Osteoarthritis & Physiotherapy

By Senior Physiotherapist: Loulou Negoescu.

Osteoarthritis

Osteoarthritis (OA) is a chronic disorder that affects movable joints, compromising the articular cartilage, underlying subchondral bone, and surrounding soft tissues (Palmieri-Smith et al., 2017). It mostly affects the hands, spine and joints such as hips, knees and ankles. It is the predominant condition leading to knee and hip replacement surgery in Australia (Australian Institute of Health and Welfare, 2018).

Although osteoarthritis can get worse over time, it is not an inevitable part of ageing and isn’t always progressive (Australian Commission on Safety and Quality in Health Care, 2017). Being overweight increases risk of osteoarthritis by two times! (Australian Commission on Safety and Quality in Health Care, 2017).

2 out of 3 people who have OA are female

Progression and exercise

Osteoarthritis isn’t necessarily degenerative, and it doesn’t always get worse over time despite common belief. Osteoarthritis can be made worse by avoiding movement and exercise. For a long time, the recommendation has been to “rest, avoid pain” this is no longer the case because it leads to muscle wastage and decrease in strength and mobility.

Conservative management* (including exercise, weight loss, and education) are recommended at ALL stages of the disease- this is important to remember

Surgery & OA

Surgery isn’t your only option, and certainly shouldn’t be your first! The Australian Commission on Safety and Quality in Health Care found that fewer than 10% of those on waiting lists for joint replacements, incorporated weight loss into their management plan for their osteoarthritis. Even when patients ultimately require surgery, weight loss and exercise is still recommended as the best practice to improve the functional outcomes before and after surgery. Exercise can delay and even prevent the need for surgery.

Physiotherapy as a First Line Treatment

• Provide necessary manual therapy treatment to the client to assist them with their pain and function
• Provide education to the client about the findings from their assessment, and what aspects of the current recommended guidelines apply to them

• Prescribe an appropriate exercise program for the client and monitor this program for 6-12 weeks to ensure the level of exercise is gradually progressed. Exercises may include: lower/upper body and core strengthening, balance, stretches, and/ or water-based therapy.

• Determine whether the client is interested in group exercise classes (such as silver strength or clinical pilates) and support their engagement and participation in appropriate classes.
• Make necessary referrals (when and if the time comes!)

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REFERENCE LIST

Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the Knee Clinical Care Standard. Sydney: ACSQHC; 2017 – Available as a PDF online here

Australian Institute of Health and Welfare. (2018). Osteoarthritis, Data – Australian Institute of Health and Welfare. [online] Available at: https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/osteoarthritis/data [Accessed 13 Jul. 2018].

Palmieri-Smith, R., Cameron, K., DiStefano, L., Driban, J., Pietrosimone, B., Thomas, A., Tourville, T. and Consortium, A. (2017). The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers’ Osteoarthritis Consortium. Journal of Athletic Training, 52(6), pp.610-623.