joints of the body, that cause inflammation, swelling and pain.

  • Gout classically affects the base of the big toe
  • Is more common in men than it is in women
  • Pain can often be sudden and only last a small amount of time
  • Is affected by your diet and other lifestyle factors
  • Different stages of gout can be called different names
  • Gout is best controlled with appropriate medication

Take Home Message

OA is a progressive condition that occurs by the joint breaking down with use (other causes will be explained further on).

RA is an auto-immune condition, and unfortunately the causes for this are genetic, and can’t be changed.

Gout is the forming or uric crystals in the joint from having excessive uric acid in the blood stream. Gout is something that formulates as a symptoms of the kidney’s not correctly removing uric acid, so go see your GP for management once Gout onsets.

Whatever your type of arthritis, it can be managed.

Unfortunately, most people don’t think about arthritis until they have it, but there are ways to help improve your pain and function and continue living a life you want with arthritis.

Delving into causes, signs and symptoms for osteoarthritis

We’ve talked a bit about how OA comes about above, but let’s delve into the waters a little deeper in this section.

Now we know OA is a progressive, degenerative joint disease that occurs in most people as they age. However, there are other factors to take into consideration that can progress the amount of degeneration, and other factors that can cause degeneration to start.

Find the main causes of OA below;

  • Age
  • Genetics
  • Other bone conditions or disorders
  • Previous Injury
  • Changes in joint mechanics (how the joint functions)
  • Being overweight or obese
  • Repetitive movements and overuse
  • Weakness/frailty

Age

The chances of developing OA increases as we age. Most people over the age of 60 will have some level of OA, it just depends on the joints affected and the severity.

The changes that occur as we age increase the likelihood of OA being present, but the severity and pain of the OA affected joint seems to be more related to other factors including injury, obesity, genetics and joint biomechanical and anatomical factors

As we age, the tissues surrounding the joints (tendons, ligaments, cartilage, bone and muscles) contribute to the development of OA due to changes within the cells themselves. These changes can lead to development of products that can change the mechanical properties of the tissues within the joint.

Due to this, OA is a condition that can also be seen in people as young as 20 or 30 years old. Changes in the ligaments, tendons, muscles, cartilage or bone due to trauma, injury or repetitive use, can start the changes we see as we age, and contribute to the development of OA.

t has been shown though that the development of OA in younger populations is much slower, meaning that at least for a while, the ability of the body to change and adapt to injury is much more efficient in younger populations than adult populations.

Some facts about OA as we age;

  • More women over the age of 50 have OA compared to men.
  • The prevalence of OA increases as we age.
  • The prevalence of symptomatic OA also increases as we age (pain/swelling).
  • Over 50% of male’s aged between 70-90 will have a meniscal (cartilage) tear that causes them no pain.
  • People over the age of 45 will develop OA much quicker after an injury than adolescents and teens.

Genetics and other Health conditions

OA is not hereditary but if you have a family history – this can make you more at risk. Other genetic traits can make the possibility of someone having OA higher. Some of these include;

  • A rare disorder that reduces collagen production (the protein that helps form and repair cartilage).
  • Slight defects in the way the bones fit together so that cartilage wears away faster than usual.
  • A gene called FAAH that has been linked to an increase in pain sensitivity, is higher in people with knee OA than in people who don’t have the disease.
  • Other bone disorders such as Rheumatoid Arthritis.
  • Health conditions including hemochromatosis (this causes the body to absorb too much iron) and acromegaly, a defect which causes the body to produce too much growth hormone.

All of these conditions effectively change the way the joint is structured or functions. A slight defect in this can cause degeneration to start, or may reduce the healing capabilities in the joint when damage does occur. This can all lead to the start of, or the progression of OA.

Previous Injury and joint mechanics

Let’s re-visit our door hinge example for this section. Let’s pretend that the hinge of the door is your joint. Now, if I ran at the door while it was closed and busted through, it would be fair to assume that I would have damaged the hinges in some way. Either the screws holding it into the door may be a little looser, or maybe the door is now not hanging straight, but is very slightly off to the side.

Every time I open and close the door after this, it rubs against the wood and starts to break down the rigid structure that kept the door strong and functioning properly in the first place.

Now the same can occur when we sustain an injury to a joint. Now the structures of our joints are quite sturdy, and quite a bit of force is usually needed to change the structure and mechanics.

However, a ligament or muscle sprain, a tear in the cartilage or even just the bones not lining up together, can all cause a change in the joint mechanism that can then lead to the development of OA.

