Introduction:
Osteoarthritis is the most common form of arthritis and causes inflammation in the lining of the joints. It occurs when the firm cartilage surrounding the joint breaks down, causing pain and swelling, and finally, over time, the cartilage gets completely worn off, leading to joint damage and more pain. Though the damage to the joints cannot be reversed, physiotherapy can help attain enhanced joint motion, improve muscle strength, and obtain the ideal body weight.
What Happens in Osteoarthritis?
Degenerative joint changes occur throughout life; other predisposing factors for osteoarthritis are older age, genetics, repetitive stress on a joint, increased body weight, defective cartilage, and other metabolic diseases.
Symptoms of osteoarthritis can gradually increase over time, making it difficult to perform daily activities. Osteoarthritis initially causes stiffness of the joints, rarely lasting more than 15 minutes; fluid accumulation in the joint causes swelling, which later develops into joint pain that is relieved by rest; cracking sensations at the joint might be felt, and muscles surrounding the joint become weak, causing joint instability. Limitations of joint movement are common.
How Effective Is Physiotherapy in Treating Osteoarthritis?
The physiotherapist will focus more on pain, joint instability, weakness, and exercise tolerance; Damage to the cartilage is irreversible, but physiotherapy is beneficial in enhancing muscle strength and ruling out the factors that are causing the deterioration of the joint.
What Is the Role of Physiotherapists in Osteoarthritis?
Osteoarthritis most commonly affects the interphalangeal joints, as well as the hip and knee joints. The physiotherapist will do the initial assessment and evaluation of the OA (osteoarthritis) patient. Initial assessment includes taking the patient's history, performing a physical examination, and conducting an investigation.
The patient's current health status is primarily determined by assessing the patient's activity limitation, participation restriction, as well as other body impairments and structures that can be related to limitations and restrictions.
Certain conditions make physiotherapy contraindicated, which is considered before beginning treatment. These conditions are as follows:
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Grade 4 of osteoarthritis in which surgery is the only effective intervention.
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Warm swollen knee joint.
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Patient with extreme pain at rest.
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Significant joint damage.
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Recent history of joint replacement surgeries.
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History of cardiovascular disease.
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Presence of one or more replacement prostheses.
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Indescribable extreme pain in the hip and knee.
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Presence of fever in a patient with OA.
After a thorough assessment of the patient, the physiotherapist will determine a therapeutic goal. The therapeutic goal is based on the patient's initial assessment and the presence of limitations and barriers in terms of the International Classification of Functioning, Disability, and Health (ICF) Core Set for Osteoarthritis.
What Happens When You See a Physical Therapist?
Other than the initial assessment, the physical therapist will determine the patient's range of motion, gait analysis, muscle strength test, and postural assessment.
Non-operative options such as weight loss, if overweight, are advised. Successful weight loss will dramatically improve pain in lower extremity arthritis.
The physical therapist will implement activity modifications such as:
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To discontinue high-impact sports ( running, tennis, baseball), change to low-impact water-based sports or cycling.
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Avoid stair climbing, kneeling, squatting, and low chairs.
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Water aerobics in a warm pool for aerobic exercise or strength training.
In patients with osteoarthritis, the physiotherapist will provide adequate education and promote self-care management. They employ a minimal effective dose of NSAIDs (non-steroidal anti-inflammatory drugs) with intermittent use.
What Are the Management Strategies for Osteoarthritis?
In patients with OA, prolonged inactivity can lead to muscle atrophy and joint stiffness. Physical therapy can improve the patient's physical functioning and reduce pain. The various modalities of physiotherapy are: stretching and strengthening exercises, massages, walking aids, and electrotherapy.
The physiotherapist should develop a treatment strategy for patients with hip osteoarthritis, design an individualized exercise program based on the patient's goals, and ensure long-term exercise compliance. They use exercises to strengthen and stretch the muscles and capsules of an arthritic hip. A properly fitted cane in the opposite hand helps unload the hip significantly. Exercises for an arthritic hip (not after hip replacement surgery):
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Leg Rotations: While lying supine, the patient internally and externally rotates the hip. Ten repetitions should be done on each leg, two sets per day.
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Leg Raises: The patient lifts their leg on each side by leaning on a chair for support. Ten to fifteen repetitions should be done, with two sets per day.
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Knee Crossovers: The patient begins by lying down on their back with their legs extended. Keeping one leg extended, the opposite knee is pulled towards the chest and slightly across the body towards the shoulder. Hold for 30 seconds and repeat on the other side.
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Minimal Sit-Downs: A 30-degree mini-squat with the patient standing over a chair- flexing the knees only 30 degrees. Ten to fifteen repetitions and two sets per day and other strengthening exercises, such as:
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Leg scissors against resistance.
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Straight leg Lifts.
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Knee-to-Chest Lifts.
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Sidekicks.
Other suggested exercise plans for patients with mild osteoarthritis of the hip:
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Active range of motion exercises.
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Stretches for hip flexor, adductor, iliotibial band,gastrocnemius muscles, and hamstring tendons.
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Aerobic conditioning (walking for one hour five times a week).
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Aquatic therapy in warm water to ‘unload.’
Knee osteoarthritis treatment can be very effective if done correctly. Electrical stimulations are used to begin the process for patients with extremely weak muscles. The suggested treatment plan for patients with osteoarthritis of the knee with mild symptoms is as follows:
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Active range of motion exercises for hip, knee, and ankle.
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Quadriceps, which are known to be ‘Natural knee braces,’ is one of the most important muscles in knee function. Quadriceps strengthening exercises make surprising differences. Quadriceps sets for Vastus medialis obliques, especially if there is a prominent patellofemoral component symptom.
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The use of a knee compression sleeve has been shown to be effective in relieving pain by shifting weight away from the injured area of the knee.
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Low-impact conditioning exercises for the knee and avoiding high patellofemoral compressive forces.
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Isometric progressive resistive exercises for quadriceps, hamstrings, hip adductors, and abductors.
Conclusion:
Osteoarthritis, a degenerative disease, can affect our day-to-day activities. Physiotherapy plays an important role in managing patients with osteoarthritis. Recent studies show that the number of people opting for surgery has decreased significantly because physiotherapy is just as effective in treating pain and improving quality of life in patients with osteoarthritis less than grade 4.
