Arthritis is a buzzword you may have heard whether you are a healthcare professional or not. Most commonly, Osteoarthritis is referred to as arthritis. Furthermore, a lot of times and joint pain related to aging is also labeled as arthritis or Osteoarthritis. As a physical therapist, I cringe when a condition is generalized without facts. The truth is, It’s not necessary to “always” have pain with arthritis, but of course, I bite my tongue (often) and just give a pretty smile. So, my aim with this post is to make people (mainly non-healthcare providers) aware of what arthritis is, and provide tips to deal with the discomfort associated with the condition.
Types of arthritis:
There are a few types of arthritis. But, the most common are:
- Osteoarthritis (OA)
- Rheumatoid Arthritis (RA)
OA and RA are different in how they present clinically as well as anatomical involvement. These include disease progression, the severity of pain, time of the day the symptoms are worse, aggravating and relieving factors for pain, and the treatment. For example, many times, OA of the cervical spine involves C5- C6 or C6 – C 7 segments while RA involves the whole cervical spine.
Few other types of arthritis are Ankylosing spondylitis, Gout, Psoriatic Arthritis, Septic Arthritis, etc.
In this article, we are only focusing on OA.
What is Osteoarthritis:
Osteoarthritis is a degenerative disease of bones and cartilage. In common words, it is the wear and tear of the bones and soft cushion (also known as cartilage) of the bones due to the inflammatory process. Since it is wear and tear, it usually occurs after 40 or 50 years of age. OA is more common in males of middle age while women are more prone to develop OA after age 60 or 65. The degeneration can occur in the younger population as well.
Activities like constant running, playing soccer, football or rugby, and being physically active or using wrong biomechanics or poor body posture are all related to the early development of OA.
Commonly, Osteoarthritis develops in weight-bearing joints. So hips and knees are more prone to develop OA. But one can also develop arthritis in the shoulder (degeneration due to overuse), ankles (overuse or genetic disorder of cartilage etc), cervical spine, and hands.
Etiology of OA:
Again, just wear and tear of your bones and cartilage. So overuse or age can cause it
Risk Factors for Osteoarthritis:
- Obesity
- Using wrong body mechanics while running, walking, squatting, etc
- Age
- Joint infection, major trauma, Hemarthrosis, etc
Signs and Symptoms of OA:
OA is the most common monoarticular joint disease. However, if a person is very active or plays a high joint impact sport (like Soccer), there are high chances of them having bilateral OA pain. The common signs and symptoms of OA are:
- Insidious or gradual onset
- Slow to progress,
- Early morning stiffness that lasts usually for less than 30 minutes
- Stiffness in a joint after a period of inactivity and relieves after some activity (mainly in old age)
- Weight-bearing activity aggravates the pain
- Rest relieves the pain
- In moderate to severe cases of OA, the patient will complain of pain at night
- Mild edema around the affected joint
- Crepitus with movement
Treatment:
There is a variety of treatment approach available for OA. The most important thing to remember is your joints are not “happy” (inflamed), so you want to relieve some pressure off of joints by strengthening the muscles around the joints. So yes, exercise is one of very usual and important treatment approach in OA. Let’s talk about exercises for a little bit.
Exercise in Osteoarthritis:
The main purpose or goal of exercise in the treatment of OA is:
- reduce pain and inflammation
- Exercise increases muscle strength
- regain mobility of joint
Pain and inflammation reduction in OA:
- Ice in the inflammatory stage to reduce swelling
- Heat to reduce pain.
- Gentle massage around the joint after Heat application
- A physical therapist can perform Grade I or II mobilization of the joint to relieve pain.
- Kinesio taping – I have had positive results with the geriatric population with taping on knee and ankle joints for arthritis pain.
- I have also used the McKenzie technique to reduce the pain. It has given me fairly satisfactory results with my patients.
