What is Osteoarthritis?
“Arthritis” is a term used to describe inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.
An estimated 27 million Americans have some form of OA. According to the Centers for Disease Control and Prevention, 1 in 2 people in the United States may develop knee OA by age 85, and 1 in 4 may develop hip OA in their lifetime. Until age 50, men and women are equally affected by OA; after age 50, women are affected more than men. Over their lifetimes, 21% of overweight and 31% of obese adults are diagnosed with arthritis.
OA affects daily activity and is the most common cause of disability in the US adult population. Although OA does not always require surgery, such as a joint replacement, it has been estimated that the use of total joint replacement in the United States will increase 174% for hips and 673% for knees by 2030.
Osteoarthritis (OA) affects your joints, the articulations between your bones such as your knees, hips and shoulders. Cartilage is a substance on the surface of bones where they meet to form joints. Cartilage helps to absorb shock and reduce friction at these points of contact and movement. A protective oily substance called synovial fluid is also contained within the joint, as one of the most viscous substances known thislubricant helps to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves. The cause of OA is unknown. Current research points to aging as the main cause.
Factors that may increase your risk for OA include:
Genetics: Research indicates that some people’s bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
Past Injury: Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
Occupation: Jobs that require repetitive squatting, bending, and twisting are risk factors for OA. People who perform jobs that require prolonged kneeling (miners, flooring specialists) are at high risk for developing OA.
Sports: Athletes who repeatedly use a specific joint in extreme ways (pitchers, football linemen, ballet dancers) may increase their risk for developing OA later in life.
Obesity: Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.
Typically, OA causes pain and stiffness in the joint. Common symptoms include:
- Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
- Stiffness in the joint after sitting or lying down for long periods
- Pain during activity that is relieved by rest
- Cracking, creaking, crunching, or other types of joint noise
- Pain when you press on the joint
- Increased bone growth around the joint that you may be able to feel
Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of an inflammation. Please consult with your doctor if you have swelling, redness, and warmth in the joint.
How Is It Diagnosed?
Your doctor using imaging such as x-ray typically diagnoses osteoarthritis, but there are signs that may lead your physical therapist to suspect you have OA. Joint stiffness, difficulty moving, joint creaking or cracking, and pain that are relieved with rest are typical symptoms.
How Can a Physical Therapist Help?
Your physical therapist can effectively treat OA. Depending on how severe the OA is, physical therapy may help you avoid surgery. Although the symptoms and progression of OA are different for each person, starting an individualized exercise program and addressing risk factors can help relieve your symptoms and slow the condition’s advance. Here are a few ways your physical therapist can help:
- Your therapist will do a thorough examination to determine your symptoms and what activities are difficult for you. He or she will design an exercise program to address those activities and improve your movement
- Your therapist may use manual (hands-on) therapy to improve movement of the affected joint
- Your physical therapist may offer suggestions for adjusting your work area to lessen the strain on your joints
- Your physical therapist can teach you an aerobic exercise program to improve your movement and overall health, and offer instructions for continuing theprogram at home
- If you are overweight, your physical therapist can teach you an exercise program for safe weight loss, and recommend simple lifestyle changes that will help keep the weight off
In cases of severe OA that are not helped by physical therapy alone, surgery, such as a knee or hip replacement, may be necessary. Your physical therapist will refer you to an orthopedic surgeon to discuss the possibility of surgery.
Can OA Be Prevented?
The best way to prevent or slow the onset of OA is to choose a healthy lifestyle, avoid obesity, and participate in regular exercise.More recent research literature suggests that movement is key to improving joint function. This is due to synovial fluid supplying nutrition to cartilage cells, with the production of synovial fluid stimulated by movement. It is also suggested that the use of joints through movement and light weight bearing may actually assist in bringing nutrition to cartilage on a cellular level.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat OA, regardless of the affected joint. However, you may want to consider:
- A physical therapist who is a board-certified orthopedic clinical specialist. This therapist has advanced knowledge, experience, and skills that may apply to your condition
- A physical therapist that specializes in the treatment of osteoarthritis
- Get recommendations from family and friends or from other health care providers
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people who have osteoarthritis.
Additional Information
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of hip osteoarthritis and hip replacement. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the
article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Centers for Disease Control and Prevention. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation: United States, 2007-2009. Published October 8, 2010. Accessed March 11, 2013. Free Article.
Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. 2010;18:1372–1379. Free Article.
Cibulka MT, White DM, Woehrle J, et al. Hip pain and mobility deficits—hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of theAmerican Physical Therapy Association. J Orthop Sports Phys Ther. 2009;39:A1–A25. Free Article.
Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–1213. Free Article.
Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785. Article Summary in PubMed.
Deyle GD, Allison SC, Matekel RL, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85:1301–1317. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Adapted with permission from the APTA. Original article authored by Christopher Bise, PT, MS, DPT.