This may not occur for some years and may develop slowly. For some, especially those that sustain an injury later in life, this process may be quite quick.

The seriousness of the injury, the amount of joint structures and tissues involved the age of the person at the time and the amount of joint deterioration up until that point can all contribute to the development of OA and its severity.

Obesity and overuse

This is quite a basic concept. The more load that you put through your joints on a repetitive basis, the more chance you have that that joint will start to deteriorate. If the muscles, ligaments and tendons in your joint can’t handle the amount of pressure and load put through them on a regular basis, then the structures within the joint will start to change.

I can hear everyone that isn’t overweight or obese in my head right now saying, ‘Well, why don’t you just lose weight?’

I’m here to tell you that I understand that it isn’t that simple. So, if you’re carrying a little extra weight, yes, it would be ideal if you could lose some of it. A 5% change in body weight has shown to have a 10% reduction in pain symptoms for those with lower back and knee OA.

However, if you are finding it hard to shift the weight, it is very important that you strengthen up the muscles and tendons surrounding the joint in order for it to be better equipped at handling extra pressure and load.

Similarly, if you repetitiously use a joint under some form of pressure and load day in and day out, then your chances of developing OA will increase.

Let’s take someone who puts roofs on houses. They have to go up and down ladders constantly, carrying large loads on their tool belt, and then have to lift and place heavy tiles on the roof. The chances of this person developing OA is significantly higher than someone who doesn’t have to do this all day, but only goes up and down ladders occasionally.

Weakness or loss of muscle strength

The strength of your muscles surrounding the joints is vitally important to both offset the development of OA, and also help manage the symptoms.

A joint that has strong muscles and tendons above, below and surrounding it, will be able to handle higher repetitive loads. This means that the cartilage and joint tissues aren’t taking all the load themselves, and will reduce the risk of OA development.

If OA is present within a joint, it is then more so important to strengthen the muscles around this area, to help reduce the load put through the joint.

If putting load through the joint can create pain and discomfort, then by strengthening muscles and improving the joint tissues, OA progression can reduce, and symptoms can improve significantly.

Signs and Symptoms

Symptoms may vary for each patient, as the severity of OA can determine the level of symptoms that someone may have. Symptoms include;

  • Pain
  • Stiffness/loss of range of motion in the joint
  • A feeling of instability
  • Grating/grinding sensation in the joint
  • Tenderness
  • Swelling
  • Bone spurs – small, hard lumps that can occur around the joint

Symptoms may initially be worst when completing activity or in the morning getting out of bed.

If you have any of these symptoms, it is best to book in to see your GP and physiotherapist. They can both send you off for scans to see what is going on within the joint, and give management plans for how to best manage and treat the symptoms.

It is important to remember that some osteoarthritic joints will have absolutely no signs or symptoms at all, and just because OA may be present within a joint, doesn’t mean that this is necessarily a bad thing.

Take Home Message

These are the things I want you to focus on and keep in your mind when reading further;

  • OA is part of a natural aging process that occurs in the joint tissues.
  • Injury, overuse or change in joint mechanics, along with the aging process, can result in the development of OA.
  • Lifestyle factors such as joint overuse or being overweight can increase the risk of OA.
  • Having a family history of OA has been shown to have an increased risk of developing OA.
  • Symptoms of OA can have differing severities.
  • You can have OA in your body and have no symptoms at all.

How is OA diagnosed?

Osteoarthritis is diagnosed through your health professional. They will collect information about family history, symptoms you have, complete a physical test and then refer you to have diagnostic scans if applicable.

In most cases further investigations such as an x-ray are not required, as research studies demonstrate a poor relationship between changes that can be seen on scans and the degree of symptoms that you are experiencing. What shows on your scan, may not be what is causing your pain.

Further information will be warranted through the use of scans if you are having symptoms of OA. The health professional will also take into consideration how long these symptoms have been present, the progression of the symptoms, and if any event or trauma has caused these symptoms.

The health professional will usually conduct a physical exam, testing joint range of motion while also testing for tenderness, pain, swelling and mechanical joint changes. A physiotherapist can also conduct these tests, and then write to your Dr if they suspect OA may be present.

Physiotherapists have a collection of tests they perform, which they can use to help identify some signs of OA. They can also help identify the contributing factors of the condition, which is really important for correct exercise prescription and symptom management.

If further information is needed, then the health professional may send you off for scans, or may complete a ‘Joint Aspiration’.

