Views & Reviews
Role of Physiotherapy In Osteoarthritis
World PHYSIOTHERAPY DAY 2022
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones wears down over time.
Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine.
Osteoarthritis symptoms can usually be managed, although the damage to joints can’t be reversed. Staying active, maintaining a healthy weight and receiving certain treatments might slow progression of the disease and help improve pain and joint function.
Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:
• Pain. Affected joints might hurt during or after movement.
• Stiffness. Joint stiffness might be most noticeable upon awakening or after being inactive.
• Tenderness. Your joint might feel tender when you apply light pressure to or near it.
• Loss of flexibility. You might not be able to move your joint through its full range of motion.
• Grating sensation. You might feel a grating sensation when you use the joint, and you might hear popping or crackling.
• Bone spurs. These extra bits of bone, which feel like hard lumps, can form around the affected joint.
• Swelling. This might be caused by soft tissue inflammation around the joint.
Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that enables nearly frictionless joint motion.
Eventually, if the cartilage wears down completely, bone will rub on bone.
Osteoarthritis has often been referred to as a wear and tear disease. But besides the breakdown of cartilage, osteoarthritis affects the entire joint. It causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone. It also causes inflammation of the joint lining.
Factors that can increase your risk of osteoarthritis include:
• Older age.
• Joint injuries.
• Repeated stress on the joint.
• Bone deformities.
• Certain metabolic diseases.
Osteoarthritis is a degenerative disease that worsens over time, often resulting in chronic pain. Joint pain and stiffness can become severe enough to make daily tasks difficult.
Depression and sleep disturbances can result from the pain and disability of osteoarthritis.
During the physical exam, your doctor will check your affected joint for tenderness, swelling, redness and flexibility.
To get pictures of the affected joint, your doctor might recommend:
• Magnetic resonance imaging (MRI).
Analysing your blood or joint fluid can help confirm the diagnosis.
• Blood tests.
• Joint fluid analysis.
What is the role of physiotherapy in osteoarthritis?
Physiotherapy is important part of OA management and will be instrumental in teaching people to: properly use joints; exercise correctly in both motion and flexibility exercises as well as cardiovascular exercises (e.g.hydrotherapy, swimming), recommend assistive devices, recommend use of modalities.
How effective is physiotherapy for osteoarthritis?
Physical therapy is the appropriate non-surgical treatment for knee OA. Physiotherapy has been suggested to not only help reduce pain, but also improve function, muscle strength, range of movement (ROM), joint stability, and aerobic conditioning. Physical therapist treatment has proven to be an effective treatment for OA, and may help you avoid surgery and use of painkillers. Although the symptoms and progression of OA are different for each person, starting an individualised exercise program and addressing risk factors can help relieve your symptoms and slow the condition’s advance.
Can This Injury or Condition Be Prevented?
The development of OA cannot be completely prevented. The best way to slow the onset or progression of OA is to choose a healthy lifestyle by avoiding obesity and participating in regular physical activity or exercise programs.
Specialist physiotherapists are trained in diagnosing and treating joint and muscle problems.
It’s important that you try to keep active when you have arthritis. Many people worry that exercise will increase their pain or damage their joints. But joints are designed to move, and inactivity weakens the muscles.
A physiotherapist will ask you about your current level of activity and any particular problems you’re having. They will also examine your joints to assess your muscle strength and the range of movement in your joints. This will help them tailor a programme of treatments, exercises and activities to meet your individual needs.
You can gradually build your strength, stamina, mobility and activity levels by following a graded exercise programme. Your physiotherapist will show you how to start gently and then gradually increase your activity, without straining yourself.
The Mental Mindset
1. Don’t forget the reason you’re doing this
Physical therapy can at times be painful, frustrating, or even boring — and that’s understandable as you’re pushing yourself more. But in those moments it’s important to keep your eye on the prize and remember why you’re doing this in the first place. “The goal of physical therapy is to progressively get stronger in order to be able to not just move more, but to move better” . A good PT will keep an updated list of your goals and check in with you about your progress.
2. Surgery is not a cure-all
Joint replacement surgery is a necessity for many patients with arthritis. But too many people think it will solve all their mobility problems and their pain will instantly go away. Unfortunately the truth is that surgery is not a quick fix. In the initial weeks afterward, things often feel worse before they feel better. One of the best ways to help yourself after surgery? Keep your PT appointments. “The most positive outcome [from surgery] requires a period of dedicated rehabilitation and we are trained to help you with that’’.
3. Ditch the victim mentality
Instead of thinking of yourself as being at the mercy of your arthritis, it’s important to think of your condition as something that can be managed, by you. “Imagine you have a tool box and in it are all the things that help their arthritis — things like medication, pain relief, exercise, heat, rest, physical therapy, and so on”. “Then you feel in control of your illness and can draw out what you need, when you need it.” Need help? A good PT can give you lots of good “tools” for your toolbox.
4. Learn how your joints work
Arthritis patients are often more committed to doing their prescribed physical therapy exercises when they understand how their joints work. “When your joints move they produce a liquid called synovial fluid, which reduces friction in your joints”. “This means that your joints might ache a little initially when you start moving the joint, but discomfort should improve with continued movement as you get more fluid to lubricate it.” Your doctor or PT can show you a model or diagram of what your joints look like when they move and how arthritis can change that.
5. You are not your X-rays
Scary-looking scans mean serious pain and disability, right? Not always. “Just because you have osteoarthritis, that does not necessarily mean you are going to have pain”. “A lot of people get really worried when they are told they have ‘bone on bone’ or have degeneration but just because that is how the joint looks, it does not mean they will have a lot of pain or issues with daily life.” A physical therapist can help you identify any weak spots and give you tips to prevent future pain. It’s important to talk to your doctor about what your imaging means for your prognosis and whether they indicate any changes in treatment may be needed.
