Change Your World Week Fall 2021 (Archived)

Osteoarthritis is the wearing away of the protective cartilage that covers the ends of the bones. It is a degenerative joint disease affecting the bone, soft tissues, and synovial fluid in a joint(s).  

Osteoarthritis is the most common form of arthritis affecting over 32.5 million adults in the United States. 

The main joints that OA affects are weight bearing joints such as the hips and knees, it can also affect the hands. 

Osteoarthritis starts with minor wear and tear to the cartilage of a joint with little to no pain, overtime the cartilage can continue to erode with the joint becoming inflamed and stiff. 

There is no known cure for OA.

• Age
• Women are more likely to get OA
• A joint injury 
• Repeated stress on a joint 
• Genetics
• Bone deformities
• Obesity

• Pain or aching - Affected area hurts.
• Stiffness, decreased range of motion - Might not be able to move your joint through its full range of motion. Usually upon awakening or after being inactive.
• Tenderness - When you apply light pressure to or near the affected joint, it can be tender.
• Grating sensation, crepitus - You might hear popping or cracking at the affected joint.
• Bone spurs or bony enlargement - Extra bits of bone, which feel like hard lumps, can form around the affected joint.
• Swelling - Soft tissue inflammation around the joint.

Interventions for osteoarthritis are modified based on patient response and should begin with conservative care. These interventions include:

Weight loss and exercise

• A combination of modest weight loss and exercise provides better overall improvements in pain, function, and mobility in older adults who are overweight or obese with knee osteoarthritis.

Physical Therapy

• Physical Therapists (PT) and Physical Therapist Assistants (PTA) follow well-known general concepts when establishing the frequency, intensity, and duration of exercise; provide additional physical therapy interventions such as electrical stimulation (for mild to severe joint effusion), and evaluate and treat dysfunctions of other body regions that may result in altered mechanical stresses on the arthritic body part.

Pharmacotherapy

• Nonsteroidal anti-inflammatory drugs (NSAIDs): aspirin, ibuprofen, naproxen, and celecoxib.
• Antiresorptive drugs- aim at altering damage done to overlying cartilage on arthritic bones.
• Viscosupplementation- (non-drug, nonsurgical treatment) involves direct injections into the knee of substances derived from sodium hyaluronate, a main component in synovial fluid. These injections help restore some viscosity and elasticity of the diseased joint fluid, and offers pain relief for 6 to 12 months.

Complementary or Alternative Therapy

• Glucosamine and chondroitin sulfate are components of cartilage taken with the hopes of decreasing pain and improving function while halting the progression of the disease, by stopping an enzyme that is believed to break down cartilage.
• Acupuncture, several herbal preparations (devil's claw root, white willow bark), and capsaicin cream.

Surgery

• Surgical intervention is considered when pain and loss of function become severe. These include: lavage and debridement, abrasion arthroplasty, subcondral penetration procedures such as drilling and microfracture, and laser/thermal chondroplasty. These interventions may benefit some individuals by potentially delaying reconstructive procedures (i.e. total joint replacements).

Disease progression is typically slow, occurring over several years. The prognosis usually depends on the joints affected and severity of OA.

Patients with OA who have undergone joint replacement have a good prognosis, with success rates for hip and knee arthroplasty generally exceeding 90 percent.

Pain is the principal morbidity in OA. This may cause the patient to become less active thereby causing morbidities due to weight gain. Although there is no known cure, individuals can substantially decrease the pain and dysfunction associated with OA, by following the guidelines for lifestyle changes, pain management, self management, and incorporating exercise and weight loss.

According to the American College of Rheumatology, losing just 10 pounds of weight over a 10-year period can reduce the chances of developing OA by up to 50 percent.

Physical therapy and exercise have been shown to be effective in the treatment of OA. It can reduce pain, improve physical function, increase isometric muscle strength (muscle length does not change), walking speed, stride length and overall improve the quality of the patient's life. Research shows clear improvements in symptoms of hip and knee OA patients who also participate in exercise programs.

The main goals of therapy for OA are pain relief, joint function and joint stability. The treatment plan may involve patient education, weight loss, exercise and orthotics (braces) if necessary. 

A combination of manual therapy and supervised patient exercise can provide beneficial effects that are still present a year later while also delaying the need for surgical intervention (knee replacements). The physical therapist/physical therapist assistant will also optimize existing and potential joint function by improving flexibility and strength of the affected joint through low intensity, controlled movements. If there is mild joint swelling, the patient should be instructed to apply ice to the afflicted area. This should be done before exercise if there is swelling present. The client should also be taught to perform a warm-up routine before exercising. Icing and warming-up for 3-4 minutes before therapy or exercise can help reduce the swelling at the joint.

Developing OA cannot be prevented. However, through exercise, you can delay the onset of the symptoms while alleviating others. Obesity is a risk factor for OA, but regular exercise has been shown to facilitate weight loss and prevent weight gain. This alone can take excess load off the weight bearing joints and remove some of the repeated stress on said joints. 

https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925

https://www.hindawi.com/journals/jar/2011/374653/

https://www.slideserve.com/ora-copeland/case-2

Pathphysiology for the Physical Therapist Assistant pg. 566-567