Osteoarthritis (OA) Diagnosis & treatment
What is Osteoarthritis?
Osteoarthritis (OA) is a common form of arthritis, which is a degenerative joint disease that affects the cartilage, the protective tissue that covers the ends of bones in a joint. Unlike other types of arthritis that may be related to autoimmune or inflammatory processes, osteoarthritis primarily involves the gradual breakdown of cartilage over time. Osteoarthritis affects mainly elderly people due to the natural ageing process and wear in joint cartilage.
Here’s how Osteoarthritis develops and progresses:
Cartilage is a smooth, rubbery material that allows joints to move smoothly without friction. In osteoarthritis, this cartilage starts to break down due to various factors, including age, wear and tear, genetic predisposition, joint injuries, and excessive stress on the joint.
In Osteoarthritis as the cartilage deteriorates, the space between the bones narrows, leading to a decrease in shock absorption. Additionally, the body may try to repair the damaged cartilage, but these attempts are often insufficient, leading to further degradation.
Over time, as the body tries to stabilise the joint, small bony growths called bone spurs or osteophytes may develop around the edges of the joints affected by osteoarthritis.
While osteoarthritis is primarily a non-inflammatory condition, mild inflammation can occur in the damaged joints due to the release of certain chemicals.
The most commonly involved joints in osteoarthritis are weight-bearing joints, such as the knees, hips, and spine, as well as joints in the hands and fingers. Symptoms of osteoarthritis can include joint pain, stiffness, swelling, decreased range of motion, and in some cases, joint deformities.
Osteoarthritis is a chronic condition, and its progression can vary from person to person. There is currently no cure for osteoarthritis, but various treatments are available to manage the symptoms and improve the quality of life for those affected. These treatments may include pain relief medications, physiotherapy, lifestyle modifications, assistive devices, and in severe cases, surgical interventions like joint replacement.
Imaging tests play a crucial role in the diagnosis and evaluation of osteoarthritis. They help healthcare professionals visualize the joint structures, assess the extent of joint damage, and determine the most appropriate treatment options. Some of the common imaging tests used to diagnose osteoarthritis include:
X-rays are often the first imaging test used to diagnose osteoarthritis. They can reveal the narrowing of the joint space, the presence of bone spurs, and changes in bone density. X-rays are particularly useful for assessing the severity of osteoarthritis and monitoring its progression over time.
Magnetic Resonance Imaging (MRI):
MRI provides detailed images of soft tissues, cartilage, and bone. It is particularly helpful in evaluating the condition of the cartilage, detecting early changes, and assessing the overall joint health. MRI can also help identify other joint problems that might be contributing to the symptoms.
Computed Tomography (CT) scan:
CT scans offer cross-sectional images of bones and can be useful in assessing complex joint structures, especially in cases where MRI may not be feasible or when detailed information about bone anatomy is required.
Bone scans are less commonly used than the other imaging techniques mentioned above. They involve injecting a small amount of radioactive material into the bloodstream, which accumulates in areas of increased bone activity. Bone scans can help identify areas of increased bone turnover, which can be indicative of joint inflammation or damage.
Each imaging test has its advantages and limitations, and the choice of which test to use depends on various factors, including the affected joint, the stage of osteoarthritis, and the specific information required for diagnosis and treatment planning. Your Doctor or Specialist will determine the most appropriate imaging approach based on the individual patient’s needs and clinical presentation.
Range of movement exercises for Osteoarthritis:
For individuals with osteoarthritis (OA), it’s important to maintain joint flexibility and range of motion to help manage symptoms and improve overall joint function. Performing this type of exercise helps move synovial fluid around the joint helping nourishment of cartilage, this may help relieve some osteoarthritis pain.
Range of movement exercises, also known as stretching or flexibility exercises, can be beneficial for people with osteoarthritis helping affected joints and improving physical activity and functional wellbeing. However, it’s essential to perform these exercises gently and within your pain limits to avoid exacerbating the painful joints any further. If used well these exercises can help moderate pain by gentle movements.
