Osteoarthritis

This is a true story…… the other day I had a 22 year old male client come in for treatment to his sore knee. We chatted about his injury (sustained playing ruby) and I was going through all the typical tests to ensure all the ligaments and cartilages were ok. He then turned to me, and I would say he genuinely looked scared (remember he is 22) and said “is it arthritis?”. Luckily I know this particular patient quite well do he didn’t take too much offense when I laughed a little at his question.

NO YOU MOST DEFINITELY DO NOT HAVE ARTHRITIS AT THE RIPE OLD AGE OF 22.

He was relieved. Now this isn’t the first time a young gen Y patient has asked me this question. Ok yes I understand if you have no knowledge whatsoever on the human body, anatomy etc this may not be such a bizarre statement which is why I am setting out to educate you. Now I am strictly focusing here on OSTEO arthritis…meaning wear and tear, degeneration of the cartilage within the joints. (There are other forms of inflammatory and rheumatoid arthritis which are a whole different story)

What is Osteoarthritis?

Osteoarthritis (OA) is degeneration or wear and tear of the joint surfaces, specifically the articular cartilage (cartilage that lines all our joint surfaces acting as a shock absorber) and subchondral bone (first layer of bone which sits directly below the cartilage). OA most commonly affects the hands, feet and spine and large weight bearing joints such as the hips and knees.

We can divide OA into primary and secondary.

Primary OA – chronic degenerative disorder related to but not caused by age (DON’T FREAK OUT…… Not all old people suffer OA). As we age the collagen fibres that makeup cartilage begin to weaken and break down. As the cartilage wears away bony surfaces become exposed, there is narrowing of the joint space which can lead to inflammation build up within the joint. In some cases the body responds to such changes through the growth of ‘bone spurs’ or bony outgrowths within to the joint.

Secondary OA: This form of OA is usually the result of other lifestyle factors however ultimately the patient suffers similar symptoms. Such factors include diabetes, congenital disorders, obesity, trauma (history of reconstructive surgery in that particular joint eg ACL surgery), infection, gout and several other diseases.

OA 3What are the signs and symptoms?

Generally the main symptoms that OA sufferers report is pain and stiffness of the affacted joint. There can be what we call ‘crepitus’ or creaking within the joints when moving the affected joint.

AS a result of this pain, stiffness and inflammation the surrounding muscles often tighten and go into spasm. For example in my patients suffering OA of the knee (probably one of the most common joints that I personally see) there is usually a fair amount of tightness through the quadriceps, hamstring and calf muscle as these all cross the knee joint.

And a little interesting fact for you all… people with OA will suffer more in the colder temperatures… why? In cold weather our bodies send less blood out to the extremities (hands, feet, ears etc) in an attempt to maintain our core temperature and protect our vital organs. Joints and muscles flushed with less warm blood will be cold and stiff. So its not uncommon for all our OA sufferers to crawl out of the woodwork and appear at our front door during the winter months!!!

In order to diagnose OA xray can be a useful tool, however a skilled therapist will be able to make this diagnosis via a thorough history and examination. The problem with xray is that what we find on these films often doesn’t correlate to the set of symptoms we find in the patient. 70% of people in their 70% could be diagnosed with OA according to xray findings BUT only half of this group will show symptoms!.

Unfortunately there is no cure for OA. No matter how amazingly skilled your physio, doctor, osteopath or chinese herbologist is they CANNOT reverse the degenerative changes that have already occurred within a joint. Treatment focuses on effectively controlling and managing symptoms.

Physiotherapy treatment can include:

  • Soft tissue massage to tight surrounding muscles
  • Electrophysical therapy to assist with pain and inflammation
  • Advice regarding exercise modification
  • Exercise Prescription (appropriate stretches and strengthening exercises)
  • Use of ice and/or heat.
  • Medications and supplements have been found to help. Discuss this with your GP.

In patients with advanced OA (cartilage has worn away completely and there literally be bone on bone contact between the joint surfaces) and who are suffering from debilitating pain may need to see an orthopaedic surgeon to discuss more aggressive management strategies. This can include injections or potentially surgical intervention (joint replacement).

Arthritis incidence is becoming more and more prevalent in our society…. There have been claims this is linked to growing obesity (the more you weight the more stress you put your weight bearing joints through) and several other lifestyle factors including workplace demands etc.

Early detection and management is vital to assist with symptoms relief and to slow the progression of the disease process.

Happy Tuesday everyone!

oa 5

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