What is Osteoarthritis? Pain and stiffness associated with swelling, tenderness, and degeneration in one or more joints, typically a result of the repetitive overuse and worsens with aging. OA is most commonly seen in the thumb CMC (carpometacarpal joint), the knees, and hips.
One of the most common reasons we see patients in the clinic is due to the sequelae of symptoms from osteoarthritis. The disease first manifests as abnormal cellular activity and joint tissue metabolism which then will progress to anatomical/physiological derangements in the joint such as:
Osteophyte formation (bone spurs along joint lines)
Now, that all might sound scary and like the worst thing that could happen to your body right?! The good news is, this doesn’t have to imply loss of function.
How is OA treated? Most of the current research supports the use of a combination of manual therapy techniques paired with therapeutic exercise to treat osteoarthritis. Having an understanding of load management through the affected joints and how to mitigate unwanted forces while still maintaining strength is key! If joint replacements are necessary, the evidence states that the better range of motion and strength pre-op, the more favorable the outcomes post-op. Moral of the story: even if you need surgery, call us for a few months of “prehab.”
Outside of PT, or as an adjunct to PT, there are various options for medical management of OA. NSAIDs such as Celebrex may help in the short term to decrease pain and improve function. Viscosupplementation with hyaluronic acid is a non-invasive series of injections into the knee joint that will help improve the water content of the synovial joints to help decrease stiffness. Finally, regenerative medicine with stem cell therapy can help regenerate bone and soft tissue to delay the need for surgical intervention.
I don’t have much pain, but my x-ray looks really bad, do I need a joint replacement? Radiographs ≠ Pain!!! Many people may have moderate to severe arthritis on imaging that do not experience much pain and are still able to participate in their daily activities of daily living as well as recreational activities. In fact, staying active and participating in functional strength training can help prolong and in some cases eliminate the need for a possible joint replacement. Think of your muscles as your “shock absorbers” throughout your body decreasing the amount of bone on bone contact during weight bearing activities. If you are weak, you lose this shock absorption and are more likely to experience pain, stiffness, and decreased function. To summarize: ARTHRITIC JOINTS NEED TO MOVE!
What is the difference between Osteoarthritis and Rheumatoid Arthritis? Osteoarthritis is the result of repetitive loading manifesting in a somewhat predictable pattern of asymmetrical degeneration of the subchondral bone and cartilage in weight bearing joints that progresses as one ages. Rheumatoid Arthritis (RA) is an autoimmune disease that is more often seen in women during child-bearing years (20-40 years old). This systemic origin results in synovial membrane inflammation throughout the body. It is most often seen as a symmetrical pattern starting in the small joints of the fingers and wrist, eventually affecting the upper cervical spine, and then into the weight bearing joints. Instead of seeing bone spurs and degeneration on x-ray, you may see osteopenia/osteoporosis, joint subluxation, or erosion of joints in an x-ray of someone suffering from RA. RA and OA will respond well to strength training programs that are targeted toward one’s individual impairments.
Are there any other types of arthritis? There are other systemic inflammatory arthritis disorders including:
Psoriatic Arthritis: This often follows after a diagnosis of skin involvement from psoriasis. This will often affect one sacroiliac joint, the small joints of the fingers and toes, followed by splitting/pitting of the nail beds, and eye inflammation. Typically, this is managed medically (no cure) and supervised activity is encouraged.
Ankylosing Spondylitis: This typically affects young males up to 40 years old and results in stiffness of the midback to low back and decreased rib expansion caused by fusing of the spine (often caused “bamboo spine” when seen on x-rays). Pain is often managed with exercise and anti-inflammatories and feels worse with rest.
Reactive Arthritis or Reiter’s Syndrome: This is a multi-joint inflammatory arthritis that is the result of an infection originating from the gastrointestinal or genitourinary system. May begin as severe joint pain that will often dissipate/resolve within weeks to months. Along with joint pain, a patient may experience difficulty/pain with urination and eye inflammation and pain.
Gout: This causes joint inflammation due to high levels of uric acid in the bloodstream resulting in painful urate crystal deposition in joints of the big toe, elbows, knees, wrists, etc. High uric acid is caused by a diet rich in purines which includes: high sugar content foods, beer, sardines, liver, live game, shellfish, and soda. Typically, this will be managed with lifestyle/diet changes and medical management.
In the end, any diagnosis of arthritis does not have to be a life sentence. Make an appointment to discuss your options with your PT and other medical providers to keep you mobile and functional! Remember: movement is medicine, motion is lotion, ______ (insert cheesy motivation here!)