Joint aspiration

This occurs when the Dr extracts fluid from the affected joint using a needle. The fluid is then tested to see if any bone or cartilage materials, inflammation markers or crystals are present. This will give information to suggest that degeneration may or may not be occurring within the joint. This test can also help rule out other types of arthritis, such as rheumatoid arthritis and gout.

X-ray

An X-ray can show joint changes and degeneration, including loss of joint space, loss of bone and cartilage and if any bony spurs are present. It will also give an idea about the joint structure mechanisms (if the joint aligns the way it should).

MRI – Magnetic Resonance Imaging

This type of scan does not use radiation, but is more expensive than an X-ray. An MRI will provide clearer images that include surrounding structures within the joint. An MRI also provides scans from differing angles that can be viewed at different levels within the joint itself.

It will provide a much more detailed picture of the joint, but may only be necessary if an X-ray does not give enough evidence for a diagnosis to take place.

Once an image has been taken, the radiographer will provide a report based on what they see within the scan. The report will usually state if they believe degeneration or osteoarthritic changes are present within the joint.

Scans will only give you a snapshot of what is happening within the joint on that day however, so understand that if OA is present, it might have been present for many years prior.

It is important to take the finding from your scan and then relate them back to the symptoms that you feel in order to determine the best management plan to move forward with.

A physiotherapist is the best person to do this for you, as they can talk through the mechanisms of why you may feel certain symptoms with certain movements, based on the finding of your scan.

Take Home Message

If you are experiencing any symptoms as stated above, go to your GP or physiotherapist to have a physical examination. If the results from that physical exam then require you to go have scans, this is the best way to get a diagnosis of OA.

Just be aware that a scan may say things such as “severe degeneration” or “significant deterioration”, and generally make it seem like your joint is in a bit of mess. The wording of a report has to be a certain way, so it is very important to talk through your scan report with a Dr AND a physiotherapist.

And always remember that the symptoms you are having are the best form of feedback you can have.

Explain them to a health professional and the best management plan can be worked out specific to you and what you are experiencing.

Here is a link to the Arthritis Foundation website. This further information on how OA is diagnosed-
https://www.arthritis.org/about-arthritis/types/osteoarthritis/diagnosing.php

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What Joints are most affected by OA?

Load bearing joints tend to be the joints that are the most affected by OA. These include;

  • Knees
  • Hips
  • Lumbar spine (lower back)
  • Cervical spine (neck)
  • Base of the thumb
  • Base of the big toe
  • Small joints in the fingers

Osteoarthritis can affect multiple joints at the same time, and is quite individual. A person that goes up and down ladders most of the day for work would most likely get osteoarthritis in their knees and hips, compared to someone who works with their hands all day, who will most likely develop OA in their fingers and hands.

OA can affect just one side of your body also. A right knee may be scanned and show significant degenerative changes, where the left knee can show no changes and be structurally sound. It really is based on the individual, and how they have used their body over the course of their years.

Any joint in the body can potentially be affected by OA, but as stated earlier in this blog, the joint that is put under repetitive load and has a higher risk factor of developing OA.

Is it worse having OA in my lumbar spine than in my knees due to my spinal cord?

The answer is, not really. If you are having symptoms of pain, swelling or tenderness in your knee, and this is affecting your function and also affecting your mental state due to pain being so bad you can’t sleep, walk properly or find a comfortable position, then this is an issue that needs to be dealt with quickly.

Similarly, you might have OA in your lumbar spine, but have absolutely no symptoms at all. You might have a scan completed for something unrelated that shows you have severe degeneration in your lumbar spine, but does this mean anything? If you aren’t experiencing any symptoms, then is it an issue that really needs to be addressed?

We can’t change the amount of degeneration that has occurred so far, so why would we really change too much?

We may start you completing some specific lower back strengthening exercises to help support the structures and reduce the risk of symptoms starting, but essentially, OA severity is based a lot on the symptoms you are experiencing.

Is the treatment I receive going to be different for what joint is affected by OA?

Yes and no. Medications tend to stay the same, but physical activity will be specific around the joint that the health professional is trying to improve. You’re missing the mark if your goal for treatment is to improve your knee pain, but you only exercise your arms.

Similarly, certain surgeries to help degenerative joints are performed differently due to the type of joint (ball and socket joint or hinge joint for example).

This will also affect the type of rehabilitation you complete post-surgery.