Strength exercises for Osteoarthritis:
Strength exercises can be incredibly beneficial for managing osteoarthritis (OA) by helping to improve joint stability, reduce pain, and enhance overall joint function. When designing a strength exercise program for OA, it’s essential to focus on exercises that target the muscles around the affected joint while considering your current fitness level and any limitations. Here are some strength exercises suitable for individuals with Osteoarthritis:
- Leg Press (Quadriceps and Hamstrings):
- Sit on a leg press machine with your feet shoulder-width apart.
- Push the platform away from you by extending your knees. Slowly return to the starting position.
- Focus on controlling the movement and avoid locking your knees.
- Perform 2-3 sets of 10-15 repetitions.
- Bodyweight Squats (Quadriceps and Glutes):
- Stand with your feet shoulder-width apart.
- Bend your knees and lower your hips as if sitting back into a chair.
- Keep your chest up and your back straight. Make sure your knees do not extend beyond your toes.
- Push through your heels to return to the starting position.
- Perform 2-3 sets of 10-15 repetitions.
- Seated Leg Extension (Quadriceps):
- Sit on a leg extension machine with your knees bent at a 90-degree angle.
- Extend your knees to straighten your legs, lifting the weight. Slowly lower the weight back down.
- Use a controlled motion and avoid using momentum.
- Perform 2-3 sets of 10-15 repetitions.
- Lying Leg Curl (Hamstrings):
- Lie face down on a leg curl machine with your ankles under the padded bar.
- Curl your legs up toward your glutes, contracting your hamstrings. Slowly lower the weight back down.
- Focus on a controlled movement and avoid arching your back.
- Perform 2-3 sets of 10-15 repetitions.
- Standing Hip Abduction (Hip Abductors):
- Stand holding onto a sturdy surface for balance if needed.
- Lift one leg out to the side while keeping your foot flexed and your toes pointing forward.
- Slowly lower the leg back down.
- Perform 2-3 sets of 10-15 repetitions on each leg.
Before starting any exercise program, it’s essential to consult with a physiotherapist, especially if you have Osteoarthritis. They can provide guidance on exercises that are safe and appropriate for your specific condition. Additionally, listen to your body, start with a comfortable intensity, and gradually increase the weight and repetitions as your strength improves. If you experience pain or discomfort during any exercise, stop and consult your physiotherapist.
How can I manage osteoarthritis?
Remember, osteoarthritis is a chronic condition, and there may not be a one-size-fits-all approach. Work closely with your primary care doctor and healthcare practitioner to develop a personalised management plan that suits your specific needs and condition. Here are some general tips that may help manage osteoarthritis and joint pain:
Learning about symptoms of osteoarthritis, its causes, and how it affects your joints. Understanding Osteoarthritis as a condition can help you make informed decisions about managing your osteoarthritis.
Engage in regular, low-impact exercises to strengthen the muscles around the affected joint and improve flexibility. Activities like walking, swimming, cycling, and gentle yoga can be beneficial.
Healthy eating and weight management:
Maintaining a healthy weight can significantly reduce stress on weight-bearing joints, such as knees and hips. Losing weight can also help slow down the progression of osteoarthritis. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall joint health.
Hot and cold therapy:
Applying heat pads or warm towels can help relax stiff joints and alleviate pain. On the other hand, cold packs can help reduce inflammation and swelling of a painful joint.
Pain relieving medications:
Over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can help manage a painful joint and inflammation. However, always consult a doctor before starting any new medication, especially anti-inflammatory drugs NSAIDS.
Physiotherapy plays a crucial role in the management of osteoarthritis (OA) by helping to improve joint function, reduce pain, and enhance overall quality of life. A physiotherapist can design a personalized exercise program and provide guidance on lifestyle modifications to better manage OA symptoms. Here’s an overview of osteoarthritis physiotherapy management:
- Initial Assessment: The first step is a thorough assessment by the physiotherapist to understand the extent of joint involvement, your specific symptoms, and your functional limitations.
- Education: The physiotherapist will educate you about osteoarthritis, its progression, and how specific exercises and strategies can help manage the condition.
- Exercise Prescription:
- Range of Motion Exercises: Gentle movements that help maintain or improve joint mobility.
- Strengthening Exercises: Target muscles around the affected joint to provide better support and stability.
