Osteoarthritis (OA)

Arthritis involves changes to the whole joint, including the cartilage (the smooth layer covering the end of a bone), the underlying bone, the ligaments and tendons, as well as the surrounding muscles. As OA progresses, the changes to the joint can cause pain and loss of movement. Swelling and changes to the bones on each side of the joint may alter the appearance of the joint.

Some people feel generally fatigued or unwell because of their arthritis, but it affects each person differently. Symptoms will vary depending on what type of arthritis a person has and its severity.

In the early stages most people notice joint stiffness or a mild ache, particularly in the morning. As the condition worsens, pain tends to increase and there will be associated swelling, redness, warmth. In the later stages joints can appear enlarged and slightly different in shape such as the bony bumps in the fingers referred to as Heberden’s Nodes. X-rays may be helpful to check the joint space in the affected joint as this can indicate the amount of cartilage loss and help gauge the severity of the disease.

Your physio will help you manage the symptoms of OA, including ergonomic advice, strategies for everyday activities and strengthening exercises to improve pain and function. Sometimes splints or brace supports can be useful to restrict movement and provide support and positioning, while heat and massage can help reduce pain and soothe sore joints and tight muscles.

Strengthening exercises are added when pain is more settled but they often need to be gradually progressed to avoid aggravation. An important part of managing OA involves changing the way activities are performed in order to reduce stress on joints, especially if they are already sore.

Osteoarthritis of the hip joint occurs when the smooth cartilage that covers the ends of the bones becomes brittle and breaks down. This can in turn cause joint inflammation and the formation of bony spurs (bony outgrowths) as the body tries to repair the damage.

OA of the hip is not simply a matter of “wear and tear” as has previously been thought, and although the exact cause is unclear, some risk factors have been identified, including:

• being overweight or obese
• having a family history of OA
• increasing age, with increased risk in those over the age of 45
• past history of hip injury or trauma

Symptoms tend to vary significantly between individuals but common symptoms include:

• pain in the groin, buttock or a point deep between the groin and buttock
• stiffness in the hip joint
• grinding, rubbing or crunching sensation with hip movement

It is important to consult your physio or GP if you experience any of these symptoms.

Physiotherapists can help manage hip OA with hands-on treatment, advice and education on how to manage the condition in a way that best suits you and your lifestyle. Your physio is the best person to advise you on activities to avoid and whether to continue participating in sports.

Your physio will first need to identify which of your muscles are weak and address this weakness by teaching you strengthening exercises that support and protect the hip joint. You may be given exercises to continue on your own at home or you could be referred to a group exercise class or hydrotherapy. You may also be treated with hands-on therapy such as joint mobilisation and massage as these may be of help in reducing your pain. If necessary, your physio may decide to assess your balance and walking pattern to improve the way you walk.

It is important to be aware that there is no cure for hip OA but research shows the condition can be well managed with exercise, weight loss and medications, with no need for surgery in many cases. However, if more conservative management proves to no longer be of help and your ability to perform activities of daily living is significantly limited, then you may be a candidate for a total hip replacement.

The articular cartilage of the knee is kept healthy by movement and load. OA develops when the articular cartilage is either exposed to higher loads than it can withstand, often over a long period of time, or when the cartilage itself isn’t able to withstand relatively normal loads.

Knee OA is one of the most common chronic musculoskeletal conditions seen by physios and affects a large percentage of the Australian population. It is a degenerative condition where:

• the articular cartilage of the knee thins and wears
• bony spurs can form in the joint
• cysts may form in the subchondral bone (bone that sits under the cartilage)
• degenerative tears can form in the menisci (the washer-type cartilages in the knee joint)
• the synovium (layer of tissue that surrounds the inside of the knee joint) can also become inflamed, increasing the production of joint fluid which in turn causes swelling

These changes contribute to pain and other symptoms experienced by those with knee OA. There are a variety of predisposing factors including:

• age – incidence is significantly greater with each decade above the age of 45, although it can affect younger people
• weight – loads on the articular cartilage of the knee are relative to body weight so being overweight not only predisposes the knee to OA it also increases the likelihood of the condition progressing because the knee is a load-bearing joint
• gender – before the age of 50 men have slightly higher rates of knee OA, but after the age of 50, the rates are higher in women
• past history of trauma or surgery to the knee, such as ligament reconstruction – which may lead to knee OA at an earlier age
• family history of knee OA – some people inherit a form of articular cartilage that is less robust than average and less able to withstand load over time
• heavy physical occupations – can place significant load on the knees over many years
• natural leg posture – “bow legs” for example result in more load being placed on the medial (inner) compartment of the knee compared to the outer (lateral) aspect, wearing down the cartilage in the medial compartment of the knee joint over time
• biomechanics – people with long-term patella (kneecap) maltracking will sustain repeated rubbing of the patella against its groove at the end of the end of the femur, causing early wear of the articular surfaces
• muscle weakness – especially in the quadriceps muscles at the front of the thigh, can contribute to increased loads being placed on the joint surfaces of the knee

Knee OA can have a variety of symptoms, related to the area of the knee joint affected by OA, the severity of the OA, the amount of strength and control around the knee, and whether there are any other conditions present within the knee such as a meniscal (cartilage) tear. However, you will likely experience some or all of the following:

• stiffness in the morning or after prolonged sitting
• pain with prolonged periods of walking or standing
• difficulty with activities such as stair climbing and stair descending
• joint swelling
• clicking, clunking, crunching or catching sensations within the joint
• reduced joint flexibility with bending and/or straightening
• altered joint shape and size
• altered leg posture such as “knock knees” or “bow legs”
• feeling of instability or giving way in the knee
• weakness in the leg muscles, particularly the quadriceps at the front of the thigh

Symptoms of OA knee commonly fluctuate, depending on activity. Initially symptoms may only be experienced during activity but as the condition progresses pain may be experienced at rest and at night.

While X-rays and MRIs can play a role in diagnosing knee OA it is important to note that knee symptoms may not always match the features seen on the images. Some people have considerable symptoms without much change shown on their X-rays, while others with quite advanced radiological changes may not be troubled much by pain at all.

Your physio can help in many ways with some management options being common to all people with knee OA and others specific to the individual, including:

• education and advice – evidence suggests than an understanding of the condition helps with pain control, coping and ongoing symptom management, helping people become active participants in management of their knee symptoms and employing strategies to help them remain active (this may include weight control)
• prescribing an exercise program – tailoring a program to help strengthen the muscles around the knee and improve how a person controls their knee position (leg weakness results in further limitation to a person being able to continue with daily activities and is linked to progression of knee OA)
• knee bracing – this may be discussed if considered to be of help to your symptoms
• manual therapy – techniques such as massage may form part of your treatment program if you have restricted movement in your knee, hip or ankle that is placing increased stress on your knee joint
• heat or cold – hot or cold packs may offer symptom relief
• rehabilitation – if your OA has progressed to the point of requiring knee replacement surgery, a physio-led rehabilitation progam will be recommended