Physiotherapy in Winnipeg for Osteoarthritis

 

 

Welcome to River East Physiotherapy's patient resource about Osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis. More than 75 percent of people older than fifty-five show the joint deformations of OA on X-rays. However, most of these people have no symptoms.

For people who do have symptoms of OA, such as joint pain and stiffness, it can become crippling.

Some people suffer from OA in just one joint, while others have it in several joints. OA affects more women than men, and most OA patients are over 45.

This guide will help you understand:

• How OA develops
• How doctors or physiotherapists diagnose the condition
• What can be done to manage your OA

Where does OA develop?

OA is most common in the small joints of the hands, the spine, the knees, the hips, and certain toe joints.

What happens in OA?

OA primarily affects the articular cartilage, the slippery, cushioned surface that covers the ends of the bones in most joints and lets the bones slide without rubbing. Articular cartilage also functions as a shock absorber.

In OA, the articular cartilage changes or decreases in size. As this happens, the joint may no longer move smoothly.

Important: Changes that actually happen in the joint are usually not correlated with the amount of pain you feel.  If we take medical imaging of healthy adults' joints, we commonly find changes to articular cartilage and bones in people who experience zero pain and disability. This means the amount of joint degeneration found on X-Rays (or other imaging) will rarely predict the amount of pain and disability you will feel.  

However, to help you understand how OA can affect your anatomy, there are main parts of the joint that may change:

1. The cartilage.  In the early stages of OA, the cartilage may thicken as your body tries to repair the damage. In all stages of OA, the cartilage may decrease from degeneration, or increase in response to treatment such as exercise.
2. The bones.  We sometimes see bone ends become thicker and smoother as OA progresses. Bone spurs, or outgrowths, often begin to form around the edges of the joint.
3. The joint space. The space in your joint is made up of joint fluid, a synovial membrane and a joint capsule.  The joint capsule is like the watertight sack around the joint, and it may become thickened and lose its stretch.  The synovial membrane lines the inside of the joint capsule, and it can become inflamed (swollen, red, hot, and painful).  The joint fluid is a smooth substance that usually helps the joint glide smoothly, but it may change in chemical composition, and there may be less of it in your joint.
4. The tendons and ligaments.  These structures anchor muscle to bone and bone to bone, respectively. They may become irritated and less strong.
5. The muscles around the joint.  Frequently, the muscles around the joint can lose their strength. This usually occurs in response to pain: when your joint hurts to move, it's normal to avoid using it or moving it. But that means muscles lose strength.  And we find strong muscles actually act as a support for the joint, so losing that support can mean even more pain.  Joint strength is one of the many things the physiotherapists at River East Physiotherapy include in our arthritis treatment plans.  

Why do I have this problem?

The exact cause of osteoarthritis (OA) is not known. There are, however, a set of risk factors that increase the chance someone will develop OA. 

We think of OA in two different categories, primary OA and secondary OA. Primary OA refers to changes to a joint from a disease process. Secondary OA means that something else happened first - an infection in the joint or a fracture, for instance - that caused damage to the joint. Even when the original problem clears up, OA can develop as a secondary condition later in life.

Major injuries and repetitive stress both may increase your risk of OA. For instance, someone who tears their ACL in their knee is at higher risk of developing OA in that same knee, later in life. People who consistently put heavy stress on the same joint, such as jackhammer operators or baseball pitchers, are also more likely to develop OA in that joint.  That said, having an injury does not guarantee OA later in life, especially if you do the work to rehabilitate your injury effectively.

Being overweight is another risk factor for developing OA - particularly OA of the knee and hip.  A study that followed overweight young adults for thirty-six years found that being overweight at a young age was closely related to developing OA later in life. The same study also showed that losing even small amounts of weight decreased the odds of developing OA.

Heredity - your genes - may also play a role for some people. OA in the fingers, which affects ten times more women than men, shows up much more often among women in the same family. Researchers do know that some genes cause problems with cartilage formation, for instance.

In some cases, rare metabolic disorders or other problems with the bones or joints can increase your risk for OA.

The primary risk factor in most patients with OA seems to be age. Older people are much more likely to develop OA.  But that doesn't mean OA is a normal part of aging, and many people live long lives without developing OA.  OA is a disease that can be treated and managed, with help of physiotherapy.

