Arthritis: A PT's Perspective

Arthritis. We hear the term a lot, but what exactly is it? Who does it effect? Are there ways to manage it without relying on medication or surgery? 


Arthritis is a blanket term that refers to more than 100 joint conditions or diseased affecting more than 100 million adults in the U.S. It is important to know that there are many forms of arthritis, but osteoarthritis is by far the most common, affecting 27 million Americans according to the Arthritis Foundation. One in two people will have knee osteoarthritis in their lifetime and one in twelve people over 60 have hand osteoarthritis.


Osteoarthritis (OA) is the type that most commonly effects us as we age or as a result of joint injury. It can best be described as the wearing down of the cartilage cushion that resides between joint surfaces. This can eventually lead to a roughening of the joint surfaces that is most commonly described as "wear and tear" and can even cause pain, sometimes severe in some cases. OA can affect many joints in the body including the hands, wrist, shoulder, knees, hips, spine, feet, etc. The most common symptoms, aside from pain in the affected joint, include stiffness and a loss of joint range of motion, a decrease in strength in the muscles surrounding the joint, and joint swelling. Initially the pain occurs only with activity but can progress to constant pain. If pain from OA progresses to the point that it is constant and severe, total joint replacement can be indicated for the knee, hip, and even shoulder.

OA often occurs as the result of many different factors. Increasing age, being overweight, female gender, knee injury, decreased bone density, decreased joint flexibility, repetitive use of joints, muscle weakness, all can contribute to the occurrence of OA. 

So, as this information begins to sound very depressing, know that there is in fact hope! Let us consider a few points and a few articles that may offer some hope regarding this issue. 


Tip #1: MANAGE YOUR WEIGHT 
You can’t change your age or sex, but you can control your weight! Weight management can significant reduce the impact of knee, hip, and low back OA. Movement and exercise, often required for weight reduction, is also beneficial as we will see below. It is well established that each pound of excess weight will place 4x that excess weight through one’s knee joint (30 lbs overweight will place and extra 120 lbs through the knee! (9)).  Weight reduction is key in minimizing joint stresses. 


Tip #2: GET ACTIVE
Moderate exercise can be beneficial in the case of knee OA as it has a positive effect on knee cartilage, whereas no exercise or overly vigorous exercise can be harmful. According to the NIH, “Persons with OA capable of exercise have been recommended to be encouraged to partake in a low-impact aerobic exercise program (walking, biking, swimming or other aquatic exercise)”. Additionally, exercises that strengthen quadriceps muscles (the muscles in the front of the thigh) have been indicated in reducing OA symptoms (2). 


Tip #3: SEE THE RIGHT CLINICIAN: 
If you want to accelerate or increase your improvement, see someone who can prescribe beneficial exercises, counsel you in weight management (if needed), and specializes in hands-on treatment. 
Take a look at this study. It is one among many that point out the fact that a combination of exercise and hands-on manual therapy techniques (utilized at Somerset Spine & Performance Physiotherapy) were able to significantly alleviate knee pain related to OA in the majority of subjects, even at 1 year out. In this particular study, the exercise-only group had a noticeable reduction in pain, but the exercise and hands-on therapy group had twice the benefit at 1 month follow up (5,7).  


There is also a plethora of research to indicate that dry needling (also used at Spine & Performance) can be significantly effective in managing symptoms of OA in the knee and elsewhere by alleviating pain and increasing muscle flexibility around the joint (6).  


What if your X-ray is bad? A lot of folks come to me thinking that they're situation is hopeless because they show degenerative changes on imaging. To that I simply say that there is an abundance of research that tells us that one can have OA on an X-ray, but have NO PAIN (1,2,3). In one study, 50% people who had X-ray confirmed OA of their knee DIDN’T HAVE PAIN. So we glean from this that one can be pain-free with the right treatment, even in the presence of “bone on bone”, and I see this clinically on a daily basis.


So, if you have a suspicion that you may have OA, or you have been diagnosed with OA, consider undergoing a thorough mechanical evaluation and treatment at Somerset Spine & Performance Physiotherapy to address your strength and flexibility deficits and to improve your overall function! Take ownership of your pain and be given the tools to succeed in reducing and even eliminating your OA pain and Start Living Life at Its Fullest Potential!


This information on this blog site is not intended to diagnose or cure any ailment or issue. If you have questions or concerns, please contact your healthcare provider. 

1. Bedson J, Croft PR.  The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature.  BMC Musculoskeletal Disorders. 2008 Sep 2;9:116.
2. Muraki, S  et al.  Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study.  BMC Musculoskeletal Disorders. 2015 16:305
3. MK Javaid, et al. Individual MRI and radiographic features of knee OA in subjects with unilateral knee pain: Health ABC study.  Arthritis Rheum. 2012 Oct; 64(10): 3246–3255.
4. Heidari, B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I.  Caspian Journal of  Intern Medicine. 2011 Spring; 2(2): 205–212.
5. Deyle, G et al. Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program.  Physical Therapy. 2005 Dec;  85:12
6. Dunning, J et al. Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews. 2014 Aug; 19(4): 252–265.
7. Fitzgerald, G et al. Exercise, manual therapy, and use of booster sessions in physical therapy for knee osteoarthritis: a multi-center, factorial randomized clinical trial. Osteoarthritis and Cartilage. August 2016 Volume 24, Issue 8, Pages 1340–1349
8. Aiken, A. Changes in knee pain, perceived need for surgery, physical function and quality of life after dietary weight loss in obese women diagnosed with knee osteoarthritis. Osteoarthritis and Cartilage. 2016 
9. Messier, SP et al. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005 Jul; 52(7):2026-32.

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