Take Home Message

OA can affect any joint in the body, but the joints that a specific person uses repetitively throughout their life, or have injured, will tend to be the joints that are most likely to develop OA.

The severity of OA can be shown through scans, but it should be based more on the symptoms expressed by the individual.

The specific treatment you receive will change depending on the type of joint involved, however all management plans for OA should include physical activity, lifestyle change, weight loss if required and possibly medication to reduce inflammation and pain symptoms.

Treatment options for OA

There are a number of treatment options that can help you manage and improve your OA symptoms. What treatment option may be best depends on the type of symptoms.

For example, if you have no pain, but your knee joint can’t bend and flex as well as what you would like, then there is no use putting you on pain medication or sending off for an injection. What you may need is a structured plan set out by a physiotherapist who can manipulate the joint and structures around it to get more bend. Similarly, if you are having large amounts of pain, swelling and tenderness in the joint, then you may need to get your pain management under control before adding in any new, vigorous physical activity that could stir pain up more. Plans must be individual to the person, and their symptoms.

Physical Therapy (Physiotherapy, Occupational Therapy, Exercise Physiology)

Most people with OA will be asked by their health professional to start moving. Everyone has heard this old saying;

“If you don’t use it, you’ll lose it!”

And nothing could be more true when it comes to moving your body when you have OA. Now some people may be worried that moving the joint will case their OA to become worse, but this couldn’t be further from the truth.

Exercising has been proven to be the most effective non-medication form of treatment for decreasing pain and improving movement in OA affected joints.

Moving the joint will enable a few things to occur.

  1. Moving the joint will help reduce the stiffness you receive. You have to remember that the joint is made up of more than just bone and cartilage. The muscles, tendons and ligaments surrounding the joint can contribute to a joint’s stiffness, and therefore can also contribute to decreasing stiffness within the joint.
  2. Moving the joint will improve the strength and endurance of muscles and tendons surrounding the joint, improving their function that will directly impact the joint function also.
  3. Moving the joint will improve flexibility and mobility, meaning your body is able to change positions more efficiently. This can help with strength and balance, two key components to maintain and improve as we age.
  4. Seeing a physiotherapist, occupational therapist or exercise physiologist that can move the joint for you may help improve stiffness and tenderness in the joint. It’s hard to stretch by yourself sometimes, and if you are struggling to get into positions in the first place, having someone do this for you can save a lot of hassle, and speed up your improvement.
  5. Moving the joint can help to decrease the speed that joint tissues age, reducing the speed of degeneration in your joint.

It may be necessary for you to also change the way you move to try to help avoid put more pressure through a joint. Talk to a physical therapist today (physiotherapy, occupational therapy or exercise physiology) to go through a physical examination and talk through is any movement changes will help you.

Medication

Medication is an important part of a treatment plan for someone who is experiencing pain, swelling and tenderness in the OA affected joint. Medication is usually taken to help pain, and this is needed in some people who may find just moving the joint without any extra load quite painful to do.

Some people don’t like taking pain medication as they feel it is just “masking the pain” and that “damage is still occurring”. However, this is not true.

Pain medication is designed to reduce the amount of pain you feel, absolutely. However, the idea is to make a movement less painful in order to be able to move the joint more, as we know that moving a joint has multiple health and symptom benefits for those suffering from OA.

For example, if you can only walk 25m before pain in your knee becomes too much and you have to sit, it will be hard to gain much health and physical benefits from this, as 25m is a short distance. But, if with pain medication, you can extend that out to 100 or 200m, then that is a 4 – 8 x improvement on your physical capabilities!

That means the body has more chance to adapt and change, and we have more opportunity to strengthen the joint and improve mobility before pain symptoms become too much.

There are a few types of pain medication that can be prescribed to people suffering from OA;