What does OA feel like?

Patients with OA have one or more joints that are painful and stiff. The pain is a deep, dull ache that usually comes on gradually. Pain is usually worse first thing in the morning, and goes down within 30 minutes or so of getting up and moving.  General movement tends to make the joint feel better. As OA progresses, however, without proper management the pain and stiffness can become constant and debilitating.

No matter which joints are affected, OA patients report many of the same symptoms:

• Many patients say that the pain is worse in cool, damp weather.
• Many OA patients feel or hear crackling or popping in the affected joints (called crepitus). This is most common in the knees.
• Joints enlarge or change shape. The enlarged areas are often tender to the touch.
• In most cases the affected joints can't move through a normal range of motion.
• In other cases the joints have become so unstable that they can actually move too much or in the wrong direction.

Some symptoms depend on the affected joint. Patients with knee OA may have problems with the joint locking up, especially when they are stepping up or down. Patients with OA of the hip often limp. OA of the hands can affect the strength and movement of fingers and make simple tasks such as getting dressed or opening a jar very difficult. OA of the spine can cause neck and low back pain as well as weakness and numbness.

How is the condition diagnosed?

It may seem that diagnosing OA would simply involve a few X-rays. However, it is very important that we rule out other forms of arthritis or causes of joint pain. We will also be interested in whether your OA was caused by another problem or injury (secondary OA).  Even if OA is the primary problem, the breakdown of cartilage may have caused problems in other parts of the joint that need to be addressed.

Both physicians and your physiotherapist are able to diagnose OA.  To do so, they will ask you detailed questions about your health and activity history. They'll seek to understand the nature of your pain, such as what makes it worse, what makes it better, how intense it is (e.g. on a scale of 1-10), and how it's affecting your day-to-day life.

Once we've asked you these qusetions, we'll do a physical exam of your joints.  We'll also look at how you're moving.  For instance, we'll look at your posture, assess your muscle balance and strength, and see how well you're able to do the basic movements and physical tasks you need to do in your day-to-day life.  For example, for someone with hip or knee arthritis, we'll likely be interested in how well you can move from sitting to standing, how you walk, whether you can pick something up off the floor easily, and how you can step up on a stair.  For athletes with suspected osteoarthritis, we'll assess the movements you need to do in your sports, such as running, swinging a tennis racket, lunging, or cycling. 

This physical exam will give us information about many things, including:

• Is your pain is stemming from the joints themselves, or from some other area or cause?
• How is your joint pain affecting your life? 
• What physiotherapy treatment will be most likely to get you to your goals for physiotherapy

If you're being diagnosed by your physician, it is likely they will order X-rays.  They may also require blood samples and samples of the synovial fluid in the joint, to try to rule out whether your joint pain is from another condition, or if it is a type of arthritis caused by inflammation (e.g. rheumatoid arthritis, junvenile arthritis) rather than osteoarthritis.  

You should know that X-rays or other medical imaging are not required to diagnose osteoarthritis. Your physiotherapist can diagnose it in clinic, based on the symptoms you're experiencing and the signs they observe during your physical exam.  Here are the factors, symptoms and signs they'll be looking at to diagnose OA:

Age: Are you older than 45 years?  Older than 50 years?

Symptoms: 

• Does your joint pain change with activity / moving the joint?
• Is your pain worse with rest, and/or does it decrease after 30 minutes of movement?
• Does your pain limit your function?

Clinical Signs: Does your physiotherapist observe:

• Crepitus in the joint?
• Restricted range of motion?
• Enlargement of the bones of the joint?
• You report tenderness around the margins of the joint, when the physiotherapist palpates?
• Warmth or no warmth of the joint?

Based on the answers to the factors, symptoms and signs listed above, your physiotherapist is usually able to diagnose osteoarthritis without the need for medical imaging.  

Here's an example of a professional diagnostic tool your physiotherapist may use for diagnosis, based on research evidence.

What can be done to manage and treat osteoarthritis?

While there is no cure for osteoarthritis (OA), the physiotherapists at River East Physiotherapy can help you manage your symptoms, in collaboration with your doctor.

