News & Information

OSTEOARTHRITIS

What is Osteoarthritis (OA)

Osteoarthritis (OA) is a joint problem that can lead to pain, decreased movement, and difficulties with daily activities.

There is no one single cause of OA, with genetic, lifestyle and mechanical factors all playing a role in its development. It first shows itself as a change to the biological and cellular processes within the joint, followed by changes to cartilage and bone, resulting in inflammation.

The good news for individuals with OA is there are many things you can do to help with your pain and function. With the right approach there is every chance you will be able to continue participating in the activities that are important to you.

Contributing Factors

There are a range of factors that may make some individuals more susceptible to developing OA.

Non-modifiable factors

Older age
Genetic factors / family history
Gender – women have a 1.5 – 2 x greater risk
Previous joint injury or surgery

Modifiable factors

Excessive loading of a joint due to high occupational or sporting demands
Physical inactivity / sedentary lifestyle
Movement mechanics (modifiable to a point)
Overweight / obese
Reduced muscle strength

It is important to focus on modifiable factors that you have control over. Managing these factors can help you take control of your situation and mitigate the effect OA has on your daily activities.

Diagnosis

Osteoarthritis is diagnosed clinically, taking into consideration:

Risk factors
Pain and symptoms
Clinical examination

Imaging may be used to rule out other causes of your joint pain but is not essential in the diagnosis of OA. OA can be diagnosed from a clinical examination without the need for special tests or x-rays if a person:

Is aged 45yrs or older
Has joint pain with activity / loading
Has no morning stiffness or stiffness lasting less than 30 mins

Individuals with OA may also have:

Crepitus (a creaky, noisy joint)
Decreased range of motion at the joint
Bony enlargement

Treatment

As it currently stands, there is no cure for osteoarthritis. The goal of all OA treatment is to manage symptoms, slow the progression of disease and improve quality of life.

First line treatments are recommended for everyone with osteoarthritis. We will look at these in more detail.

Weight loss if indicated

The mechanism by which weight management helps with osteoarthritis symptoms is twofold:

Lower body weight results in less mechanical stress being placed on joints
Less adipose tissue (fat mass) results in decreased systemic inflammation. Inflammation is an important part of your OA pain.

Education

Education around OA is aimed at dispelling misunderstandings and unhelpful beliefs that may become an obstacle to taking control of your situation and to leading an active, healthy life.

It is important to understand that:

Improvements in pain and function can happen over time

Pain is a modifiable symptom related to sensitised joint structures rather than solely related to damaged structures. Pain is influenced by many things, including stress, sleep, general health, and beliefs.

Pain flare ups are a normal part of OA

Osteoarthritis is not simply ‘wear and tear’. Excessive loading of a joint can result in OA, but so can lack of exercise and a sedentary lifestyle.

Joint replacement surgery is not inevitable.

Appropriately dosed physical activity and exercise helps with pain, function, and overall health.

Exercise

There is a distinction between physical activity and exercise. Physical activity is a broad term that includes any activity that increases your heart rate. All adults should aim for a minimum of 150 mins of physical activity a week. Accumulating minutes in smaller bouts during the day is fine.

Individuals with OA often participate in lower levels of physical activity due to pain and/or an incorrect belief that they will make their condition worse.

Exercise is a subset of physical activity. Therapeutic exercise for OA is targeted to the individual and is aimed at addressing:

Pain
Function
Muscle strength
Range of motion
Joint stability
Confidence
Appropriate joint loading

The cartilage in our joints receives its nutrition through the joint being moved and loaded. A lack of movement results in a lack of this nutrition being delivered. Underloading can contribute to OA. In fact, data shows that recreational runners have a lower incidence of knee osteoarthritis than sedentary individuals.

motion is lotion

Pain during exercise is not associated with increased joint damage or worsening of your osteoarthritis. Mild to moderate pain is acceptable. We want to see pain levels return to your baseline (your pre-exercise levels) within 24 hours of activity.

Recommended exercise frequency:

2 x week is considered a minimum effective dose
3-4 x week is associated with better outcomes.

Before choosing the appropriate exercises, we conduct a thorough consultation, discussing relevant medical and injury/pain history, and your goals. We will then perform some physical assessments that look at your:

Joint range of motion
Sit to stand quality
Step up quality
Walking / gait
Strength testing
Provoking movements / activities

Once we have a picture of your pain symptoms, your physical capacity, and your goals, we will recommend some exercises.

Some examples include:

Exercise is safe and effective for individuals at all stages of OA. Furthermore, for those where surgery becomes necessary, supervised exercise prior to surgery is associated with a faster postoperative recovery.

Staying active is a key component of taking control of your osteoarthritis symptoms and function.

The Vitruvian Team.

The Involvement of Neutrophils in the Pathophysiology and Treatment of Osteoarthritis
Chaney et al. Biomedicines. 2022

Pathogenesis and management of pain in osteoarthritis
Dieppe et al. The Lancet. 2005

PEAK program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis)
Melbourne School of Health Sciences

Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults with Knee Osteoarthritis: The START Randomised Clinical Trial
Messier et al. Journal of the American Medical Association. 2021

Gait, physical activity and tibiofemoral cartilage damage: a longitudinal machine learning analysis in the Multicenter Osteoarthritis Study
Costello et al. British Journal of Sports Medicine. 2023

NICE guidelines: Osteoarthritis

The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis
Alentorn-Geli et al. Journal of Orthopaedic & Sports Physical Therapy. 2017

painHealth

Immediate outcomes following the GLA:D program in Denmark, Canada and Australia. A longitudinal analysis including 28,370 patients with symptomatic knee or hip osteoarthritis

Roos et al. Osteoarthritis and Cartilage. 2021

Good Life with osteoArthritis in Denmark (GLA:D): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide

Skou et al. BMC Musculoskeletal Disorders. 2017

Implementation of the Good Life with osteoArthritis in Denmark (GLA:D) program via telehealth in Australia: A mixed-methods program evaluation

Ezzat et al. Journal of Telemedicine and Telecare. 2023

Role of Inactivity in Chronic Diseases: Evolutionary Insight and Pathophysiological Mechanisms Booth et al. American Physiological Society. 2017

VITRUVIAN EXERCISE PHYSIOLOGY