  • Acetaminophen (brand name Tylenol)
    • This pain medication is used to help get relief from headaches, migraines, minor aches and pains, low to moderate arthritis pain, muscular aches, toothaches and menstrual cramps. The medication does not work as well if inflammation and swelling are the main cause of your pain. It works similar to aspirin.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) (Ibuprofen, naproxen sodium)
    • These types of medication can usually be bought over the counter and include oral and gel medications. If a stronger dose is needed, then stronger NSAIDS can be prescribed by your GP.
    • These work by reducing inflammation (duh, it’s in the name!), but do this by reducing the production of prostaglandins. This is an enzyme in the body that promotes inflammation within the body.
  • Duloxetine (Anti-depressant medication)
    • This is a medication normally used to treat depression, but has been found to improve pain for people living with OA.
    • Some people don’t like the idea of taking a medication used for depression, but please understand that it is the process within the body that the medication changes that causes an improvement in pain.
    • It is therefore an effective medication when used in the right circumstances.
    • Now all medication has the potential to have side effects for people. So, it is always important to speak with your Dr or pharmacist first before looking to change or start a new medication. Don’t change the doses yourself, but be aware and monitor and report side affects you may be feeling.
    • There are many types of medications that all do similar things, and you may need to try a few before you find one that suits your body. This is doubly important if already taking other long-term medication, as some medications can clash and cause side effects.
  • Steroid Injections
    • A steroid, or cortisone/corticosteroid, injection contains a strong anti-inflammatory medication that may help to settle pain that is not changing with physiotherapy management or that is hindering you from completing an exercise program or functioning with daily life.
    • A cortisone injection may be administered for certain conditions to relieve pain, such as for bursitis, OA, mild trigger finger or low back pain, but injections of cortisone and an anaesthetic such as lidocaine can sometimes be used to confirm a diagnosis.
    • Corticosteroid injections are commonly delivered by a specialist under a guided ultrasound to ensure the correct structure is targeted. Corticosteroid, as well as a local anaesthetic (such as lidocaine), may simultaneously be drawn into a syringe, which is then inserted into the tissue where the solution is injected.
    • A steroid injection can be used to help reduce inflammation in the short term, but for longer term benefit physiotherapy and active management strategies are most important.
    • With some conditions, the symptoms of the condition recur after a few weeks or months. In this situation, another cortisone injection can be given, but risks of side effects increase with more frequent or regular injections.
  • Surgery
    • Now there may come a time where no amount of conservative management or medication can help your function, or help reduce pain that you receive. A good indicator to know whether surgery may be the best option for you to consider is if you are waking up during the night due to pain in the affected joint. Sleep is a huge part of the bodies recovery system, and if your pain is disrupting that significantly, then the joint may need to be replaced.
    • Now it is very important to state that surgery should never be your first option with a progressive condition such as OA. Trying to manage your symptoms with physical therapy and medication is always the best option first, because once you opt in for surgery, you can’t change this. With physical therapy and medication, if this doesn’t work, then surgery can always be the next option.
  • So when should I get surgery to help my OA?
    • There are a few types of surgery that you can opt for, and if you have OA, chances are it can be operated on regardless of the amount of degeneration. But do you really need to?
    • Multiple studies have shown that conservative management of OA (exercise, lifestyle change and medication), is just as effective as having arthroscopic surgery (keyhole surgery where they smooth out cartilage and remove debris within the joint).
    • People tend to forget that having surgery is not an easy process for the body to go through either. If you have to be put under anaesthetic, your body has to recover from coming out of this, as well as the trauma of the surgery itself.
    • Surgery may aim to help improve symptoms and function in a joint, but straight after surgery, the body needs to recover and heal from the invasive techniques that surgery inevitably involves. This takes time, and some people think it will be a quick and easy fix.
    • Now the hard part about this is actually getting in to see someone about surgery. If you have private health, this can be a relatively smooth experience, and you can be ready to go with your operation within a few weeks of getting a referral.
    • However, if you need to move through the public system, the waiting times for joint replacements can be quite long (12-24 months). So it is important to discuss all your options with your Dr and physical therapist before deciding what cause of action is best for you.

Everyone agrees that surgery is the best option, so what now?

It is important to continue to move and stay active right up until your surgery for the following reasons;

  • Firstly, your body is designed to move, and exercise provides natural lubrication to the joint, and keeps the tissues as flexible as possible.
  • ‘If you don’t use it you lose it!’ Exercise keeps the muscle nice and strong.
  • It will address and improve any unhelpful postures and movement patterns, which we want to minimise post-surgery.
  • It keeps the rest of your body fit and healthy and aims to prevent your function from getting worse leading up to surgery.
  • It better prepares you for what to expect post-surgery so there are no surprises.
  • It reduces the risk of falls.

In a nut shell, the better your muscles are working before surgery, the easier it will be to get them going again afterwards, and that means you can get back to your daily activities sooner.

A physiotherapist or exercise physiologist can set up some pre-surgery exercises that are specific for you.

Types of Surgery

Arthroscopic Surgery – This type of surgery is a type of “exploratory” surgery and is mainly used to confirm or further investigate a diagnosis that has been made through the previous diagnostic tests included in section 6.

