Physical Therapist’s Guide to Osteoarthritis
“Arthritis” is a term used to describe inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.
An estimated 27 million Americans have some form of OA. According to the Centers for Disease Control and Prevention, 1 in 2 people in the United States may develop knee OA by age 85, and 1 in 4 may develop hip OA in their lifetime. Until age 50, men and women are equally affected by OA; after age 50, women are affected more than men. Over their lifetimes, 21% of overweight and 31% of obese adults are diagnosed with arthritis.
OA affects daily activity and is the most common cause of disability in the US adult population. Although OA does not always require surgery, such as a joint replacement, it has been estimated that the use of total joint replacement in the United States will increase 174% for hips and 673% for knees by 2030.
Physical therapists can help patients understand OA and its complications, and provide treatments to lessen pain and improve movement. Additionally, physical therapists can provide information about healthy lifestyle choices and obesity education. This is important because some research shows that weight loss can reduce the chance of getting OA. One study showed that an 11-pound weight loss reduced the risk of OA in women.
What is Osteoarthritis?
Your bones are connected at joints such as the hip and knee. A rubbery substance called cartilage coats the bones at these joints and helps reduce friction when you move. A protective oily substance called synovial fluid is also contained within the joint, helping to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves.
The cause of OA is unknown. Current research points to aging as the main cause. Factors that may increase your risk for OA include:
- Age. Growing older increases your risk for developing OA because of the amount of time you’ve used your joints.
- Genetics. Research indicates that some people’s bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
- Past Injury. Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
- Occupation. Jobs that require repetitive squatting, bending, and twisting are risk factors for OA. People who perform jobs that require prolonged kneeling (miners, flooring specialists) are at high risk for developing OA.
- Sports. Athletes who repeatedly use a specific joint in extreme ways (pitchers, football linemen, ballet dancers) may increase their risk for developing OA later in life.
- Obesity. Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.
Typically, OA causes pain and stiffness in the joint. Common symptoms include:
- Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
- Stiffness in the joint after sitting or lying down for long periods
- Pain during activity that is relieved by rest
- Cracking, creaking, crunching, or other types of joint noise
- Pain when you press on the joint
- Increased bone growth around the joint that you may be able to feel
Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of an inflammation. Please consult with your doctor if you have swelling, redness, and warmth in the joint.
How Is It Diagnosed?
Osteoarthritis is typically diagnosed by your doctor using an x-ray, but there are signs that may lead your physical therapist to suspect you have OA. Joint stiffness, difficulty moving, joint creaking or cracking, and pain that is relieved with rest are typical symptoms.
Your physical therapist can effectively treat OA. Depending on how severe the OA is, physical therapy may help you avoid surgery. Although the symptoms and progression of OA are different for each person, starting an individualized exercise program and addressing risk factors can help relieve your symptoms and slow the condition’s advance. Here are a few ways your physical therapist can help:
- Your therapist will do a thorough examination to determine your symptoms and what activities are difficult for you. He or she will design an exercise program to address those activities and improve your movement.
- Your therapist may use manual (hands-on) therapy to improve movement of the affected joint.
- Your physical therapist may offer suggestions for adjusting your work area to lessen the strain on your joints.
- Your physical therapist can teach you an aerobic exercise program to improve your movement and overall health, and offer instructions for continuing the program at home.
- If you are overweight, your physical therapist can teach you an exercise program for safe weight loss, and recommend simple lifestyle changes that will help keep the weight off.
In cases of severe OA that are not helped by physical therapy alone, surgery, such as a knee or hip replacement, may be necessary. Your physical therapist will refer you to an orthopedic surgeon to discuss the possibility of surgery.
Can this Injury or Condition be Prevented?
The best way to prevent or slow the onset of OA is to choose a healthy lifestyle, avoid obesity, and participate in regular exercise.
This article was originally published on the American Physical Therapy Association’s website. Click here to view it.
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