- Braces and splints can be used to provide external support to the joint and to reduce pain
- Adaptive equipment like cane or walker to walk or a reacher for shoulder arthritis to perform the difficult function with more ease and less pain.
To increase muscle strength in osteoarthritis
Having proper muscle strength is extremely important for preventing arthritis. You want to have strong muscles to continue your daily activities in a pain-free range. I will only start exercises in pain-free range, and if the pain is severe I will go back to the treatment approach of concentrating on reducing the pain. The key point is to avoid moderate to severe pain while challenging muscles for strengthening.
The basic exercises for knee OA are knee squats, Straight leg raise, ankle pumps, Hip Abductions, short arc quads, Lying on the tummy and bending knees, Lying on tummy and kicking hips up (reverse straight leg raise). Read my posts on how to strengthen the knee and reduce pain for detailed instructions on how to perform the exercises.
Few important exercises for shoulder OA are: pendulum exercises (back and forth, side to side, clockwise and anticlockwise), finger ladder (straight and sideways), moving shoulder in all direction with a cane or rolled towel (in front, sideways), back scratch alternatively with both hands, pulleys in all directions etc. Read my post on shoulder exercises for detailed instructions on how to perform these exercises.
For resistance, you can put ankle or wrist weights, start holding to 3 or 5 seconds for each exercise and gradually increase the counts. Ask your physical therapist to count your RM and tell you what number of resistance to start with.
How to count RM:
In 1970, Moffroid and Whipple come up with the overload principle. This principle explains how much intensity or resistance is needed to achieve high levels of function. To achieve the appropriate strengthening of the muscles, the exercise prescription must be at least 60% of the maximum.
RM is defined as the resistance that can be moved one time and one time only before muscle fatigue to the degree to failure or loss of form occur. That means a person can not move the same weight or resistance again as he or she is unable to generate the same amount of force through the full range of motion.
A person can choose to exercise in their 15 RM or 10 RM to achieve the strengthening of the specific muscles.
Some other resistance exercises you can perform are wall squats, deep squats (you need to make sure you are using gluts (butt muscles) and not putting too much pressure on knees), climbing stairs up and down, knee to the chest in standing, agility training with bosu, or exercise band. You may want to have supervision or guidance to avoid any injury for this kind of resistance exercise.
To regain mobility of joint
There are different ways to increase the range of motion of an arthritic joint. The approach depends on the severity of arthritis, pain level, level of physical activity, and joint involvement. Some joints are easier to gain mobility around it compared to others due to anatomical position and physiological structures. Some examples of exercises to improve mobility are, joint mobilization, passive ROM in pain-free range, functional training, type of contraction depending on muscles you are concentrating on. Most of these exercises should only be performed under clinician supervision.
Personally, my full treatment session will consist of: Heat to relax the muscles and improve blood supply around the area, followed by exercises to improve mobility and strength, and then massage as a completion of the treatment session. I modify the session based on the severity of pain, inflammation and activity level of my patient.
Surgical intervention for OA:
Your orthopedic doctor may recommend a variety of procedures depending on the severity of arthritis, functional limitation and pain. The intervention can vary from corticosteroid injection, minimally invasive techniques like aspiration of fluid, or total knee replacement.
Natural remedies in OA:
There is not much research out there regarding the effect of natural remedies on OA pain. I have personally seen and met patients whose results vary widely with the use of the same remedy. So, take this information with a grain of salt. It never hurts to try natural remedies as long as you are not allergic.
- Ginger powder or Ginger tea
- Aloe Vera Gel
- Apple cider Vinegar
- Massaging with warm Garlic oil
- Turmeric powder or tablet during the inflammatory phase
How to avoid or prolong the onset of OA:
Yes, you read it right. You can either prevent or prolong the onset of OA pain. Few things you can do to prolong the onset of OA pain are:
- Weight reduction if you are obese, or maintaining your ideal body weight and exercising.
- Maintaining a healthy lifestyle.
- Exercising regularly
- Using correct body mechanics (posture)