OA is a chronic but very manageable disease. We work with you to set your goals for physiotherapy.  Most patients goals involve reducing their pain, improving how their joints move, and getting back to the day-to-day activities they enjoy most.  

For treating OA at River East Physiotherapy, we offer one-to-one sessions with a physiotherapist and group classes for hip & knee osteoarthritis.  Our group classes are designed to prevent the need for joint replacement surgery, prepare for joint replacement surgery, or rehabilitate effectively from joint replacement surgery.  

Call us to book an appointment with a physiotherapist:

The huge advantage of physiotherapy treatment for osteoarthritis is it is completely drug-free.  Here are some examples of what your physiotherapist at River East Physiotherapy may recommend, to help you reach your goals:

• Customized aerobic exercise.
• Customized strengthening and range of motion exercises. These are most often taught and monitored by physical or occupational therapists.
• Nutrition strategies 
• Use heat or cold treatment to reduce pain and improve movement
• Knee taping or bracing, if it is appropriate for the joint(s) affected by your OA
• Custom orthotics in your shoes if the lower extremity is affected
• Therapeutic massage from one of our Registered Massage Therapists
• Using adaptive equipment to help take pressure off your joints, such as a cane or special gadget to open jars.
• Participate in education programs or support groups, such as our GLA:D Canada Education and Exercise program.

To complement your physiotherapy program, your doctor may also recommend drugs to alleviate your pain. For instance, they may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. The main risk with NSAIDs is they can be very hard on your stomach and kidneys over time. Given the chronic nature of OA, you may be taking these drugs for many years.

In rare cases of extreme pain, your physician may prescribe stronger pain medications.

All these medications can interact with other drugs. You must let your doctor know what other medicines you are taking, and you must work closely with them to set up dose amounts and schedules.

In recent years, two unique compounds have been used by people with OA. These compounds are gaining greater acceptance among many health care providers. Glucosamine and chondroitin sulfate are dietary supplements taken in pill form that have shown benfits of reducing pain and increasing joint mobility. These treatments are controversial, yet some medical professionals feel there are enough benefits to encourage their patients to supplement with these compounds.

As physiotherapists, we cannot recommend any drug-based treatment for OA.  But we do encourage you to ask your doctor about drug-based pain relief, especially if you've completed your full physiotherapy treatment plan, as prescribed by your physiotherapist, and you're still unable to meet your goals.

• Click here to learn more about our Arthritis Relief program at River East Physiotherapy.
• Click here to learn more about our classes for hip & knee joint replacement rehab. 
• Click here to learn about our GLA:D Program for managing symptoms of hip & knee arthritis.

River East Physiotherapy provides physiotherapy in Winnipeg.

When you've completed an extensive physiotherapy treatment plan and your pain from osteoarthritis (OA) continues to interfere with your life, your doctor may recommend surgery. While this option may sound scary, surgery can be very effective in treating advanced OA.

Many types of surgical procedures have been designed to treat OA. Perhaps the most well known treatment is artificial joint replacement, or "arthroplasty".

Artificial joint replacement should be the last resort for treating OA, once you've confirmed your painful joint cannot be treated in any other way.  Your doctor, your surgeon, and your physiotherapist will recommend you try more conservative options before joint replacement surgery. Joint replacement surgery is a major surgery, with all the risks associated with major surgeries.

However, if you have done everything you can to manage your OA, with no success, joint replacement surgery can be a very effective option for getting you back to your active lifestyle.

Want to learn more about preventing joint replacement surgery?  Our physiotherapists at River East Physiotherapy have advanced, post-graduate training in treating OA. Click below to learn more about:

• Our Arthritis Relief Program, including
• The GLA:D Program for managing symptoms of hip & knee osteoarthritis

Or call us to book a one-to-one assessment with a physiotherapist, and get the care you deserve now.

It will take some work, but OA is very manageable. Always keep in mind OA doesn't always worsen over time. In many patients, the pain and symptoms can stabilize with physiotherapy treatment. In some patients, especially those with OA of the knee, the disease can actually reverse itself - such as by generating new cartilage. And even when the OA does continue to progress, it often moves very slowly.