Arthritis (Osteoarthritis) and Physiotherapy
Arthritis (Osteoarthritis) and Physiotherapy
Osteoarthritis is basically wear and tear or age related degeneration of the cartilage that lines the bony surfaces of a joint and potentially the bone itself, such as the hip/knee/spine/shoulder/thumb and other finger joints. Any joint can get arthritis, but these are the most common joints to be affected by arthritis.
Some people get earlier and more severe arthritic changes in one or more joints. This may be secondary to a previous injury or joint fracture, or due to unbalanced/uneven alignment of the joint surfaces such as with knock knees, bowed legs at the knees, hip dysplasia/leg perthes disease/clicking hip from birth, scoliosis of the spine etc. Arthritic/degenerative/normal wear and tear changes to our joints does not necessarily mean someone will be in pain. Many people have arthritis and do not experience pain or deterioration in their function. It more depends on the severity of the degeneration and many other factors. Some people have very minor degeneration but may experience significant pain. Others have similar or worse degenerative changes and do not experience pain. A very important rule or recommendation all therapists/doctors need to keep in mind is- TREAT THE INDIVIDUAL, NOT THE MRI/X-RAY. Of course, MRI/X-ray/other imaging results can be very informative and helpful in guiding assessment and treatment, especially in ruling out more serious pathology where there is any suspicion of this based on symptoms/previous history.
Joint cartilage when worn down will lead to increased stress on the bone surface underneath and if the wear is uneven it can lead to increased stress on parts of the joint surfaces that are experiencing more compression and weight bearing or load than the surfaces that are less compressed and loaded. This is similar with an engine or machine that is out of alignment, you will get more wear and tear on the surfaces that are experiencing more compression under load. That is why realignment/tune-ups/services of engines/machines prolong the life/good functioning of the engine/machine. Similarly, appropriate and effective PHYSIOTHERAPY can really facilitate the optimum functioning of your joints, thus helping to reduce pain and wear and tear/degeneration of the joints of the leg/arm/spine/pelvis and improve function and quality of life.
SO HOW CAN APPROPRIATE/EFFECTIVE PHYSIOTHERAPY HELP WITH ARTHRITIS?
- Improving/optimising JOINT ALIGNMENT
- Improving/optimising muscle/joint/ligament/tendon PLIABILITY/FLEXIBILITY (basically all the soft tissue/connective tissues of the local symptomatic joint system and any and all of the joint/muscle/ligament/tendon/neurovascular/viscera or organ structures that may impact on the symptomatic joint.
- Improving/optimising STRENGTH of the local/primary muscles working on the involved joint and muscle strength of all muscles that can impact on the effective/efficient function of the involved joint. So if a person has degenerative changes of the tendons/muscles of the rotator cuff that control shoulder joint movement it is important to strengthen/enhance loading ability of these rotator cuff muscles and tendons to attain pain free function of the shoulder, but strength of the leg muscles is a very important factor in shoulder function, as is strength of the core muscles of the core/abdomen/spine. Likewise, for the knee, strength of the prime movers of the knee is very important, but strength of the hip muscles is crucial to the function of the knee. The stronger all of the associated muscles are, the less stress is placed on the involved joint.
- Also, for the knee joint, for example, the alignment of the ankle and foot joints can be very important. So for example, if the foot is flat or pronated, this may have an affect on the knee joint, potentially causing compression and more stress on the outside or lateral compartment of the knee joint, possibly being a contributing factor to wear and tear of the outside/lateral compartment of the knee joint. If the foot is supinated, or the opposite to flat foot, this can cause increased stress on the inside or medial compartment of the knee joint. Addressing alignment of the ankle and foot joints and associated muscle/ligament/tendon flexibility/function can have a positive effect on the alignment/function of the knee joint. Orthotics/insoles potentially may a have role in and be of benefit in optimising the foot/ankle alignment, thus impacting the alignment/function of the knee joint. This can also affect the hip joint and the spine. Physiotherapists if trained in this biomechanical assessment of the foot/ankle complex can assess if insoles will be of benefit in the management of the knee joint issues/pain/function, and if appropriate can prescribe what is needed in an orthotic/insole to address the biomechanical issues present.
- Cardiovascular fitness and more optimum body weight may also be factors that are pertinent with some people to help optimise joint function. Psychosocial (stress factors) and lifestyle factors (sleep, diet, exercise, work/life balance) may be of relevance to greater or lesser degrees. Effective physiotherapy should help address these factors and refer onto appropriate health professionals as needed.
- A combined approach is called for to address all contributing factors to a person’s symptoms and function.