Physical Therapy for Osteoarthritis
Have you been suffering from joint pain for a few days, months, or even years? Does this pain feel like an aching sensation that might get sharp with certain activities? Do you notice some creaking or cracking in joints as you move them? These are some common descriptions of symptoms in those who are experiencing arthritic pain.
Osteoarthritis (OA) is the condition in which the cartilage lining the ends of bones begin to wear down. This is a natural and unavoidable part of the aging process, and the amount of U.S. adults with OA in the hand, hip, or knee is over 20 million (Neogi). Many people with OA experience pain, a sensation of pressure or grinding in their affected joints, decreased range of motion, strength, and an inability to perform some of their daily activities.
Many of my clients who are over the age of 50 come in after seeing their physician and tell me that they were diagnosed with arthritis in a painful joint after their MD looked at the X-rays. The truth is, most people at that age have some visible degenerative changes on imaging in many, if not all, of their joints. Whether or not they experience pain, or if arthritis is actually the source of the pain, is another story entirely. There have been many studies that conclude that asymptomatic individuals can have abnormal findings on X-rays or MRIs, as well as other studies indicating that symptomatic individuals can have completely normal findings on imaging. Although this is another topic of discussion, it is important to rule out other causes of pain, such as acute pain from an accident, muscle pain, referred pain from another body structure, or even pain that is tied to emotional stress. Once you have ruled out other causes and have combined imaging with other objective tests that point to OA, then it is much more likely that OA is the source of your pain.
Understanding how osteoarthritis causes pain is important in understanding how physical therapy can be useful for treatment. Decreased cartilage on the articulating areas of a joint cause abnormal pressure on bone tissue. This can lead to decreased blood flow, growth of bone spurs, development of microfractures, and a state of fairly constant bone repair and remodeling. This state of constant repair often results in a continued cycle of inflammation within the joint, which ultimately leads to an over-excitability of pain receptors. Oftentimes pain will occur during daily activities involving use of the affected joint, so people will in turn avoid the activity, making them weaker and eventually unable to perform the activity. This cycle is then repeated and over time, people may notice they are unable to do simple things like stand up out of a chair or climb stairs without severe pain.
I often get the question, “How is PT going to help my arthritis? I thought cartilage doesn’t grow back.” No, articular cartilage does not regenerate, and unfortunately, physical therapists do not have a magic cartilage wand. What PT does do, however, is help you determine the sources of your pain, reduce inflammation in the affected joint, and address modifiable risk factors. I educate my patients about the appropriate levels of activity for their individual goals, work to improve their strength and flexibility, and address faulty movement patterns that put their joints at increased risk. Another important focus is modifying certain activities or positions to make them more efficient or manageable for a specific impairment. Finally, there are several manual therapy techniques that I perform to help reduce overall pain, such as joint mobilization, soft tissue massage, dry needling, and more.
If you have been diagnosed with pain related to OA, it is important for you to know what the appropriate actions are to take so that you can reduce its effects on your daily life. A skilled physical therapist can help you reduce pain and determine which of your modifiable risk factors can be improved. From that point, the two of you can conceive a plan moving forward to keep you living the life that you want without the fear of constant pain.
Data obtained from the following article:
Neogi, Tuhina, and Yuqing Zhang. “Epidemiology of OA.” Advances in Pediatrics, U.S. National Library of Medicine, Feb. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3545412/.