Osteoarthritis

Osteoarthritis is a condition affecting the joints of the human body: ‘osteo’ referring to bone, ‘arth’ referring to joint, and ‘itis’, usually referring to inflammation. (However, it is important to note that not all forms of osteoarthritis have inflammatory factors present in the joint). Most people think of osteoarthritis as something that occurs for older adults, but osteoarthritis and other forms of arthritis can develop at younger ages too.

Causes of Osteoarthritis

Research shows that osteoarthritis is a lifestyle condition for most people, meaning that it is affected by a range of lifestyle factors that can be changed and modified. For example, dietary intake, weight or amount of physical activity can all affect the health of a joint and how it ages over time.

Symptoms of Osteoarthritis

It is important to note that for some people osteoarthritis will be asymptomatic, meaning they won’t experience symptoms and therefore won’t be aware of it unless it’s discovered through an x-ray or other scan.

Someone living with symptomatic osteoarthritis can be affected in many ways, predominantly

  • Pain
  • Swelling or stiffness in a joint (or in multiple joints)
  • A feeling of increased heat and even redness at the joint as well

The joints affected by osteoarthritis are often the larger joints that are used more, for example knees, hips, shoulders and spine.

Research suggests that at least one in five people over forty-five years old will have osteoarthritis. While this is certainly concerning, osteoarthritis is often a preventable or manageable condition. Best practice guidelines show that physical activity and weight loss can be effective for proper management for many people and should be trialed first, as opposed to becoming reliant on pharmacological interventions such as opioids and anti-inflammatories or invasive interventions such as joint replacements.

Is Osteoarthritis Always Progressive and Lifelong?

Osteoarthritis is usually related to changes in the joint structure as compared to when it is in its healthy, younger form. In some people, osteoarthritis will continue to progress, while for others it will never progress. The reasons for this might relate to the type of arthritis it is.

There is significant research to show the rate of progression can be modified with certain interventions. Two strong interventions are the right type of physical activity (typically prescribed by a Physiotherapist) as well as weight loss management (typically supported by a Dietician).

Physiotherapy, Occupational Therapy & Assistive Equipment for Osteoarthritis

A Physiotherapist will carry out an assessment that will include an examination of gait, balance, strength and range of movement. From there, they will formalise a graded exercise program. This is a program developed to allow for gradual improvements in the tolerance, resilience and strength of the joint and the associated tendons and muscles, allowing for more and more movement over time.

Often Physiotherapy will include manual therapy such as massage, or technical equipment such as taping or acupuncture, in order to modulate pain in the short term. This decrease in pain can allow for more movement, which in turn can build strength and balance.

An Occupational Therapist is typically involved when a client is living with more advanced osteoarthritis. Difficulty with activities of daily living and basic movement is a sign that someone may benefit from the support of an Occupational Therapist. For example, if getting up and downstairs is becoming severely difficult due to pain in the knees, an Occupational Therapist can assess the environment and recommend changes ‒ sometimes as simple as a single handrail ‒ to help the client move more comfortably and safely with their knee pain.

Another common referral for an Occupational Therapist occurs when someone requires assistive equipment for their hands. In cases of advanced arthritis or rheumatoid arthritis, actions such as opening cans and bottles can become challenging. An OT can ensure the client has the appropriate equipment to support their needs, such as modified cutlery or can and bottle openers.

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Osteoarthritis FAQ

  • Is it possible for someone to be affected by multiple types of arthritis, or other related diagnoses?  

    Many of the people we support will have comorbidities.

    People are living with multiple pathologies, and sometimes with multiple types of arthritis (for example rheumatoid arthritis and osteoarthritis) and other joint conditions as well.

    For these reasons, Community Therapy will carry out a comprehensive assessment process, taking into account any supporting medical information that the client has. In some cases, supporting documentation is in the form of a summary letter from a GP, while in other cases it may be information from a hospital. Our assessment will also involve a comprehensive set of questions to determine if there are any undiagnosed conditions.

    With regard to treatment, many of these different pathologies have common links in their treatment. This may include physical activity and exercise, as well as hands-on therapy from a Physiotherapist. There will be differences: some joint conditions are highly irritable, while other joint conditions can tolerate more vigorous activity and be progressed faster in the rehabilitation process.

  • Is diagnosis of arthritic conditions purely a physical examination, or are blood tests and scans involved?

    A typical diagnosis for osteoarthritis comes from a subjective and objective assessment conducted by a Physiotherapist or a general practitioner. An orthopaedic surgeon is sometimes involved, and diagnosis may include an X-ray such as a plain film radiograph.

    In some rare cases, a CT or MRI is used to confirm osteoarthritis-related changes in a joint. Blood tests do assist in the diagnosis of other types of arthritis, such as rheumatoid arthritis.

  • In what ways do you use outcome measures to measure and improve the activities of daily living for those with osteoarthritis?