Essentially, the surgeon will make a small incision near the joint, and then using a small camera called an arthroscope, will insert this into the joint. The camera will then display what it sees onto a television screen that the surgeon can look at.

The surgeon will move the camera around to have a look at as much of the joint and surrounding structures (ligaments, tendons, cartilage) as possible, and then make a diagnosis based on what they see.

Now in the same surgery, if the surgeon deems it necessary, they can use the same incision, or make another small incision, and try to repair or clear away damage that has occurred in the joint.

For example, if the patient reports having pain on the left side of their knee every time they bend it, and the surgery sees that the cartilage has a tear in the left side that gets caught every time the knee bends, then they may choose to repair the tear and smooth the cartilage to allow the knee to bend without pain developing.

Arthroscopic surgery can be theoretically used on any joint in the body, but the most common joints examined are;

  • Knees
  • Hips
  • Shoulders
  • Elbows
  • Ankles
  • Wrists

Now as much as arthroscopic surgery is deemed less invasive as open surgery, it still requires you to go into a hospital and be placed under anaesthetic.

There will be a recovery time after the surgery and it is still important to complete appropriate exercises and activity given from your physical therapist right up to and after your surgery.

Total Joint Replacement and Partial Joint Replacement surgery

Total Joint or Part-joint replacement surgery is used to replace arthritic or damaged structures in the joint with a plastic, metal or ceramic device called a prosthesis. The prosthesis is moulded and shaped to replicate the anatomy of a ‘normal’ and healthy joint.

Total joint replacement surgery usually takes a few hours to perform, and the techniques and ways that the surgeon replaces the joint will change according to the type of joint they are working on, and the amount, type and area of damage within the joint.

With a Total Joint Replacement, the surgeon will remove damaged cartilage and bone and replace it with a prosthesis. A Total Joint Replacement refers to the fact the surgeon will likely replace both sides of the joint, rather than just one.

Refer to the link below for our video discussing the new anterior approach type of Total Hip Replacement surgery

A Partial Joint replacement only occurs in the knee and refers to when a surgeon replaces only one part of the joint. The surgeon has the option to replace the medial (inside), lateral (outside) or the patella (knee cap) portion of the knee joint as part of the surgery.

This type of surgery can only be done when one part of your knee joint is causing the issue. If the rest of the joint is healthy, there is no need to replace the whole joint.

Partial Joint replacements are still an invasive, open surgery, but is quicker and the patient loses less blood during the surgery, meaning they have less recovery time post-surgery.

Partial joint replacements are more often seen in younger populations where degenerative changes in the joint have occurred due to trauma or injury.

Take Home Message

There is a structured process put in place by both Dr’s and physical therapists to determine whether you;

  1. Have osteoarthritis in a joint
  2. The severity of degeneration within the joint
  3. The current strength and function of the joint
  4. How the joint limits your day to day function
  5. Signs and symptoms individual to you

The management plan will be specific to your current level of function and movement/symptom based goals. This management plan could include one or many of the following things;

  • Physical Activity
  • Joint Manipulation
  • Medication
  • Injections
  • Surgery

It’s important to know that because OA is a progressive disease, the management plan put in place may be progressive as well. What works or has worked in the past for function and symptoms management may not work as OA progresses. This is when further interventions such as injections or surgery may be the best option.

Gain multiple opinions from differing medical and health professionals before consenting to having surgery. It is important that you know and understand all the options you have in front of you. Better to make an informed decision rather than a rash decision based on one opinion.

OA is not a life threatening condition, so take your time in processing a diagnosis and figuring out a management plan that works for you.

Here is a link that provides more information on knee arthroscopy. Why it would be performed, how it is done and what’s involved in recovery are all discussed –
https://orthoinfo.aaos.org/en/treatment/arthroscopy/

Here is a link that provides more information on joint replacement surgery. Why it would be performed, how it is done and what’s involved in recovery are all discussed –
https://orthoinfo.aaos.org/en/treatment/total-joint-replacement/

The best Physical Activity and Exercise treatment for OA

There is extensive research out there that has shown the benefits exercise and activity has on improving pain, reducing swelling and increasing function for those people with osteoarthritis.

As stated, everyone’s symptoms of pain or discomfort with movement is different, so it is important to have a good understanding of what you feel you can and can’t do from a movement perspective, and discuss this with your health professional. However, even if movement is causing you significant discomfort, there will always be some exercises that you can complete that will be manageable.

