Osteoarthritis: All your burning questions answered by a physiotherapist (Part 1)

5 October 2021

In celebration of World Arthritis Day, we’d like to play our part in raising awareness for Osteoarthritis – the most common form of arthritis around the world. In this article, we answer the most common questions regarding osteoarthritis, including how physiotherapists can help with managing osteoarthritis.

What is Osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis in the world, affecting 10% of adults & 20% of elderly in Singapore. Common symptoms are joint pain and stiffness, which may affect your mobility and ability to perform daily activities.

What causes Osteoarthritis?

Articular cartilage is the smooth, rubbery, white tissue that covers the ends of bones where they meet to form joints. Healthy cartilage in our joints allows the bones to glide over each other with very little friction. 

In osteoarthritis, inflammation of the cartilage causes joint pain and swelling, which limits movement and activities. OA can occur in any joint, but the most commonly affected joints are in the hands, knees, hips and spine. The joint cartilage can become thinner in certain areas within the affected joint. Hence cartilage health is crucial in OA. What many people do not know is that cartilage needs exercise to grow! A great illustration of this is how astronauts lose muscle, cartilage, and bone mass when they are out in space. In zero gravity, there is no resistance or weight to their joints. In comparison, a study showed that runners had a decreased risk of osteoarthritis compared to walkers.

osteoarthritis

There is also increasing new evidence that OA involves body-wide low-level inflammation and is not just a “wear and tear” condition. Inflammation makes the danger detectors (nociceptors) in the body and nerve cells in the spinal cord, your pain system, more sensitive. This means that the movement or activity that you could do without pain when your body is not in an inflammatory state, becomes painful when your body is in an inflammatory state. So yes, you are feeling pain, but you feel the pain is “more” due to your pain system being sensitised. “Overuse” of the joints used to be the commonly blamed culprit for OA, but now we know that chronic conditions such as obesity, fatty liver disease, diabetes, cause long term low-level inflammation in the body, and increases the risk of OA (inflammation of the joint cartilage).

Am I at risk of Osteoarthritis?

These are the risk factors for developing OA, with new updates in bold:

  • Older age
  • Gender: Women have a higher chance of developing OA compared to men
  • Chronic conditions which cause long term low level inflammation in the body. Eg, obesity, fatty liver disease, diabetes.
  • Muscle weakness: A sedentary lifestyle results in less muscle mass. Muscle strength is important as muscles help to protect and cushion the joints during movements and impact activities.
  • Previous joint injury
  • Genetic predisposition: Certain people inherit a tendency to develop OA, such as having defective cartilage; or being born with abnormal joint/s alignment

How do I know if I have Osteoarthritis?

The most common symptoms include:

  • Joint pain with or without swelling
  • Joint stiffness
  • Increased pain and related symptoms with increased activities
  • Rest improves symptoms

The symptoms of OA vary greatly from person to person, from mild to severe. You could also have periods where you are symptom free with periods of flare ups occasionally. 

If you have joint pain or stiffness that is not going away, it would be advisable to see a medical doctor or healthcare professional such as a physiotherapist. A thorough review of your symptoms and a physical examination will be done. Your doctor may also order further tests such as X-rays and blood tests.

What can a medical or healthcare professional do for me?

Conservative treatment that do not involve taking medications include:

  • Physical activity moderation
    Learning how to space out or pace activities which worsen your pain. This means you do NOT need to stop or avoid activity altogether.  
  • Muscle strengthening exercises
    Many studies have shown that exercise programs which combine both aerobic and resistance training help to decrease pain and improve physical function. Your physiotherapist can advise you on specific strengthening exercises for your affected joint/s, and also prescribe a tailored exercise program for you.
  • Fat loss
    Fat loss is very critical if you are overweight. It reduces the stress on your joints – every half kilogram of weight loss can decrease the load on your knee by 3 to 6 times. A healthy weight also reduces the amount of inflammation in your body, which will reduce pain.

Conservative treatment that involve taking medications include:

  • Oral medication such as painkillers and anti-inflammatory non-steroidal drugs (NSAID) 
  • Pain relieving creams
  • Joint injections to relieve severe pain

If you have very severe symptoms, or if you do not respond to conservative treatment, your doctor may suggest surgery. Joint replacement surgery would be the next option, particularly if you have knee or hip OA, and did not have good progress with conservative treatment options.

Seek physiotherapy treatment

As osteoarthritis is a degenerative condition – it is recommended to seek medical help sooner rather than later. Once your cartilage wears out, it is impossible to “grow back” or heal. Preventative measures can be taken to ensure the cartilage does not continue to wear out.

If you think you might be experiencing osteoarthritis or pain, contact us to speak with our team of physiotherapists. In the next article, we will be addressing other questions such as whether it is ok to exercise and sharing self care tips for osteoarthritis.