In the previous blog post, CSSM physio Peter Stath introduced some concepts to help better understand osteoarthritis and the impact it has on lifestyle and overall mobility. If you missed it, you can catch the first part of this series here. 

The focus of this instalment is to inform you of the treatment options available to you if you have been told you have arthritis and/or are considering what other treatment options are out there that may assist in your management.  

Exercise is said to be the most effective, non-surgical treatment for knee OA (McAlindon et al. 2014) and combined with weight management and education strategies, remains the best practice first line of treatment.  

• Exercise is important to reduce pain, improve joint range of motion and maintain/increase muscle strength and endurance.  
• Education is aimed in improving the overall knowledge and confidence in an individuals ability to self-manage the condition, while correcting any misnomers and negative beliefs that may be present.  
• 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 (RACGP) 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.”   

One of the most significant barriers to exercise for the management of OA is the misconception that exercise will be harmful or detrimental to the joint and/or remaining cartilage. The cartilage in fact, benefits from suitable and appropriate loading while the subsequent benefits of exercise can be seen in the surrounding musculature while simultaneously preventing at least 35 other chronic health conditions.  

Thus, the advantage of undergoing a program like CSSM’s new GLA:D program, allows you to engage in physical activity and exercises that are tailored to your specific case, and are supervised by a physiotherapist to ensure they are being performed safely and under suitable loads and intensities.  

The second line and third line of OA treatment typically involve strategies that are not necessarily delivered by physiotherapists. It is also important to note that these strategies should not be given separate from, or without first line of treatment being explored first or as well as.  

Common second line of treatments aim to reduce pain and maximise comfort through passive means and can include:  

• Symptom relieving medication (Panadol, neurofen, injections)  

• It is important to note that the RACGP recommend against the use of opiods for pain management in osteoarthritis.  

• Dietary supplements (glucosamine, fish oil, turmeric)  

• Other passive interventions such as; insoles, taping, heat/cold therapy, dry-needling.  

Physiotherapists may have a role in recommending and prescribing gait aids, pain management via TENS or heat/cold application, and recommend relevant insoles/braces – however, the benefits of these strategies are typically not sustainable, and are not as effective in reducing overall pain while improving mobility when compared to exercise.  

Finally, the third line of treatment options for osteoarthritis refers to replacement surgery. Typically, there are two types of surgery that are often considered in cases of osteoarthritis.  

Arthroscopy  

Performed with an arthroscope by your surgeon, this form of surgery is associated with no further benefits for knee osteoarthritis when compared to placebo surgery. The British Journal of Sport Medicine in 2017, strongly recommend against arthroscopy for nearly all patients that experience degenerative knee joint conditions as outcomes were no better when compared to exercise therapy.   

Arthroplasty = Joint replacement surgery  

Generally indicated for severe stages of osteoarthritis where both first and second line of treatments are no longer providing benefits. 80-90% of patients experience good results  following these procedures, however 9% of hip and 20% of knee patients experience no pain relief.  

In summary, the decision and consideration of surgery for osteoarthritis should always be a shared decision-making process that should involve the patient first and foremost, and the rest of the care team including but not limited to the GP, Allied Health Professional and surgeon.  

If you would like to know more about the treatment options available to you including being a part of the GLA:D program, please contact the clinic on 03 9889 1078 or speak to one of our health professionals who can provide you with more information.  

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 

Henriksen, M., Creaby, M. W., Lund, H., Juhl, C., Christensen, R. (2014). Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials. Rheumatology Research, 4;4:e005368. doi:10.1136/bmjopen-2014- 005368 

McAlindon, T., Bannuru, R., Sullivan, M., Arden, N., Berenbaum, F., & Bierma-Zeinstra, S. et al. (2021). OARSI guidelines for the non-surgical management of knee osteoarthritis. Retrieved 5 May 2021, from 

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.