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Osteoarthritis getting in the way?


What is osteoarthritis


Osteoarthritis (OA) is a normal part of aging. It is a process whereby inside of surfaces of a joint wear away and the cartilage deteriorates. Bony formations can also occur which change the shape of the joint itself. This wearing away of the joint surface can cause symptoms such as pain, swelling and loss of range of motion at the joint. However, these symptoms are not present in all people who have OA.


1 in 13 Australians report having osteoarthritis, with 2/3 of these people being female. The prevalence of osteoarthritis steadily increases with age. Some people will get to a point in their life where a knee or hip replacement is brought up by their health care provider after a period of joint pain that is affecting day-to-day life.



Sore knees stopping you from participating in the things that make you happy?

Are you unsure about whether to get a hip replacement? Have you tried physiotherapy?

In this blog post we address some facts about osteoarthritis and the role physiotherapy can play in helping you manage your knee or hip pain.



How do I know if I have OA?


A physiotherapist can diagnose your OA using clinical criteria developed by The National Institute for Health and Care Excellence (The NICE guidelines). The Royal Australian College of General Practitioners endorses the use of clinical criteria without the need for imaging.


A physiotherapist may request imaging if the presentation of a person’s OA is not typical, such as:

· A history of trauma

· Rapid worsening of symptoms

· A hot or swollen joint

· Or suspicion of a more serious pathology


What are the risk factors for OA?


What are the risk factors for OA?

A traumatic joint injury is one of the strongest risk factors for developing OA. 50% of people will develop OA within a decade after injuring a joint. Obesity also contributes to the development of OA due to the increased mechanical stress applied to joints in the body and through obesity related metabolic factors which can cause pro-inflammatory processes in cartilage and bone. Jobs that require high levels of physical labour (e.g. Brick layer or builder), particularly those that require kneeling or lifting also increase the risk of OA.



Why not replace the joint sooner?

Everyone experiences OA pain differently.


Pain is not simply an ‘alarm’ arising from a damaged part of the body. Pain is a complex emotional response to physical stimulus that is associated with memories, beliefs and social or environmental context. Pain experienced from OA is no different.




People may experience OA pain before any structural changes appear on imaging and in contrast those with advanced OA may experience little to no pain at all.

Physiotherapists understand the complex nature of pain and will focus less on the imaging of a joint and focus more on the individual and what factors may be influencing your pain such

as general physical and psychological health, social and environmental factors and a person’s beliefs about pain.


Why not replace the joint sooner?


It is a common belief that the only way to ‘cure’ OA is through surgery. Many people do get relief from a joint replacement, however, nearly 20% of people who have a knee replacement are not happy with the outcome and 30% of people still suffer from pain, stiffness and difficulty with activity day to day. 93% of people who have a hip replacement are satisfied with the outcome however the remaining people report having a worse quality 12 months after surgery, worse than compared to pre-surgery.


How can Physiotherapy help you with OA?


All guidelines for OA recommend that exercise be the first intervention prescribed. It is a common misconception that exercise can make OA worse. Findings from two recent studies that included 1700 participants concluded that exercise does not trigger increased inflammation or damage the surfaces of joints in people with OA.


Exercise strengthens the muscles around a joint leading to improve stability and mobility and is essential for joint health as it can stimulate cartilage regeneration. Therefore, a physiotherapist will not recommend rest but encourage you to engage in a guided physical activity program that is also very beneficial for your general health.


Physical activity can also help prevent over 30 chronic diseases, many of these are also common in people with OA, especially obesity which as discussed plays a large role in the development of OA.


Surgery should be discussed after attempting a thorough high-value care plan with your physiotherapist that includes exercise therapy, education and if required a weight management plan.

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