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Episode 9 - Osteoarthritis

Tom Gross is a physiotherapist. Beginning his career as a locum clinician for aged care and is now currently working in community and in-patient rehabilitation. He has a keen interest in orthopaedic physiotherapy and works closely with patients suffering from osteoarthritis from all ages, including those having undergone joint replacement surgery.

I’ve been told I have osteoarthritis or I know someone that has it. But what does this mean, and how do I get it?

Osteoarthritis is an inflammatory joint condition characterised by an imbalance between cartilage degeneration and cartilage regeneration. It can affect any joint in your body but is most seen in our hands, knees, and hips.

Osteoarthritis is not “wear and tear”, nor is it a normal part of ageing. The development of osteoarthritis is dependent on several risk factors, some we can change and others we cannot.

How common is it?

In 2017-18, almost 1 in 11 Australians have osteoarthritis. This prevalence increases to 1 in 5 over the age of 45, then 1 in 3 over 75.

What causes osteoarthritis?

There is no direct cause of osteoarthritis. The development of osteoarthritis is dependent on modifiable and non-modifiable risk factors.

Examples of non-modifiable risk factors are our age (the older we are, the higher the risk of developing osteoarthritis), gender, and genetics/family history.

Examples of modifiable risk factors include previous injuries, joint overload, or underload (eg excessive physical activity without adequate conditioning OR inactive/sedentary behaviour), increased body weight/obesity, and muscle weakness.

How do I know whether I’ve got osteoarthritis?

Most doctors and allied health professionals (including physios, chiropractors, and osteopaths) should be able to determine a diagnosis of osteoarthritis WITHOUT the use of medical imaging. This is because the progression of symptoms can be slow and variable amongst individuals, and it can take several years for osteoarthritis to be seen on an x-ray! Some classic features of osteoarthritis include:

- Pain through the affected joint during weight-bearing or physical activity

- Restricted range of motion through the affected joint because of pain.

- Swelling

- Early morning stiffness that may last for a few minutes

- Joint instability

- Crunching or clicking noises

- Decreased strength

- Some obvious deformity in extreme cases of OA (knock knees or bow-knees).

Okay so how do I treat osteoarthritis?

The first line of treatment that must be recommended to you is exercise, solid education, and weight management (if appropriate – this is not a feasible option for everyone so carefully consult this with a trusted and experienced health professional before pursuing). Exercise is the safest, cheapest, and most time effective intervention for treating osteoarthritis. It outperforms placebo treatments, medication-based treatments alone, and can delay or avoid the need for a joint replacement surgery altogether!

But wait, doesn’t exercise cause damage to your cartilage? I see all these runners in their 20s and 30s develop arthritis in their 50s!

On the contrary, ongoing research is demonstrating that recreational running is NOT linked with the eventual development of knee osteoarthritis. The effects of a single run on your knee cartilage are small and temporary, meaning that it will not cause damage to your cartilage after one run. In fact, recent studies have shown recreational runners (which have included participants who have run for more than 15 years) have an equivalent or lower risk of developing knee osteoarthritis compared to non-runners.

What about my parents? They are in their 80s and running is not a viable exercise for them. Is there an alternative?

Walking, or any exercise that they can perform, is a suitable alternative for osteoarthritis as long as it covers the following:

o It should be prescribed to your needs, goals and preferences

o It should include hydrotherapy if you cannot complete land-based exercise.

o A supervised exercise programme should include a minimum of 12 sessions over 6 weeks at 30-60 minutes each session (rough x2/week)

o If possible, encourage to increase frequency of sessions by 1-2 times or extend programmes to a minimum of 12 weeks to optimise outcomes

o Provide education to improve compliance, exercise progression, and learning how to modify physical activity and exercise if a flare-up occurs.

My pain gets worse after I exercise! Is that okay?

Pain during exercise is okay if it is within an acceptable zone. Any increase of pain that is unacceptable 24-48 hours after you exercise generally indicates you’ve done a bit much and may need to cut back. Talk to your healthcare professional to help gauge this.

But my doctor says my x-ray just shows bone on bone! How can exercise fix that?

My most important message for people suffering with osteoarthritis is that symptoms can improve and that there is hope for you. Many of these statements exist because there is still a prevailing misconception that exercise corrects structural changes inside the joint. We don’t treat the x-ray, we treat the patient. Furthermore, there is a poor correlation between the degree of osteoarthritis on a scan and a person’s degree of pain and disability. Pain does NOT equal damage, exercise is NOT dangerous, we need an optimal amount of load to support cartilage health, and the avoidance of exercise is NOT helpful.

Alright, I’m keen to exercise! Where do I start?

The GLA:D (Good Living with osteoArthritis: Denmark) programme is an excellent place to find a clinic to start exercise and receive general information about the condition and how to manage it. It was developed in Denmark by two researchers and clinicians with the aim to provide up-to-date treatment for people living with hip and knee osteoarthritis. 3 out of 4 participants who completed this programme avoided surgery for one year, and this was maintained at 68% after two years!

Follow the link for more details:


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