As written by Southampton Physiotherapist, Phil Coleman
Osteoarthritis (OA) is a very common condition involving the degeneration of joints in the body, commonly affecting the knees, hips, lower back and neck, base of the thumb and big toe and finger joints. The degeneration particularly affects the cartilage, the smooth, slippery surface between the joints. The body cannot replace cartilage but attempts to repair the damage but makes it worse, laying down new bone in the form of osteophytes (bony spurs).
Types of Osteoarthritis
There’re two main types of OA – primary, where there’s no clear cause of the breakdown of cartilage, although there may be a genetic link, and secondary, where OA may develop in later life following injury such as a fracture or ligament damage. For example, ankle fractures commonly become arthritic and footballers with a history of major knee ligament damage may develop knee OA. More recently, a high BMI has been linked to OA in weight bearing joints.
Doctors commonly call OA “wear and tear” arthritis but this is quite misleading. Although it is true that it’s more common in older people, knee OA, for example, is generally less common in runners than non-runners. In fact, runners tend to develop thicker cartilage in response to the stress of running rather than wear out their cartilage.
However, there’re some sports where there is abnormal loading on the joints which may lead to OA. For example, tennis players (such as Andy Murray) are prone to hip OA and golfers may develop spinal OA (hence Tiger Woods’ spinal fusion).
SIGNS AND SYMPTOMS
Pain and stiffness are early signs, leading to reduced range of movement and loss of function. Later, there may be swelling and heat and deformity. For example, in the knees there may be the inability to fully straighten, the feeling that the knee may give way, stiffness after sitting and, later, deformity into a varus (bow) leg. A classic sign in hip OA is the inability to flex the hip, making it hard to put on socks or shoes, as Andy Murray experienced! There’s also often groin pain.
If OA is suspected, a GP may order an x-ray. As cartilage does not show on x-ray, space between joints indicates how much cartilage there is. Reduced joint space is therefore a sign of OA, together with osteophytes. However, there’s a poor correlation between x-rays and a patient’s pain and function, hence the phrase “treat the patient not the scan”. See the x-ray picture below.
TREATMENT AND MANAGEMENT
Although physiotherapy cannot cure OA, it can help maintain or improve range of movement, function and strength. One side effect of OA is muscle wastage through disuse, especially around the quadriceps with knee OA and this needs to be addressed early. Exercise is encouraged and tailor made for the patient. Physiotherapy can also include manual therapy and stretching techniques. GPs may offer steroid injections, a powerful anti-inflammatory, which may give short term relief. Other treatment techniques can be foot insoles to alter the loading on the joints.
SURGERY AND BEYOND
As a last resort, joint replacement surgery may be offered but this should not be taken lightly as, with all surgery, there’re risks involved such as risk of infection and DVT. Questionnaires such as the Oxford Knee Score and Oxford Hip Score are ways to ascertain if surgery is indicated. Current research is looking at stem cell science to repair damaged cartilage and so obviating the need for joint replacement.
X-ray (front view) of knees. Note the loss of joint space and bow angulation of the arthritic knee.
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