Osteoarthritis (OA) or arthritis is a chronic disease that typically leads to pain, a significant reduction in movement and gradually worsening joint function commonly seen in the knee and hip. While there still remains a great deal to understand about arthritis and its development, there are a number of well-established risk factors we know that contribute to the development of osteoarthritis. Some of which include:
Aging (individuals over 60 years of age are at most risk)
Obesity (increased load on the joints potentially leading to undue stress and damage over time).
Female sex. It would seem women are more likely to develop OA over men. It has been proposed that this may have something to do with menopause, however it is unclear as to why.
Repetitive movements with excessive loading. Lifestyle and certain occupations whit significant mechanical demand have been linked to higher rates of OA.
Previous injury to the joint/history of surgery to the affected joint.
One of the biggest questions that clinicians come across is “will exercise wear out my joints?”
The simple answer is NO. The “wear and tear” model was negatively framed, is inconsistent with evidence and advice on physical activity, and is woefully inaccurate, reinforcing expectations of inevitable decline and reduced quality of life.
There are however increased risks of doing too much too soon. This is where patients decide or are encouraged to go beyond their level of tolerance. It usually leads to aggravation and more often than not, it ends with disappointment, fear of movement and loss of faith in their recovery.
How is osteoarthritis managed?
Physiotherapy and exercise therapy are currently primary treatments for individuals who develop OA. This is particularly true for patients who are diagnosed with knee and hip arthritis. Exercise has been proven to restore and build strength to the muscles surrounding the joint while also increasing the stability around the affect area. It is important to understand that this process does not happen overnight. Research has shown a minimum of 12 weeks of structure rehab, consistently applied by the patient and a supervised is necessary to begin to see clinically significant improvements.
When symptoms progress significantly, imaging shows worsening pathology and conservative measures have failed, it is time to discuss other options with an orthopedic specialist. There are a number of surgical interventions, including a total joint replacement, which are very effective in restoring function. However, it is important to note that this is an extremely invasive procedure and is only considered as a last resort.
Recommendations for exercise:
The type of exercise chosen should be based on the patient’s preferences, goals and levels of tolerance.
150 minutes per week of moderate intensity activity is recommended.
Aim for at least 2 days per week of strength training. Exercises should be aimed at targeting all joints of the lower extremity.
Regular exercise should be performed for at least 12 weeks to begin to see greater changes and improvement in pain and function.
Patient education:
Patients should aim to understand as much as they can about their condition as this can have a significant impact on beliefs, perceptions and ultimately recovery.
Understanding a combination of weight loss (when necessary), regular exercise and a list of other lifestyle factors (nutrition, sleep, stress) can all help manage your condition. There is no one size fits all approach.
Managing expectations on recovery, setting appropriate and realistic goals with a treatment plan can help adherence to the program. Usually, progress can take longer than expected or desired.
Occasional flare ups of symptoms throughout recovery are normal and are to be expected. It usually does not indicate further damage has occurred and typically is short-lived.
What is the role of medication?
Pharmacological interventions are primarily used to improve pain and decrease inflammation in the affected joints. It is important to understand that this is not a cure. It is a means to allow the patient to continue with their exercise program through pain relief and some relief from inflammation.
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