Osteoarthritis signs and treatment with physiotherapy

 What is osteoarthritis?

It is a degenerative joint disease that gradually destroys the cartilage in your joints. This may cause the affected joint to become painful, stiff, and swollen, causing a loss of joint movement.

Both men and women are affected, but after the age of 45, it is more common in women.

• What is osteoarthritis?
• What are the types of osteoarthritis? 
• Cause of Osteoarthritis
• Signs of osteoarthritis
• Diagnosis of osteoarthritis
• Physiotherapy treatment of osteoarthritis

What are the types of osteoarthritis? 

The most common types include:

Knee Osteoarthritis:

• Knee osteoarthritis is one of the most prevalent forms. It often develops in weight-bearing joints and can be associated with aging, joint injuries, and obesity. Symptoms include pain, stiffness, and reduced range of motion in the knee joints.

Hip Osteoarthritis:

• Hip osteoarthritis involves the degeneration of cartilage in the hip joint. It can cause pain, stiffness, and reduced mobility in the hip area. 

Hand Osteoarthritis:

• Hand osteoarthritis affects the joints of the fingers and thumb. It can lead to the formation of nodes or bony enlargements at the joint margins. Hand osteoarthritis can be more common in women and may be associated with both genetic and environmental factors.

Spinal Osteoarthritis:

• Spinal osteoarthritis, also known as spondylosis, involves the degeneration of the cartilage and bone in the spine. It can affect the facet joints (located in the back of the spine) and may lead to the formation of bone spurs. Symptoms may include back pain, stiffness, and, in severe cases, compression of nerves.

Foot and ankle osteoarthritis:

• Osteoarthritis can also affect the joints in the feet and ankles. This can lead to pain, stiffness, and difficulty walking. It may be associated with factors such as joint injuries, abnormal foot mechanics, and genetic predisposition.

Cause of Osteoarthritis

1. Primary:

• This is the most common type, accounting for about 85% of all OA cases.
• The exact cause remains unknown, but it's generally attributed to the natural wear and tear on joints throughout life, particularly age-related degeneration of cartilage.
• Primary OA typically affects weight-bearing joints like knees, hips, spine, and feet, but can also involve fingers, hands, and shoulders.
• Risk factors for primary OA include age, family history, obesity, repetitive joint use, previous injuries, and hormonal changes.

2. Secondary:

• This type arises from a specific, identifiable cause that damages the joint and leads to cartilage breakdown.
• Common causes of secondary OA include:
• Joint injuries: Trauma, fractures, ligament tears, or meniscus tears can damage the joint structures and increase the risk of OA later in life.
• Congenital joint abnormalities: Malformations or misalignments in the joint structure from birth can lead to an uneven distribution of forces within the joint, eventually causing cartilage breakdown.
• Metabolic disorders: Conditions like gout, diabetes, and hemochromatosis can cause inflammation and damage to joints, contributing to OA.
• Infections: Bacterial or viral infections in the joint can damage cartilage and surrounding tissues, leading to OA.
• Other inflammatory conditions: Certain inflammatory diseases, like rheumatoid arthritis or psoriatic arthritis, can damage joint structures and increase the risk of OA development.

Signs of osteoarthritis

1. Joint Pain: Pain is a hallmark symptom of osteoarthritis. It is often described as a deep, aching pain in the affected joint. The pain may worsen with joint movement and improve with rest.
2. Stiffness: Joint stiffness, especially after periods of inactivity or upon waking in the morning, is common in osteoarthritis. Stiffness may gradually improve with movement as the day progresses.
3. Reduced Range of Motion: Osteoarthritis can lead to a decreased range of motion in the affected joint. This limitation may make it difficult to fully bend, straighten, or move the joint through its normal range.
4. Joint Swelling: In some cases, osteoarthritis can cause swelling in the affected joint. Swelling is typically a result of inflammation in the joint.
5. Joint Tenderness: The affected joint may be tender to the touch. This tenderness is often localized to specific areas within the joint.
6. Joint Instability: As osteoarthritis progresses, the affected joint may become less stable, and individuals may experience a feeling of joint instability or weakness.
7. Crepitus: Crepitus refers to a crackling or grating sensation that may be felt or heard when moving the affected joint. This can be due to the roughening of the joint surfaces.
8. Bony Enlargements: Over time, the formation of bone spurs or osteophytes at the edges of the joint may lead to visible bony enlargements. These can sometimes be felt under the skin.
9. Pain with Weight-Bearing Activities: Osteoarthritis in weight-bearing joints, such as the knees and hips, often causes pain during activities like walking, standing, or climbing stairs.
10. Limited Functionality: As osteoarthritis progresses, it can impact an individual's ability to perform daily activities, such as walking, climbing stairs, or grasping objects.

Diagnosis of osteoarthritis

The diagnosis of osteoarthritis (OA) typically involves a combination of medical history, physical examination, and imaging studies. Here's an overview of the diagnostic process:

Medical History:

• Your doctor will discuss your symptoms, their duration and severity, and any specific activities that worsen or improve them.
• A family history of arthritis or joint problems can also be relevant.

Physical Examination:

• The doctor will carefully examine the affected joint(s), assessing for tenderness, swelling, range of motion, and crepitus (grating sensation).
• Specific maneuvers may be performed to test for joint instability or pain provocation.

Imaging Tests:

• X-rays: These are the most common initial imaging tests, showing narrowing of the joint space, bone spurs, and changes in bone density, indicating osteoarthritis.
• MRI (Magnetic Resonance Imaging): This provides a more detailed visualization of soft tissues like cartilage and ligaments, helpful in early stages or suspected additional injuries.
• CT (Computed Tomography) scans are less commonly used but may help visualize specific bone structures and plan surgery.

Physiotherapy treatment of osteoarthritis

Physiotherapy plays a crucial role in the management of osteoarthritis (OA). A physiotherapist can work with individuals to improve joint function, reduce pain, and enhance overall mobility. 

Goals of physiotherapy:

1. Pain Reduction
2. Exercise
3. Weight control
4. Rest and joint care

Treatment Approaches:

1. Pain Reduction:

• Ice therapy for acute pain and swelling

• Ultrasound for chronic pain and swelling

• Wax therapy is useful for hand pain.

2. Exercise Therapy:

• Stretching exercise, also called range of motion exercise (ROM),

• Isometric exercise: This is an exercise in which muscles are tensed for some time without actually moving them. It can be performed without actually bending a painful joint. As muscles are exercised against resistance, their size and power will increase.

• Aerobic exercise: for example, swimming (especially in a heated pool), walking

3. Weight control: A healthy diet and daily exercise help to reduce weight.
4. Manual therapy: soft tissue massage can improve joint mobility, reduce pain, and enhance circulation.
5. Electrotherapy uses mild electrical currents to reduce pain and increase blood circulation. For example, IRR, heat pad, OR hot pack,
6. Assistive Devices: Splints, braces, canes, or walkers can provide extra support and reduce stress on the affected joint, improving mobility and safety.

It's important to remember that a physiotherapy program for osteoarthritis is individualized, considering the patient's age, fitness level, severity of symptoms, and specific joint involvement. Consulting a qualified physiotherapist for a personalized treatment plan is crucial for maximizing the benefits and managing osteoarthritis effectively.