That nagging pain at your shoulder, the feeling that your knee is about to give, the stiffness in your joints, the “crack” sound when you move your joint, are some of the signs of osteoarthritis (OA). This is by far the most common joint condition which occurs when the surfaces within your joint undergo wear and tear, so that the joint does not always move as smoothly as it should. Osteoarthritis (OA) can occur in both the elderly and the young- likelihood of occurrence increasing by certain predisposing factors. It is however more likely to occur in the elderly and middle- aged, 50 and above.
Osteoarthritis (OA) broken down is “osteo” which is bone and “arthritis” is inflammation. Your joint can best be described as the meeting point of two bones- which allows for a certain range of movement. OA can affect any joint in the body but we will look at the joints in your arm; the shoulder, elbows, wrist, and the leg; hip, knees and ankle. These joints are classified as synovial joints; because they contain synovial fluid, which lubricates the joint surfaces. The ends of each bone surface are covered by a fibrous cartilage. The cartilage has two primary purposes: It allows for the smooth movement of a joint due to its smooth surface and it serves as a cushion between the bones during weight bearing such as standing, walking, jogging.
OA is developed when some of the cartilage (cushion) covering the ends of the bones at the joint, roughens over time, and becomes thin. There is some bone on bone friction action which continues the wear and tear process. In response to this change, all the structures within the joint begin to react in a bid to repair the damage: there may be production of extra joint fluid. Stiffness of the joint may also occur when ligament and joint capsules thicken.
Symptoms of OA include pain, stiffness first thing in the morning or after prolonged rest of the joint, swelling, a grating or creaking sound during movement of the affected joint and reduced range of movement at the joint.
Symptoms of OA if not treated on time may be progressive pain at the joint, progressive wear tear of the joint cartilage, more joint damage, progressive weakness of surrounding muscles due to reduced movement and muscle guarding. Over time you may have difficulty in walking, raising the shoulder or even dressing up- depending on which joint is affected.
Factors that put you at risk include ageing and being of the female gender. Genetics also could put you at risk, if it runs in your family. Also, bone deformities such as “bow leg” (varus) or “K leg” (valgus) predispose the knees to OA. These deformities, exert unnatural stress on the joints hence, the risk for OA. These are the factors we have little control over. Active young people may also acquire this joint condition if they have endured previous injury at a joint or perform a certain job that requires them to carry out the same movement several times on a joint. This is most evident in sportsmen and factory workers. Obesity and overweight could also put you at risk for OA, as there is more stress on joints and hence facilitates their wear and tear. This is why women that are overweight may have OA. The repetitive stress from sports or occupation, as well as our weight are factors, we have control over.
How can a physiotherapist can help? A physiotherapist may perform some tests on the joint and request for an X-ray to conclude on the stage of the OA. Based on the stage of joint wear and tear, she would employ various physical therapy interventions which may include manual therapy and exercise therapy, to increase the range of movement of the affected joint and to improve the strength of the surrounding muscles respectively. Transcutaneous Electrical Nerve Stimulation (TENS) and thermotherapy may also be employed to reduce joint stiffness and pain.
Balance and coordination exercises may be taught to activate joint proprioceptors and hence improve joint stability. The Physiotherapist may also recommend certain assistive devices, for example in the case of severely affected joints in the leg, some individuals may benefit from wearing a knee brace, holding a walking cane, use of special footwear or shock absorbing insoles. These would help stabilize affected joints during movements and reduce the stress on the affected joint by evenly distributing the body weight.
What can you do at home? Some simple remedies can be carried out to relieve the pain and swelling on the joint and to improve the range of movement of the joint. General exercises would go a long way to keep the joint active and surrounding muscles strong. Weight should also be kept at healthy levels to reduce stress on the affected joint.
It is important to seek early intervention so that the condition does not worsen. For the final stages of OA, it would be advisable to consult an orthopedic surgeon who may consider surgery as an option.
Final word: Keep moving the joints, stay active. If any particular movement does not help with the pain or stiffness, consult a physiotherapist.
Geetha Opata (Physiotherapist)