VITRUVIAN EXERCISE PHYSIOLOGY
News & Information
OSTEOARTHRITIS
What is Osteoarthritis (OA)
Osteoarthritis (OA) is a joint problem that can lead to pain, decreased movement, and difficulties with daily activities.
There is no single cause of OA, having genetic, lifestyle, and mechanical risk factors. It first shows itself as a change to the biological and cellular processes within the joint, followed by changes to cartilage and bone, resulting in inflammation.
The good news for individuals with OA is there are many things you can do to help with your pain and function, and the outlook for most people is positive. With the right approach there is every chance you will be able to keep doing all the things that are important to you.
Contributing Factors
There are a range of factors that may make some individuals more susceptible to developing OA, including both non-modifiable and modifiable factors.
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These include:
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Age
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Genetic factors / family history
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Physical inactivity / sedentary lifestyle
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Excessive loading of a joint due to high occupational or sporting demands
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Other joint disorders such as rheumatoid arthritis
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Previous joint injury (trauma) or surgery
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Joint alignment / mechanics
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Being overweight or obese (due to both increased joint stress and chronic inflammation)
It is important to focus on modifiable factors that you can change, such as physical activity, weight, managing stress, and understanding your pain. Managing these factors can help you take control of your condition and mitigate the effect OA has on your daily activities.
Facts & Misconceptions
Fact
Improvement in pain and disability can happen over time.
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By attempting to understand your OA and adhering to a positive and active approach, you can improve pain symptoms and physical function.
Fact
Pain and function are not strongly related to joint changes seen on scans.
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What your joint looks like on the inside and the symptoms you feel are not strongly correlated. Pain is a modifiable symptom related to sensitised joint structures rather than solely related to damaged structures.
Misconception
Osteoarthritis is simply wear and tear.
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The term ‘wear and tear’ implies our joints just wear out through use. This is a simplistic and problematic way to view OA, as it implies inevitable decline. There are many factors that contribute to OA, as outlined above. Physical activity and loading of the joints are safe and can be protective.
Misconception
Running is bad for your knees.
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Overall prevalence of hip and knee OA in recreational runners is significantly lower than seen in sedentary individuals.
Misconception
Pain is associated with worsening of OA.
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Pain flare ups and fluctuating symptoms are a normal part of OA. Mild to moderate pain during activity is not associated with worsening or progression of OA.
Diagnosis & Treatment
Osteoarthritis can be diagnosed from a clinical examination without the need for any special tests or x-rays if a person:
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Is aged 45 years or older
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Has joint pain related to activity
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Has no or less than 30 minutes of morning joint related stiffness
​X-rays, scans or blood tests may be required if your doctor needs to rule out other causes of your joint pain.
As it currently stands, there is no cure for osteoarthritis. The goal of all OA treatment is to manage symptoms, slow the progression of disease and improve daily quality of life.
There are three core components of best management of OA (considered high value care):
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1. Information and education about OA
2. Physical activity and exercise
3. Weight loss for people who are overweight/obese
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In addition to these core treatments, other adjunctive treatments that may be helpful for some people, include:
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Heat (such as heat packs or hot water bottles)
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Cognitive behavioural therapy (strategies to support helpful thinking about pain and your habits when you have pain), particularly in combination with exercise
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A short course of manual therapy (such as joint mobilisation or massage)
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Assistive devices (such as tap turners, walking sticks and others)
Medications cannot change the underlying OA disease process. They can help with pain and provide a therapeutic window’ to allow you to stay active, to stay engaged at work and at home, and to exercise regularly.
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Oral and topical (applied to the skin) nonsteroidal anti-inflammatories (NSAIDs) may be helpful
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There is no strong evidence for the benefit of paracetamol with OA
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For people with moderate to severe pain, corticosteroid injections can be considered for short-term relief and to help engage with exercise
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Surgery is considered for individuals who:
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Experience symptoms that have a profound impact on quality of life AND;
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Have tried (and persisted with) the best non-surgical treatments without experiencing any improvement
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There are some treatments that are considered low value care due to a lack of evidence of benefit, or where the potential harms outweigh any benefits. These include:
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Relying on passive treatments (things being done to you)
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Acupuncture
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Ultrasound therapy
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Glucosamine
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Shockwave therapy
Role of strenth exercise & physical activity
Exercise is considered part of first line care for all individuals with OA.
Exercise recommendations:
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30 mins of moderate intensity aerobic physical activity on 5 days per week (accumulating minutes in shorter bouts throughout the day is fine)
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Reduce the amount of time you spend sedentary over the course of the day
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Include 2-3 muscle strengthening sessions each week, particularly targeting muscles surrounding the affected joints
Interventions based on education and appropriately prescribed exercise have been shown to result in:
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Less pain and reduced symptom progression
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Improved quality of life
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Reduced use of joint related pain medication
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Increased physical activity.
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There isn’t a ‘one size fits all’ approach. Different types and intensities of exercise have been shown to improve OA symptoms. Receiving guidance from an Exercise Physiologist can assist in determining the most effective exercise type, frequency, intensity and duration for your individual circumstance (your current level of function, pain symptoms, goals, and your activity preferences).
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Exercise can also help with other variables related to OA symptoms, including chronic inflammation, tissue sensitivity, fear of movement, anxiety and depression.
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Exercise is safe and effective for individuals at all stages of OA. Both high and low intensity resistance training has been shown to offer benefit with no exacerbation of OA progression. Furthermore, for those where surgery becomes necessary, supervised exercise prior to surgery is associated with a faster postoperative recovery.
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Staying active is a key component of doing well and taking control of your situation.
The Vitruvian Team.
The Involvement of Neutrophils in the Pathophysiology and Treatment of Osteoarthritis
Chaney et al. Biomedicines. 2022
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Pathogenesis and management of pain in osteoarthritis
Dieppe et al. The Lancet. 2005
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PEAK program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis)
Melbourne School of Health Sciences
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Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults with Knee Osteoarthritis: The START Randomised Clinical Trial
Messier et al. Journal of the American Medical Association. 2021
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Gait, physical activity and tibiofemoral cartilage damage: a longitudinal machine learning analysis in the Multicenter Osteoarthritis Study
Costello et al. British Journal of Sports Medicine. 2023
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NICE guidelines: Osteoarthritis
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The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis
Alentorn-Geli et al. Journal of Orthopaedic & Sports Physical Therapy. 2017
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