Do you get knee pain that persists for 30 minutes in the morning? Or perhaps your hip feels quite stiff and sore after sitting for a period of time when getting up? Have you recently been told you have osteoarthritis and are unsure what this means?

Fear not, in this two-part series CSSM and GLAD-accredited physiotherapist Peter Stath will equip you with a better understanding of this complex yet widely prevalent condition and quash any misconceptions you may have around this area.  

Osteoarthritis (OA) is one of the most common lifestyle diseases in people aged 65 years and over. OA is typically referred to as joint ‘wear and tear’ and patients are typically referred for imaging to see the ‘degree of damage’ in the joint surfaces. However, not only do these statements contribute to increased sensitivity of pain and/or reduction in exercise out of fear, but they are also incorrect. 

OA is a disease involving the entire joint with the articular cartilage being the structure most affected.  

Articular cartilage covers the ends of our bones and absorbs forces that our joints encounter throughout our daily activities. In a healthy joint, there is a delicate balance of regeneration and degeneration of cartilage. OA occurs when this balance is disrupted.  

There are several factors that may predispose an individual in developing OA, these can be split into modifiable and non-modifiable risk factors.  

Non-modifiable risk factors:  

• Age: unfortunately OA becomes more frequent as we enter the later stages of life  
• Gender: affecting women > men overall
• Genetics: to some extent this can be modified to reduce overall risk  

Other structural changes in the joint may be due to cartilage being exposed to too much load at once (via an acute injury such as an ACL rupture), too much load over a long period of time (an overuse injury) or if the cartilage is unable to withstand normal loading patterns due to underlying disease. 

Too little load can also be a factor as our tissues require a certain amount of stimulus to drive the regeneration process. 

The focus of this blog series is on the modifiable risk factors in the presence of OA.  

 Modifiable risk factors:  

• Physical inactivity 
• Muscle strength and endurance: weakness will not provide adequate support to the joints
• Weight management  

So how do you know if you have osteoarthritis? The condition often starts in a single joint with symptoms developing slowly however, experiences will vary from person to person.  

Some typical signs and symptoms include: 

• Pain with weight bearing  
• Joint stiffness, particularly in morning or when moving after prolonged rest  
• Reduced range of motion 
• Red, hot and swollen joints  
• Muscle tightness 

Now that you have a base understanding of osteoarthritis you may be thinking, what are my treatment options? Will I be in this pain forever with no respite? The answer is no, there are many treatment options available for OA however some are recommended earlier than others.  

The best practice and current first line of treatment for OA consists of exercise, weight management and education strategies.  

• Education is aimed at improving the overall knowledge and confidence in an individual’s ability to self-manage the condition, while correcting any misnomers and negative beliefs that may have developed.  

• Exercise is important to reduce pain, improve joint range of motion and maintain/increase muscle strength and endurance.  
• Weight reduction also assists with the load tolerance at the affected joints (hip, knee, ankles) which has positive effects on pain management and overall functional improvements. 

The Australian Clinical Practice Guidelines which are published by the Royal Australian College of General Practitioners recommend that all Australian’s seeking care for OA should be offered exercise.  

“We strongly recommend offering land-based exercise for all people with knee and hip OA to improve pain and function regardless of their age, structural disease severity, functional status or pain levels.”   

Your physiotherapists at CSSM can assist you in devising an individualised exercise program to your specific needs to help you achieve your goals and reduce your pain levels.  

Alternatively, you can enquire about joining our new GLA:D Program that we are now offering in the clinic.  

GLA:D stands for Good Life with OsteoArthritis Denmark – an evidence-based program designed by physiotherapists that originated in Denmark and is now available in Australia. So far, 30,000 people have undertaken the program.

Each GLA:D participant will have their own personalised program designed to suit their body and functional goals. 

The program is made up of a 6-week program that provides patients with the exercises and skills to self-manage their osteoarthritis. After a one-on-one consultation, participants will undertake 12 tailored exercise sessions and 3 education sessions. 

The GLA:D program has been found to reduce osteoarthritis pain by an average of 36 per cent as well as reduce the need for analgesic consumption, the use of sick leave and the perceived need for surgery.  

About the author 

Peter Stath is a CSSM physiotherapist who places a strong emphasis on exercise rehabilitation to compliment manual therapy treatments. He has previously worked within the National Premier League Victoria as well as part of the medical team for Futsal Victoria.  

Peter is focused on staying at the forefront of the industry in terms of the latest techniques, advancements, patient care and rehabilitation so that he can continue to play a key role in his patients’ recovery. 

He has a passion for treating all aspects of musculoskeletal or sporting pain with a particular interest in shoulders, knees and ankles, and injuries within the adolescent athlete.  

REFERENCES  

Bennell, K., Hall, M., & Hinman, R. (2016). Osteoarthritis year in review 2015: rehabilitation and outcomes. Osteoarthritis And Cartilage, 24(1), 58-70. doi: 10.1016/j.joca.2015.07.028 

Brand, C., Harrison, C., Tropea, J., Hinman, R., Britt, H., & Bennell, K. (2014). Management of Osteoarthritis in General Practice in Australia. Arthritis Care & Research, 66(4), 551-558. doi: 10.1002/acr.22197 

Bricca, A., Juhl, C., Steultjens, M., Wirth, W., & Roos, E. (2018). Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. British Journal Of Sports Medicine, 53(15), 940-947. doi: 10.1136/bjsports-2017-098661 

Sophia Fox, A., Bedi, A., & Rodeo, S. (2009). The Basic Science of Articular Cartilage: Structure, Composition, and Function. Sports Health: A Multidisciplinary Approach, 1(6), 461-468. doi: 10.1177/1941738109350438 

The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.