osteoarthritis treatment

If you have Osteoarthritis, you are not alone!

And we can help!

It is estimated that 1 in 8 Canadians has Osteoarthritis(OA) and OA is considered one of the leading causes of disability among adults.

It is estimated that 1 in 8 Canadians has Osteoarthritis.

OA is considered one of the leading causes of disability among adults (Miller 2020) and these numbers are rising as our population is aging.

Knee OA disability rates increased 75% between 1990 & 2013 and it is expected to continue to rise.

“By the year 2030, an estimated 67 million adults (25% of the projected total adult population) aged 18 years and older will have doctor-diagnosed arthritis, compared with the 52.5 million adults in 2010-2012.” (McAlindon 2014)

At Resolution Physiotherapy & IMS Clinic in Barrie, we are excited to have Orthopaedic Surgeon, Dr. Raaj Vora on our team as well as Physiotherapists who have post-graduate training in the rehabilitation of Osteoarthritis.

If you have OA pain that is slowing you down, contact us today so we can help get you back to life with increased function and less pain!

What is Osteoarthritis?

“Osteoarthritis (OA) is one of the leading causes of disability in the adult population. OA is most often a slow progressive joint disorder, characterized by joint pain, cartilage degeneration, and decreased joint function.” (Altman 2019)

“A healthy joint requires not only a fine-tuned balance of molecular signals regulating homeostasis but also the ability to respond to damage, restoration, and remodeling. Biomechanical, metabolic, and biologic changes, as well as trauma and isolated cartilage lesions, may lead to the loss of this homeostasis, resulting in degeneration of the articular surface and, ultimately, to osteoarthritis (OA).” (Kon 2018)

To put it simply, OA occurs when there is and imbalance between cells that cause inflammation (called IL-1b cells) and cells that reduce inflammation (called IL-1a cells). In a normal knee joint, the balance between these 2 cells is equal meaning that there is no inflammation in the joint. With OA, this balance is altered where the percentage of inflammation causing cells is much higher and this leads to inflammation in the joint which causes a breakdown of the articular cartilage, increased joint compression, bone spurring, reduced mobility and pain.

With the population aging, and the prevalence of OA increasing, it is important that modern medicine addresses this imbalance with the goal of modifying the course of the disease as well as improving quaity of life for our clients. Up until now, treatment has focussed on treating the symptoms without being able to alter the biochemistry of what is happening in the joint.

At Resolution Physiotherapy, we are very excited as there are now new treatments available, including nSTRIDE (see below for detailed description) which are not only improving pain and function, but are also changing the biochemistry in the joint which may result in an alteration in the OA disease process as a whole.

What are risk factors for Osteoarthritis?

There are a number of risk factors for OA.
If you have OA, it is likely that you have one or more of the following (Richmond 2013, Heidari 2011):

• Age — Advancing age is one of the strongest risk factors for OA, and OA is uncommon under the age of 40. About 13% of women and 10% of men aged 60 years and older have symptomatic knee OA (Heidari 2011).

• Gender — For reasons unknown, women are two to three times more likely to develop OA than men

• Family history: If other members of your family have or did have OA, your risk of developing OA increases.

• Obesity — People who are obese are at high risk of developing OA. Losing weight may reduce this risk.

• Occupation — OA risk is higher with occupations that require repetitive sitting or kneeling, or that involve heavy lifting, prolonged standing or walking

• Injury — Previous joint injury or trauma, including ACL or meniscal injury increases the risk of future OA

• Sports — The risk of OA may be increased in people who participate competitively in sports that predispose to joint injury, especially when OA develops before the age of 45

Which joints are most commonly affected by Osteoarthritis?

“Any joint can be affected by osteoarthritis (OA) but the disease occurs most commonly in joints that have experienced repetitive stress or injury.

Knee: The knee is the most common lower-limb joint affected by OA. People with OA often experience knee pain when doing routine activities such as walking and going up and down stairs.

Hip: OA of the hip can be deceptive. Some people feel pain in the groin area, while others feel pain in the buttocks, front of the thigh, sides of the hips, or lower back. Some of these pain symptoms are not necessarily due to OA of the hip. They may be due to conditions in other areas causing pain in the hip region, known as “referred” pain. Likewise, patients can be surprised when their doctor tells them the problem is their hip joint when they experience pain elsewhere.