    There are different types of outcome measures that can be used to take objective measurements of the signs, symptoms and functional impairments of osteoarthritis. At Community Therapy we have access to a range of tools in order to make this a standard component of our treatment plans.

    Objective measurements are often related to an individual’s specific goals. For example, if a client is living with knee osteoarthritis in both knees, they may have a goal of improving their balance in order to enjoy an activity such as lawn bowls. In a case such as this we undertake baseline measurements to establish a patient’s current balance capacity, and we would then follow up with more measurements to quantify change over time.

    The same approach can be applied to goals relating to endurance or strength; we will tailor the outcome measures to a client’s specific goal.

  • How does osteoarthritis and subsequent narcotic medication relate to fall rates?

    Osteoarthritis can increase someone’s risk of falls.

    It is considered to be an association, not a causation. For example, a person with a diagnosis of osteoarthritis may have a higher risk of falls due to associated decreased strength and balance when compared to what is considered normal for their age. Questions then arise around whether it is the osteoarthritis increasing the falls risk or actually the decreased strength and balance as a result of living with osteoarthritis. The functional impairments of living with osteoarthritis is considered to be causing that increased falls risk.

    With regard to associated medications, in cases where pain is being managed with a prescribed opioid there can be a direct risk of falls due to side effects. This is because some opioids and other pain medication may increase drowsiness and/or dizziness which can significantly increase the risk of falls.

  • Would it be helpful to provide you with scans at the first assessment?

    Scans, x-rays, CTs and MRIs are not critical during an initial assessment. While it is helpful to have scans if they are available, we understand that in many cases scans may not have been taken yet, or referrals may be directly from a GP based on suspected osteoarthritis.

    An initial appointment includes a thorough assessment and in many cases, scans aren’t immediately required. Our process will usually involve trialling interventions over several weeks in order to determine positive changes from those interventions. If we think that there is a specific reason why an x-ray needs to be taken (for example, if one of our clinicians identifies potential signs of other problems or diagnoses) then we will investigate with scans as required.

  • Are there cases in which Community Therapy would recommend surgery for an osteoarthritis patient?

    It is outside the scope of practice for a Physiotherapist or OT to recommend surgery. That is the scope of practice for an orthopaedic surgeon. It is the Physiotherapist’s responsibility to determine if the osteoarthritis and its associated symptoms can be managed conservatively in order to achieve that person’s goals.

    For example, if someone is living with chronic low back pain due to osteoarthritis, we support them with eight to twelve weeks of conservative therapy. This would consist of progressive strength and physical activity and range of motion exercises. We would also look at ways to decrease body weight, possibly in conjunction with a dietician. If symptoms have stayed the same or worsened, and the GP has been involved as well, we would seek the opinion of an orthopaedic surgeon.

    An orthopaedic surgeon would assess for the suitability of the next level of intervention (such as injectables like corticosteroid) and would monitor that intervention together with our physiotherapy treatment. If in several weeks or months there had been no marked improvements, then surgery would start to be considered.

  • What is meant by perturbation training techniques and can you give an example?

    Perturbation training is most applicable to falls prevention, but it is often used for other conditions as well. Many people living with osteoarthritis have an increased risk of falls. This is due to impaired strength and balance and often stepping responses as well. (They may lose their balance, but then not be able to step quickly enough to right themselves.)

    For these reasons, perturbation training can be applicable for those with osteoarthritis. The training is a well-researched way of looking at disrupting someone’s balance in order to train their stepping response. Research demonstrates that it can decrease the risk of falls by 50% or more.

  • Can osteoarthritis be prevented?

    It is common for people to engage Community Therapy seeking advice on prevention when they have a significant family history of osteoarthritis and wish to avoid the kinds of treatments and joint replacement surgeries that they have seen family members go through.

    We conduct comprehensive Physiotherapy assessments to determine lifestyle or preventable factors that could decrease a person’s risk of the symptoms of osteoarthritis.

    We assess how people are managing their weight, what their diet is like, their daily activities and exercise regime. From there, we can tailor an evidence-based plan to help that person negate the symptoms of osteoarthritis as much as possible.

  • How does osteoarthritis affects the hyaline cartilage, joints, bones, ligaments, capsules and muscles?

    There are many mechanisms that contribute to the ways in which osteoarthritis will degrade or deteriorate a joint. This can be related to a decrease in joint cartilage and synovial fluid production which in turn leads to an increased amount of friction in the joint on bony surfaces.

    Over time this seems to increase the sensitivity of the joint to pain. This can cause susceptibility to pain when pressure changes occur – for example through changes in the weather or through changes in pressure caused by movement. People also will experience resting pain for what appears to be no reason at all or may report having pain from pressure of bed sheets on their joints.

    A person experiencing pain from osteoarthritis is sometimes inclined to decrease the amount of physical activity they do. This can further accelerate strength and muscle changes; losing strength within the tendons, ligaments and muscles can actually enhance the initial joint pain. Support from a Physiotherapist can provide people with the strategies to keep moving for better long-term outcomes.