What is OA?
Osteoarthritis is a disease that most commonly affects the knees, hips and finger joints. The disease affects the whole joint but specifically impacts the cartilage in your knee that covers the end of the bones (known as articular cartilage), causing it to become thin and fragile.
What causes OA?
The damage to the articular cartilage occurs because 1) the healthy cartilage is overloaded for a prolonged period of time or 2) the cartilage is unhealthy and cannot manage the load placed on the joint.
How is it diagnosed? Do I need an X-ray?
A physiotherapist or GP will be able to diagnose OA without the need for an x-ray or MRI but they may be required to rule out anything more sinister. The truth is that the symptoms of OA may be present for many years prior to any changes being seen on imaging. Additionally, the severity of changes seen on radiographs does not always correlate with the level of pain and disability and therefore a diagnosis and treatment plan should be made based on symptoms not changes seen on an x-ray.
What are the common symptoms of knee OA?
- Pain when weight bearing and/ or on movement
- Stiffness that is often worse in the morning
- Heat and swelling
- Giving way
- Crunching, clicking noises
- Difficulty with general mobility e.g. going up/down stairs and moving from sit to stand
- Poor knee alignment e.g. knock-knee or bow-legged
What makes you more susceptible?
There are factors that make you more susceptible to developing OA that you can’t change such as your age, gender (female >male) and having a family history of OA. However, there are factors that are more in your control such as your weight, physical inactivity, muscle weakness and previous traumatic injury e.g. ACL or meniscal tears & overuse injuries occurring due to repetitive activities e.g.labourers.
What is the best treatment for OA or knee pain?
To date there is no known cure for OA. The Royal Australian College of General Practitioners (RACGP) guidelines for the management of knee OA recommend that the best first line treatment methods are land-based exercise, education and weight management.
Many people believe the only way ‘to ﬁx’ osteoarthritis is surgery. Current evidence suggests that knee arthroscopic surgery is no better than other non-surgical interventions (ie, exercise therapy, injections), or even sham surgery, for people with symptomatic mild to moderate osteoarthritis (Palmer et al 2019, Moseley et al 2002).
Many people with severe osteoarthritis do get signiﬁcant pain relief from joint replacement surgery. However, up to one in ﬁve people with knee osteoarthritis who undergo this procedure are not satisﬁed with the outcome, with 30 per cent still presenting symptoms such as pain, stiffness, and difﬁculty in daily activities after surgery.
Specific dosage and type of land based exercise as prescribed by your physiotherapist in conjunction with good education can reduce pain, improve overall function and mobility. Although nothing is able to regenerate the damaged cartilage, the correct amount and type of exercise can nourish what cartilage is present. The key to this treatment is that there is no size that fits all and you need to have a specific individualized program to reap the full benefits. Therefore it is ideal to be guided by a physiotherapist.
Your physiotherapist may also provide some manual physiotherapy techniques to aid short term pain relief and your GP may prescribe some pain relief medication. Although these treatments are good to help with short term relief they best serve to enable you to get more active.
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Written by Caitlin Collenette, Physiotherapist.