What you should know about Osteoarthritis (OA)
In celebration of World Physical Therapy Day 2022, the occasion shines a light on Osteoarthritis and the role that physiotherapists play in the prevention and management of the condition. Osteoarthritis (OA) is a common joint condition that typically affects adults aged 50 and above. However, according to the Ministry of Health Singapore, 23.7% of Singaporeans aged 18-50 also experienced chronic joint pain.
How Osteoarthritis affects joints
In a normal and healthy joint, there is a tissue called cartilage that covers each end of the bone. Cartilage helps with shock absorption and allows the smooth sliding of the joints needed for movements. However, in OA, the wearing and thinning of the cartilage remove the cushioning of the bones. Hence, bone-on-bone rubbing can restrict movement and cause pain.
Osteoarthritis is not just a wear and tear disease. Recent evidence has also shown that low-grade inflammation is associated with OA. Inflammation responds to joint injuries by facilitating tissue repair. However, when inflammation remains unresolved, it can cause cartilage degeneration. In conditions such as diabetes and obesity, there is an increased presence of inflammatory cells that prolong inflammation and increase the risk of OA.
Risk factors for Osteoarthritis
There are certain factors that can increase your risk of osteoarthritis such as:
- Joint injuries or repetitive joint overuse
- Sedentary lifestyle
- Chronic inflammatory conditions – diabetes, high cholesterol, obesity
- Gender – females are more likely to develop OA
Signs and Symptoms of OA
Here are common signs and symptoms of osteoarthritis:
- Pain after increased activity or at the end of the day
- Stiffness of the joints
- Crepitus (creaking and cracking sound with joint movements)
Top 3 common types of OA and conservative management for OA
Knee OA is not only caused by inflammation. Biomechanical factors such as joint laxity, obesity, malalignment, poor balance and lower limb muscle weakness can cause abnormal loading of the knee. Hence, this can influence the onset of knee OA.2 The good thing is that factors such as balance and muscle weakness are modifiable with Physiotherapy.
In knee OA, the muscles often tighten up to change the forces going through the knees. This can lead to poor loading of the knee and exacerbate the pain. The hip muscles are helpful in offloading the knees and keeping the lower limb stable. Therefore, if the lower limb muscles are weak, this can increase the loading of the joints, potentially causing pain.
Given how the hip is a big weight-bearing joint in the body, it is not surprising that hip OA is common. The causes of hip OA are unknown. However, previous hip injuries and conditions such as congenital hip dysplasia are associated with the development of hip OA. People with hip OA often experience referred pain in the buttock and groin, hip stiffness and pain with weight-bearing activities such as walking, climbing stairs and running. In order to maximise function, training the hip muscles such as the gluteals have been found to be helpful.
Since OA is a degenerative condition, the spine is also a commonly affected area. Age-related changes in the spine such as loss of disc space, bony spurs and facet joint inflammation are normal. These changes seen in scans do not necessarily correlate to the pain or stiffness we experience in our back or neck. The good news is that strengthening the surrounding spinal muscles can offload the spine and slow age-related changes.
Conservative Treatment and Management for OA
- Self-management of pain with oral medications such as painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) or pain-relieving ointments. However, do consult a licensed pharmacist to check for allergies, indications and dosage.
- Pain often deters people from walking or exercising. When muscles are not used, it creates a vicious cycle of pain and weakness because the weaker the muscles are, the harder it is for a person to function as it is painful for them. However, numerous studies have shown that when the cartilage is subjected to moderate loading, it stimulates the regeneration of the cartilage. This is why exercises are crucial in joint health.
- Resistance training – 8 to 12 weeks of resistance training was associated with improving pain and function in people with knee osteoarthritis
- Low-impact exercises – Walking and hydrotherapy can help build bone density, cardiovascular health and muscle strength. The reduction of gravity in the water helps to reduce pain with weight-bearing exercises.
- Range of motion exercises to help gain more movements in the joint needed for day-to-day function
Physiotherapy for effective osteoarthritis management
Physiotherapy is incredibly useful in the management of OA as it can maximise their function and allow patients to have an improved quality of life. A physiotherapist can offer treatment techniques to relieve some pain. Education will also be provided on pain self-management. Most importantly, a physiotherapist will know how to prescribe a tailored exercise program to address the condition. The dosage and frequency of the exercises will be given such that patients will be able to exercise within their tolerated pain limits.
At times, conservative management may not work. Patients might consider options such as joint replacement surgeries if the pain persists or worsens. However, prosthesis used in surgery often lasts for only 10-15 years which is why seeking conservative management such as Physiotherapy is an excellent way to prolong the need for surgery.