Osteoarthritis (OA) is defined by the Arthritis Foundation as a “degradation of articular cartilage that is caused by a combination of hereditary, developmental, metabolic and mechanical causes.” Due to these multifactorial causes, there is NO ONE cure or preventative measure that can be taken. Recent research has shown that up to 60% of OA cases are thought to be from genetic factors. Thus, osteoarthritis is related to, but not caused by age.
Osteoarthritis affects 27 million people in the United States and by the age of 65 as much as 80% of the population will demonstrate radiographic (x-ray) evidence of OA. However, ONLY 60% will be symptomatic. Mechanically, OA is considered to be a product of living on planet Earth – Good old gravity pushing down on us wears the weight bearing joints down over time. Degenerative changes occur due to excessive stresses on the joint, which may be from years of high impact sports or activities, excessive weight gain over the years, or structural abnormalities caused by muscle weakness or poor flexibility.
The disease process is of gradual onset which involves a thinning of the articular cartilage or the cushiony material between where two bones make contact. Over time, the cartilage loses water content and thins and the excessive stresses cause a breakdown of the tissue which can develop into the bone on bone pressure, which causes an inflammatory reaction and production of bone spurs, excessive fluid/swelling, and subsequent pain.
The mainstay of treatment for osteoarthritis is a combination of lifestyle modification (diet, activity changes), analgesics (acetaminophen or NSAIDs), and physical therapy. Studies have shown that physical therapy is more effective than medications alone in treating OA of the knee. To get the most benefit you must address multiple factors, it takes a combination of the above things to improve function, decrease pain, and hopefully delay the need for surgical intervention.
In evaluating a patient with a diagnosis of OA, Physical Therapists examine several factors including range of motion, strength, flexibility, balance and coordination, joint structure, and function. In a physical therapy evaluation we examine the range of motion (ROM), available degrees of movement of the affected joints, and compare that to the non-effected side and to normal joint motion. From this, we determine what exercises or manual techniques we can use to help restore normal motion. A loss of joint mobility can be a big factor in the speed of joint degeneration due to the fact that with a loss of normal ROM, the forces are directed thru a smaller surface area. Thus, the smaller area takes more stress and wears down quicker. I heard a surgeon tell a patient one time that complained about not being able to squat and kneel – “You can’t squat and kneel because you quit squatting and kneeling” the old adage is very true if you don’t use it you will lose it.
Another factor that is evaluated by a physical therapist is overall joint flexibility. One of the main sources of pain in OA is the “bone on bone rubbing”. Therefore, if the muscles that surround the joint are tight then the joint surfaces are compressed tighter together which increases the pressure and speeds up the degeneration. Physical therapists are experts in assessing muscle length and can teach many safe techniques for proper stretching.
After evaluating the components of movement your physical therapist will then examine the way that you move and determine if there are aspects that can be corrected such as balance and coordination that can allow you to move more efficiently and reduce the stress on your joints.
From your physical therapy evaluation, the therapist compiles all of the data from the exam and comes up with an individual physical therapy prescription which should involve exercises to increase strength and balance, stretches to increase flexibility, and manual techniques to improve joint mobility. Many times if we see someone soon enough and they work diligently (it takes 6-8 weeks to see true strength gains.) Then the better chance we have of helping them avoid joint replacement surgery. However — once someone reaches the point where the cartilage has completely degenerated and there is extensive bone on bone contact then there is little anyone can do short of joint replacement.
I have many patients that want the “quick fix” and they ask me about all of the gadgets and products and what works and doesn’t work. Well, the main point is that there isn’t ONE thing that “fixes” arthritis. The existing research points to a combination of exercise, pain relievers, and activity modification. Some common devices that individuals utilize are orthotics, braces, supplements, and topicals.
Orthotics help address structural issues that cause excessive stresses to the joint. If someone overpronates (rolls in) at the foot then they also put more stress on the inside of the knee joint. So an orthotic can help by allowing someone to achieve optimal structural alignment. But this will only play a key role if they are worn during most weight-bearing activities and if started in your 20’s or 30’s before cartilage loss takes place. You can get a good quality custom orthotic for about $300.00 from a certified orthotist / prosthetist or physical therapist. Make sure that they will modify/adjust the orthotic themselves to ensure proper fit.
Magnetic braces are another big item that people use to help joint pain – the one thing I can say is that if magnetic therapy works you shouldn’t have to pay several $100’s for magnetic braces you can just tape a refrigerator magnet to the joint because a magnet, is a magnet, is a magnet!!
Supplements are another multimillion-dollar market in which we invest to stay healthy. Again it comes down to people looking for the “magic pill”. Unfortunately, it doesn’t exist yet. One of the only supplements that have been researched extensively is Glucosamine and Chondroitin. Early studies showed some benefit when used in combination for reducing dysfunction in weight-bearing joints from arthritis, but recent larger-scale studies have shown no significant effect beyond placebo. Therefore, most current joint supplements may only give the patient expensive urine.
There are also tons of bracelets, holograms, and joint creams touted to relieve arthritis pain – but you need to realize that if there was any merit they wouldn’t be selling them on late-night TV. However, it has been reported that there can be as much as a 30% placebo effect with treatments, so if you believe that it will help you, then there is a good chance that it can – the mind plays a very important role in healing.
Again, it is your body and you can’t get another one. There is no substitute for regular exercise. To keep your joints healthy it requires a lot of hard work and effort — and with the help and guidance of a physical therapist, you can continue to enjoy life and keep moving.
