Beyond the joint: A Modern Physio view of OA

Lachlan Hough

APA Titled Musculoskeletal Physiotherapist

What is Osteoarthritis (OA)?

Osteoarthritis (OA) is a chronic inflammatory condition that affects the whole joint including bone, cartilage, ligaments and muscles, often causing pain, swelling and stiffness. The most commonly affected joints are the knee and hip, but it can affect any joint in the body.

Old view of OA

If you were asked what words come to mind when you think of osteoarthritis (OA) it might sound something like this:

“it’s wear and tear”
“my knee’s worn out”
“it’s bone on bone”

Sound familiar? Well, you’re not alone. These are common beliefs that represent what we used to think about OA. The old view was that over time our joints wear out due to every day “wear and tear” as we get older.

A common statement to hear in a physio’s office is: “I don’t think anything can be done, at some stage I’ll need a knee replacement”.

Often you will have heard friends, family, and even health professionals use these phrases, but they don’t tell the full story of OA.

The unfortunate effect of these beliefs is they often leave people feeling helpless and discourage them from doing things that can help.

What sense does exercise and movement make, if you’ve been told your knee is “worn out” due to using it?

Why would you feel good about doing things that hurt, if you’ve been told the grinding noises and sensations you feel are because your knee is “bone on bone”?

Whilst there is no cure for OA at this stage, there are certainly things that can help reduce the burden and help people to keep more active and experience less pain.

New view of OA

Here’s a different thought to challenge the old view: If OA is all to do with “wear and tear” in the joint, shouldn’t the pain be the same all the time? Surely the wear and tear can’t be less some days and more on others?

Fortunately, we now know much more about OA than ever before. Rather than being a problem with the joint alone, OA is now seen as a joint problem and a systemic inflammatory problem. A systemic problem involves the whole body/person, not just the arthritic joint.

Inflammation may be influenced by many things. These include:

Movement – “Too much too soon”
Lack of Movement – “Too little for too long”
Diet
Poor sleep
Prolonged stress
Thoughts and beliefs
Drinking alcohol
Smoking

The pain you feel when you move and load your joint may be less to do with damage to your joint, and more to do with how the above things may be increasing inflammation and making your joint more sensitive. These things are often modifiable, helping to put some power back in the hands of those with OA.

Modern physio management of OA

A lot of active people have degenerative joints on Xray, but no pain. Exercise helps to reduce a number of the drivers of inflammation, as well as unloading the joint. Your physiotherapist can talk to you about different exercise options including gym and strengthening exercise, hydrotherapy, Pilates or yoga to name a few.

What matters most is that you find something and stick with it. Consistency is the key.

Physiotherapy will also involve management of other lifestyle factors such as stress, sleep, and smoking as discussed above.

Take home message

Did anything you read surprise you? For now, the main takeaway is that there are many things that can influence how your joints might feel at any given time. The flip side of that? There are also many things that may help. Degenerative joints are common. You can improve your pain even though the joint doesn’t get younger.

The physiotherapists at City Baths Spinal and Sports Medicine can help you unpack what things may be contributing to your pain and help you to develop strategies to address them. They are skilled in helping people with OA strengthen their muscles, increase their exercise levels and improve their pain.

For some, a joint replacement may be the right course of action. Your physio will always discuss all options honestly with you, based on the best available evidence, empowering you to make the best decision.