I can’t stress to you the importance of moving the affected joint. By not moving the joint, you won’t activate the muscles surrounding it, and then when you are required to move it, the muscles and tendons will be very stiff, causing pain themselves. You then add that on top of the pain you receive from the degeneration in the joint, and you’re going to have a very grumpy joint!

Range of Motion and Gentle Movement

Now, if the joint affected by OA is causing you significant discomfort and pain when you try to load it (walking, lifting, lifting your hand above your head etc.), it is still important to take the joint through its range of motion without adding extra load.

The easiest way to do this is by sitting or lying down if OA is affecting your knees, hips or lower back, and shoulder and neck exercises can be completed standing or lying down.

If you have restricted range of motion, or you can move your joint to a certain position, then if you try to go any further, you receive pain, then just work the joint through a range of motion where discomfort is manageable.

I’d love to tell you that you won’t receive any discomfort or pain from this, but the reality is, that osteoarthritis can be painful, especially in the later stages. But recovery is the key.

If you can move your joint until the point of discomfort, but after a short rest, this discomfort reduces and you are able to move the joint again, then this is ok. If you move the joint into discomfort or pain, then receive this pain for the rest of the day and into the next day, then it might not be the best exercise to complete for you.

t’s important to talk to a physiotherapist or exercise physiologist about this, and gain a good understanding of your limits. Having someone there to help you move your joints may also be beneficial, if you find doing this yourself tiring and painful.

Hydrotherapy

If you find moving your joints while on land is quite painful, or your walking tolerance is quite low, then you may consider hydrotherapy exercise.

If you have pain and limited movement then starting hydrotherapy classes are a great way to get moving and strengthen again. Enjoy the supportive water that uses the buoyancy to reduce load and pressure on your joints.

Warm water also tends to have a greater impact, as this helps to loosen the muscle and tendons around your joint to aid better movement.

Hydrotherapy is a great way to get moving, and is perfect for pre-surgery and post-surgery rehabilitation as well.

Strength

Gaining muscular strength is paramount in any OA management plan. The health benefits of getting strong are numerous, and can help not only your OA symptoms, but other health conditions also.

By strengthening your muscles, you not only help create joint protection and support, but you help reduce the risk of falls, improve range of motion and increase daily function. Muscles are part of everything we do.

They make our bodies move, and when trained appropriately, make our bodies more efficient and stable.

It is important that you are strong in both your upper and lower parts of your body, even if your OA is only affecting one joint.

Having the strength to be able to push yourself up off a chair if you can’t stand normally due to pain is important.

Having the strength to get up off the ground without using your arms if your shoulder is painful is important also! Strength training should be specific to your needs, but everyone, especially as we age, should aim to get stronger throughout their whole body.

Strength = function, and function = happiness

To start some basic strength exercises at home, follow the below links for videos that focus on different body parts;

These are great exercises to start to strengthen and improve the movement of your shoulder blade and your shoulder. Ellen, a Senior myPhysioSA Physiotherapist in Adelaide, explains and Epic Blog Post Template V1 demonstrates exactly how to do the exercises, what you should feel and how it is working to help your shoulder

Here is an easy to do whole body exercises that strengthen your body to make household jobs such as vacuuming, mopping and lifting the washing easier.

If you have OA of the knee or hip then a great way to help your pain and get the joints moving again is to try these easy seated exercises.

If you do choose to have surgery to manage the OA, building your strength beforehand can lead to better outcomes post-surgery. These knee exercises are useful to do before having a total knee replacement or a knee arthroscopy

It is a fact that one of the best ways to help ongoing knee pain is to exercise and strengthen around the knee. This video shows you how to start doing the right exercises correctly, so get started now.

If you have hip OA, strengthening the muscles around the joint can help reduce your pain and improve your function.

Here is a video where one of our Exercise Physiologists demonstrates correct technique for some simple hip strengthening exercises you can do at home.

If you are interested in joining a group based exercise class that is supervised to make sure you are doing the appropriate strength exercises, then click the link for more information on what we can offer you.

Our Exercise Physiology classes in Mount Barker and Payneham can help with arthritis, and also;

  • Diabetes (Type 1 and 2)
  • Weight management
  • Post-operative rehabilitation
  • Heart Rehabilitation
  • Body deconditioning
  • Falls history
  • Parkinson’s Disease
  • Stroke Rehabilitation
  • Cancer Rehabilitation
  • Rheumatoid Arthritis
  • COPD and Asthma
  • Cerebral Palsy

The reality of living with Osteoarthritis

OA is a progressive condition and once degeneration caused by OA is there, we can’t reverse that. But we can manage it, and still lead an active and happy lifestyle that isn’t dictated by pain.