- Low-Impact Aerobic Exercises: Activities like walking, cycling, or swimming can improve cardiovascular fitness and joint function without excessive stress on the joints.
- Balance and Proprioception Exercises: These help prevent falls and improve joint awareness, which is important for joint protection.
- Flexibility Exercises: Gentle stretching to maintain or improve joint flexibility and prevent muscle tightness.
- Pain Management Techniques:
- Manual Therapy: Hands-on techniques like joint mobilisations and soft tissue manipulation can temporarily relieve pain and improve joint mobility.
- Assistive Devices: The physiotherapist can recommend and teach the use of assistive devices such as braces, splints, or walking aids to support and protect the joints.
- Lifestyle Modification: The physiotherapist can advise you on ergonomic adjustments, proper body mechanics, and techniques to minimize joint strain in daily activities.
- Home Exercise Program: A customized exercise routine that you can perform at home between physiotherapy sessions to maintain and improve your progress.
- Progress Monitoring: Regular follow-up appointments with the physiotherapist to assess your progress, make adjustments to your exercise program, and address any concerns.
- Psychosocial Support: Dealing with chronic pain and limitations can take a toll on mental well-being. Physiotherapists can provide support and coping strategies.
Avoid activities that may strain or worsen the affected joints. Use proper body mechanics and techniques to reduce stress on your joints during daily activities.
Balance rest and activity:
Find a balance between rest and activity. Pacing yourself can prevent overexertion and reduce the risk of joint pain flare-ups.
Avoid smoking and limit alcohol:
Smoking and excessive alcohol consumption may contribute to inflammation and worsen osteoarthritis symptoms.
Chronic stress can exacerbate pain. Engaging in relaxation techniques, such as meditation or deep breathing, can help manage stress.
Some people find relief through alternative therapies like acupuncture or chiropractic care. While these may not work for everyone, they can be worth exploring.
Steroid injections, also known as corticosteroid injections, can be used as a treatment option for managing pain and inflammation associated with osteoarthritis (OA). These injections deliver a potent anti-inflammatory medication directly into the affected joint, providing targeted relief. Here’s an overview of steroid injections for osteoarthritis:
- Mechanism of Action: Corticosteroids are powerful anti-inflammatory drugs that can help reduce inflammation and pain in the joint. They work by suppressing the immune response and reducing the production of inflammatory chemicals in the joint space.
- Indications: Injections are often considered when more conservative treatments, such as physiotherapy, exercise, and over-the-counter pain medications, have not provided sufficient relief for OA symptoms. They are commonly used for larger joints like the knee, hip, and shoulder.
- Procedure: The injection is usually administered by a healthcare professional, such as a rheumatologist or orthopedic specialist. The procedure involves inserting a needle into the joint space and injecting the corticosteroid medication along with a local anaesthetic for to relieve pain immediately.
- Benefits: Injections can provide quick relief from pain and inflammation, which can be especially helpful for managing flare-ups. Reduction in inflammation can lead to improved joint function and mobility. In some cases, steroid injections can provide enough relief to postpone the need for surgical interventions like joint replacement.
- Duration of Relief: The duration of pain relief varies from person to person. Some individuals experience relief for several weeks to a few months, while others may have longer-lasting effects.
- Risks and Side Effects:
- Temporary Flare: A small percentage of individuals might experience an initial increase in pain and inflammation for a day or two after the injection.
- Infection: There is a slight risk of infection at the injection site.
- Joint Damage: Repeated injections over a short period might potentially contribute to joint damage.
- Weakening of Tissues: Steroids can weaken tissues, such as tendons, if used excessively.
- Elevated Blood Sugar: For individuals with diabetes, steroid injections can cause temporary spikes in blood sugar levels.
- Frequency: The frequency of steroid injections should be discussed with your healthcare provider. It’s generally recommended to limit the number of injections within a specific time frame to reduce the risk of side effects.
- Considerations: Steroid injections are not suitable for everyone. People with certain medical conditions, such as active infections or bleeding disorders, might need to avoid them. Additionally, long-term and frequent use of steroid injections is generally discouraged due to potential side effects.
