Osteoarthritis

Introduction

Osteoarthritis (OA), also known as degenerative joint disease (DJD), is the most common form of arthritis. It can be classified into two categories: primary osteoarthritis and secondary osteoarthritis. OA usually presents with joint pain and loss of function; however, the disease is clinically very variable and can present merely as an asymptomatic incidental finding to a devastating, permanently disabling disorder.EtiologyRisk factors for developing OA include age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities)We define two types of OA, primary and secondary. Both involve the breakdown of cartilage in joints, which causes bones to rub together.Primary Osteoarthritis: absence of an antecedent insult. A strong genetic component of the disease primarily affects middle-aged womenSecondary Osteoarthritis: Involves a specific trigger that exacerbates cartilage breakdown. Common triggers for secondary OA include

• Injury: Bone fractures increase a person’s chance of developing OA and can bring about the disease earlier.
• Abnormal mechanical forces (e.g. occupational stress, obesity)
• Inactivity
• Inflammatory Diseases: Perthes’ disease, Lyme disease, and all chronic forms of arthritis (e.g., costochondritis, gout, and rheumatoid arthritis)
• History of certain conditions eg Diabetes, Marfan Syndrome, Wilson’s Disease, Joint infection, Congenital disorders of joints, Ehlers-Danlos Syndrome, Hemochromatosis

Characteristics and Clinical Presentation

• Pain
• Limitation in movement (loss of ROM)
• Sounds: The sounds you can hear are cracking, scraping, and sounds from crepitation.
• Difficult and painful mobilization
• Mild swelling around a joint.

Physiotherapy Management

OA causes reduced muscle strength (particularly in those muscles around the affected joint), decreased flexibility, weight gain, limitation in the ability to do ADL activities and often compromised mobility. Increased physical and psychological function and an increased feeling of well-being are the main goals of an integrated exercise program. Increased joint motion, enhanced muscle strength, increased aerobic capacity and optimal body weight are immediate objectivesFalls prevention strategies also play an important role in therapy for older clients. People with osteoarthritis are also more prone to falls.Physiotherapy is an important part of OA management and will be instrumental in teaching people to: properly use joints; exercise correctly in both motion and flexibility exercises as well as cardiovascular exercises (e.g. hydrotherapy, swimming), recommend assistive devices, recommend the use of modalities (e.g. heat or cold therapies, TENS).

Typical Treatment Plans for OA

Basic Physiotherapy

Not for patients with acute painful joint swelling and cardiovascular diseases.

• Warm-up and range of motion
• Strengthening (quad sets, supine straight leg raises, prone hip extensions, seated isometric knee extensions, single-leg leg presses, standing hamstring curls, and standing heel raises)
• Aerobic program
• Cooling down with muscle stretching (quadriceps femoris, hamstring, and calf muscle stretching)
• Long-sitting knee flexion and extension range of motion, and treadmill walking
• All lower-extremity exercises need to be performed bilaterally
• Manual therapy can be used as a treatment tool for osteoarthritis. According to a systematic review, manual therapy (mobilization with movement, passive joint mobilization, patellar mobilization therapy ) and exercises effectively reduce knee pain and increase functionality. However, further research is needed to determine the long-term effects of manual therapy on knee OA.

Agility and Perturbation Training Techniques

Agility techniques:

• Sidestepping
• Braiding (lateral stepping combined with forward and backward crossover steps)
• Front crossover steps during forward ambulation
• Back crossover steps during backward ambulation
• Shuttle walking(forward and backward walking to and from designated markers)
• A drill requiring multiple changes in direction

Perturbation techniques and balance training