In some worst cases, the joint is so worn away that the only way to stop pain from developing is to have a joint replacement. This most commonly occurs at the knee and hip.

However, research has shown that the more active someone is, the less pain they report with everyday tasks. It has also shown that completing regular activity has better outcomes post-surgery for those that require a joint replacement.

The growing issue is that physical activity is usually a trigger for pain in most patients with OA. And most people report having trialled walking or some physical activity with poor results.

But find some tips below on how you can get started managing your OA pain to not let it dictate your life:

  1. It’s ok to feel some pain, as long as it is managed
    • If the pain you feel tends to be more of an ache or discomfort rather than a stabbing pain, you can work into this slightly. I’m not saying ignore your pain or work so hard you can’t move for days after, but see what you can complete without your pain flaring up for the remainder of the day/next day.
    • For some, the pain of osteoarthritis may never subside. But if we can get you moving more and completing more tasks throughout the day with similar levels of pain as previous, then we have made some improvement.
  2. Keep the joint mobile
    • By sitting or not moving the joint at all, all you are succeeding in doing is stiffening the structures around the joint and reducing fluid within the joint which is vitally important to maintain in osteoarthritis. This will only add to your pain levels when you do try and move, which will demotivate you to move at all! It’s a vicious cycle.
    • Try to move the joint through manageable pain levels with no resistance. The joints are supposed to bend and move. If at first it’s painful to do, keep the movement slow and small. Gradually try to Epic Blog Post Template V1 improve the range you take the joint through each day and you should find you will be able to get more range of motion with similar pain levels as previous after a week or so.
  3. Get strong
    • Having a plan in place to strengthen the supporting muscles and tendons around the affected joints. It could be a home exercise regime, a gym or group class based program or an appropriate favourite physical activity or sport that you can do i.e. swimming, cycling, walking.
  4. ) Try some hydrotherapy
    • It’s understandable that some people don’t like the water, and others have reasons as to why they don’t like the idea of getting into a pool. But hydrotherapy has been strongly recommended by allied health professionals in the treatment of osteoarthritis. It is encouraged that all those who have access to a pool and proper access into the pool (manageable steps or a ramp) to trial it.
    • Moving in the water is fantastic, due to the buoyancy of the water taking away some of the loading forces of gravity. It’s a great way to start moving in a reduced risk environment. Just be aware not to do too much initially. Always finish a session feeling like you could do a little more.
  5. Seek out an Allied Health Professional for guidance
    • An exercise physiologist, physiotherapist or occupational therapist can provide you with guidance to complete specific physical activity aimed at managing and reducing pain. They can talk you through the ‘how’s’ and ‘why’s’ of the physical activity we suggest, and will consistently be there to talk about and teach you how to best manage your pain based on what you tell us.
  6. Medication
    • If your GP has given you medication to use for relieving pain or settling inflammation, then take it! Of course if you get side effects, then contact your GP and discuss it immediately. If you can keep a ‘base level’ of pain medication in your system, it can help to avoid spikes of pain that might stop you doing the activities that you love to do.
    • If you are taking a medication and either aren’t sure whether it’s helping or you just don’t like taking medication and want to cease it, always talk to your GP first.
  7. Be Patient
    • OA doesn’t come on overnight. And unfortunately, it’s going to take some time to see some improvement. But be patient. Understanding the process and the time things will take is just as important as completing the activity itself. You will have some flare ups, and you will have some Epic Blog Post Template V1 pain. But this is perfectly normal, and your allied health professional will be there every step of the way to talk you through it.

Take Home Message

Content

What is the Latest Research?

Coming soon!

Overall Take Home Message

  • Wear and tear is a normal part of ageing, “like wrinkles on the inside”.
  • Exercise and increasing your activity levels are proven ways of helping manage the symptoms of arthritis.
  • There are 3 key types of arthritis: osteo-arthritis, rheumatoid arthritis and gout.
  • It is also important to know that the symptoms that you may feel due to arthritis may be completely different to someone with the same type of arthritis in the same joint.
  • Lifestyle factors such as joint overuse or being overweight can increase the risk of OA.
  • Having a family history of OA has been shown to have an increased risk of developing OA.
  • Whatever your type of arthritis, it can be managed.