6. Start making changes now
“One of the things patients with arthritis should understand is that time is of the essence. Arthritis is a progressive and chronic disease,”. Avoiding action or “powering through” can cause further damage to occur. The sooner you start taking steps to deal with and treat your arthritis, the better your prognosis can be.
The Exercise Prescription
7. Motion is lotion
When it comes to soothing painful joints sometimes the best treatment may be the last one you want to do — move it. “Movement is integral in keeping your joints as mobile and limber as possible; stop moving and you’ll see an immediate increase in pain, stiffness, and disability,”. “ Keep moving as you normally would, as much as possible, and continue to exercise even through small bouts of pain.” Major pain is a reason to stop, but it’s good to push through a little discomfort..
8. Learn to love the elliptical machine
When it comes to arthritis, not all exercises are created equal. This is especially true if you have osteoarthritis; certain types of exercises can increase the wear and tear on your already damaged joints. “ Usually recommend low-impact exercise such as the elliptical machine or swimming, as they are more gentle on your joints”. “These types of movements are less likely to cause further injury and will maintain or even improve your mobility.”
9. Get pumped
While cardio will keep your joints lubricated and flexible, when it comes to the long-term health of your joints, it’s important to strengthen the muscles that support them. “As you strengthen the muscles that support the joint, you offload the pressure”. However, it’s important to work with your physical therapist to figure out which exercises are best for your particular type of arthritis. For instance, if your knees are the problem then you’ll want to focus on strengthening your quads, hamstrings, hips, and low back.
10. Strength train without weights
Some people aren’t up to ‘pumping iron’ in the gym and that’s totally fine — there are lots of strengthening exercises you can do just with your body. Pilates is a gentle way to strengthen the muscles that stabilise arthritic joints while improving range of motion and flexibility. Other options are yoga, tai chi, or bodyweight strength workouts you find online. Just be sure to run it by your PT first so they can make sure they are appropriate for your arthritis.
11. Do dexterity exercises
Don’t forget your small muscles in your exercises. Movement is the best thing you can do for your joints but people often forget that applies to the small joints, like fingers and toes, as well. “If you have arthritis in your hands, do hand dexterity exercises— like opening and closing your hand and picking up small objects — to warm up in the morning”. A PT can help you figure out which dexterity exercises are best for you.
12. Switch up your workouts up
It’s easy to get in a rut with exercise but it’s better for your joints if you can be flexible (ha!) with your workouts. “It’s really about finding the right type of exercise and modifying activities so you can keep moving without serious pain”. That might mean walking one week, swimming the next, and lifting weights in between. Your physical therapist can recommend specific activities that will work best for you at your current pain level.
13. Don’t overdo it
“Many people with arthritis do too little activity, which can cause their joints to become stiff and painful, but others may be doing too much activity, which can add stress to the joints”. (And both things can be true for the same person in different situations!) The whole point of exercising is to help you, so if your activities are so intense that they require hours of recovery afterward or cause major pain flare-ups then it’s time to talk to your PT about making adjustments and cutting back.
14. Get your posture evaluated
Good posture is important for everyone but it’s essential for people with arthritis because poor biomechanics when you sit, walk, or lift can put extra strain and wear and tear on joints. “A physiotherapist can help to correct your biomechanics”. “We can help correct your bad habits and postural problems so you wear down your joints less, thereby helping to slow the progression of arthritis and reduce pain.”
The Lifestyle Hacks
15. Spread out your housework
Gone are the days when you can binge-clean your entire house on a Saturday morning. Instead of trying to be superhuman, assign chores to different days and build breaks into your schedule. “ Don’t do all your cleaning in one go, do a bit at a time, it’ll still get clean.”
16. Lower your shelves
Learning to live with arthritis means making adjustments and adaptations to your daily home routine. For instance, moving your shelves down to lower levels so you don’t have to reach over your head, is a simple fix.
17. Get a paraffin wax hand treatment
Moist, hot therapy is the best for painful joints. Patients with arthritis in their hands or feet can use a paraffin wax treatment.
18. Slide your furniture
Picking up or pushing heavy furniture is a problem for most people with arthritis. If you have bad form it can injure you or worsen your pain. Thankfully, they make furniture sliders — plastic discs that you put under bed, couch, or table legs — that allow the furniture to glide over your floor. You can buy smooth plastic ones for use on carpeted floors or fuzzy ones for wood or tile floors.
19. Lighten up your grocery list
Another easy adaptation is to consider the size and weight of things you normally buy at the store and consider alternatives. “My patients with arthritis in their hands often have difficulty carrying a gallon of milk, which is heavy and hard to manipulate, so instead I tell them to get two pints”. Another option is to have your groceries delivered. It may be worth the fee to have someone else do the heavy lifting.
20. Turn up the heat, skip the ice
Heat is one of the best tools you have for dealing with painful flare-ups in your joints, yet many patients still primarily use ice, often based on old advice for treating injuries. “For chronic pain, use heat packs to help maintain blood flow and improve flexibility in your joints”. “Ice is better suited for more acute injuries because it can make joints feel more stiff.”
21. Stretch before you get out of bed
Joints stiffen up during the night when they’re not being used. That’s one of the reasons that mornings are often the toughest time of day for people with arthritis. “Stretching is the antidote to morning stiffness” . “Start with gentle stretches while still lying down and then continue stretching while sitting on the edge of your bed, prior to getting up every morning.”
You and Health Physio Rehabilitation Team
Dr. Tiatula Longkumer (PT) MPT
Dr. Inavika Swu (PT) BPT
Dr. Soni Phom (PT) BPT
Nagaland Multispeciality Hospital Midland, Dimapur Nagaland