Hand: OA of the hand is commonly linked to a family history of the condition. What causes osteoarthritis? In the fingers, symptoms include pain and swelling of the joints. In the thumb, pain is most commonly experienced at the base of the thumb and worsens with gripping and pinching movements.

Foot and ankle: OA can affect the ankle and the joints within the foot, commonly the joint at the base of the big toe. This causes pain when walking and can result in swelling or deformity at the joint that can lead to the formation of bunions. In addition to the big toe, bunions can have a “knock on” effect when the angle and displacement of the big toe results in the second toe putting pressure on the third toe. Bunions have the potential to compound foot pain and deformity.

Back and neck: The first sign of OA is typically stiffness or pain. In general, once the source of the pain is identified, an OA diagnosis is straightforward. Unfortunately, an OA diagnosis of the back and neck is not always straightforward. Although back pain is very common, definitively diagnosing the source of back pain is a challenge. Is the cause OA (a joint problem) or is it something else (a disc or injury-related problem)? The challenge arises because osteoarthritic changes in the spine seen on x-ray and other imaging studies do not always cause pain. Since the incidence of OA increases with age, you may indeed have OA in your older back but the source of your pain may be another condition, injury, or disease.” (OARSI https://www.oarsi.org/which-joints-does-osteoarthritis-affect, McAlindon 2014)

What symptoms will you have with OA?

Symptoms and severity of symptoms can vary dramatically amongst people who have OA but common symptoms of OA include (OARSI https://www.oarsi.org/patients):

• Joint pain that usually occurs when using the joint or at the end of the day after using the joint

• Stiffness that occurs more frequently first thing in the morning; or stiffness later in the day after sitting for periods of time but which lasts for less than around 30 minutes once you get moving

• Joint noises such as cracking, crunching, grinding sounds when the joint moves

• Swelling, when your joint appears larger and feels warm to touch, can be caused by the inflammation associated with OA leading to joint fluid buildup

• Instability, when the joint may feel weak or likely to give way when you put pressure on it

How is Osteoarthritis diagnosed?

Our Physiotherapists can diagnose OA by reviewing your medical history and your current symptoms, including the level of discomfort or pain you are experiencing, especially when engaging in certain types of activities. Your Physiotherapist will also do a thorough examination that includes examination of your joints to assess for tenderness, ease and range of motion, presence of swelling, joint sounds such as cracking and grating, joint stability, and whether you have any boney alignment changes.

Although imaging studies, such as x-ray, are not necessary to make a diagnosis of OA, they may be required to confirm your diagnosis and the severity of your degenerative changes prior to receiving interventional treatments from Specialists at Resolution Physiotherapy.

What treatments are available for OA at Resolution Physiotherapy?

At Resolution Physiotherapy, we offer both Conservative and Interventional Treatments for OA, which have been shown to improve pain and function.

Conservative Treatments include Physiotherapy, Knee OA Bracing, and Therapeutic Exercise including the research validated GLAD program

Interventional treatments include N-Stride, an exciting new treatment which can improve pain for up to 3 years with a single injection, as well as PRP, Hyaluronic Acid, & Cortisone Injection, treatments which provide shorter term relief of Osteoarthritic related pain.

Treatments for Osteoarthritis

Physiotherapy

Recent studies have shown that nonoperative, Physiotheapy treatment may delay or even prevent the need for surgery at 5-7 years in more than 50% of patients with knee OA (Gwynne-Jones 2020). Other studies have demonstrated that Manual Physiotherapy can reduce pain and stiffness with daily activity, improve function, reduce the need for medication and injections, and delay total joint arthroplasty (Allen 2019).

Our Physiotherapists have completed extensive post-graduate training and use Advanced Manual Physiotherapy and modalities to reduce pain, improve mobility and function for our clients with OA, including:

• Joint mobilizations

• Gunn IMS

• Active & Passive Myofascial Release techniques

• Active Cupping

• Radial Shockwave Therapy

Therapeutic Exercise

Therapeutic Exercise has consistently been shown to be effective at reducing pain and improving function with Osteoarthritis.

Our Physiotherapists use client specific video exercise programs to maximize performance and success for our clients, as well as the GLAD OA exercise program, which is a research validated exercise program specifically to reduce pain and improve function with OA.