Always consult with your healthcare provider before pursuing steroid injections or any other treatment options for osteoarthritis. Your provider will assess your individual situation and recommend the most appropriate course of action based on your medical history, current health status, and treatment goals.
Hyaluronic acid injections
Hyaluronic acid (HA) injections are a treatment option used for osteoarthritis (OA), a degenerative joint condition that primarily affects the cartilage. HA is a naturally occurring substance found in the synovial fluid that lubricates and cushions joints. In people with OA, the viscosity and amount of HA in the synovial fluid may decrease, contributing to joint pain and stiffness.
HA injections are sometimes referred to as “viscosupplementation” and are intended to alleviate pain and improve joint function in individuals with OA. The injections are typically administered directly into the affected joint by a healthcare professional.
Here’s how HA injections work:
- Lubrication: HA injections aim to restore the lubricating properties of synovial fluid. By injecting HA into the joint, it can improve joint mobility and reduce friction between the bones.
- Pain Relief: HA injections can also have anti-inflammatory effects, which might help reduce pain and swelling in the joint.
- Stimulation of Natural HA Production: Some studies suggest that HA injections might stimulate the natural production of hyaluronic acid within the joint, leading to longer-lasting benefits.
It’s important to note that the effectiveness of HA injections can vary from person to person. Some individuals experience significant pain relief and improved joint function, while others may not see as much benefit. Additionally, the effects of HA injections are usually temporary, and repeat injections might be needed to maintain the benefits.
HA injections are generally considered safe, with few reported side effects. However, as with any medical procedure, there can be risks, including infection, bleeding, and allergic reactions. It’s crucial to discuss your medical history and any potential allergies with your healthcare provider before undergoing the procedure.
Resources and support:
Managing osteoarthritis (OA) involves a combination of medical advice, lifestyle changes, and support. Here are some resources and avenues for support that can help individuals with OA:
Healthcare Professionals: Consult with your primary care physician or a rheumatologist for accurate diagnosis, treatment options, and ongoing guidance.
Physiotherapists: Physical therapists can design exercise programs tailored to your needs, helping you improve joint flexibility, strengthen muscles, and manage pain.
Occupational Therapists: Occupational therapists can suggest strategies and adaptive devices to make daily tasks easier while minimizing joint stress.
Patient Education Websites and Support Groups:
- Arthritis Foundation: Provides information, resources, and tools for managing arthritis. (Website: arthritis.org)
- Mayo Clinic: Offers comprehensive information on arthritis, including symptoms, causes, and treatment options. (Website: mayoclinic.org)
- Arthritis Foundation Community: Online forum for individuals with arthritis to connect, share experiences, and seek advice. (Website: community.arthritis.org)
- Inspire Arthritis Support Groups: Online platform hosting various arthritis-related support groups. (Website: inspire.com)
- Local Arthritis Organizations: Many local communities have arthritis support groups that meet in person or virtually. These groups provide opportunities for sharing experiences and tips for managing OA.
- Books and Literature: There are numerous books written by medical professionals and individuals sharing their experiences with OA. Examples include “The Arthritis Helpbook” by Kate Lorig and “Living with Arthritis” by Cheryl Koehn.
- Apps and Tools:
Remember that while these resources can provide valuable information and support, it’s essential to consult with your healthcare provider before making any significant changes to your treatment plan or lifestyle. Each person’s experience with OA can vary, so working closely with medical professionals is crucial for effective management.
Management of osteoarthritis involves a combination of lifestyle changes, medications, therapies, and sometimes surgical interventions to help alleviate pain, improve joint function, and enhance overall quality of life. It’s important to note that osteoarthritis is a chronic condition, so the goal of management is to effectively control symptoms and prevent further progression.
Remember, the management plan should be personalized to your individual needs and severity of osteoarthritis. Consult with your healthcare provider to develop a comprehensive plan that addresses your specific condition and goals. Regular follow-ups are important to track your progress and make any necessary adjustments to your treatment plan.
At Lilyfield Physiotherapy we run the GLA:D program, which is an evidence based approach using education and exercise to manage your osteoarthritis condition. The aim is to educate you about osteoarthritis and teach physical activity to help keep your strength, function and moderate or reduce osteoarthritis pain to a manageable level.