Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. Having had a few articles recently that have mentioned arthritis, such as our blogs on hip and knee replacements, I thought this time we could look into what arthritis is in a bit more detail, the causes, its effects and how physiotherapy can help with arthritis.

What is Arthritis?

The word arthritis is usually used to describe osteoarthritis but in fact there are two main types of arthritis: rheumatoid arthritis and osteoarthritis which are very different from each other. In general, when most people say arthritis they actually mean osteoarthritis. This blog will look at what is by far the most common form and that which as physiotherapists we will often come into contact with: osteoarthritis. We will go into more detail later but osteoarthritis is a process of degeneration of the cartilage in our joints and a subsequent inflammation of the joint.

What Cause Osteoarthritis?

To understand what cause osteoarthritis and the processes involved when someone gets osteoarthritis it is necessary to have a little understanding of anatomy and joints. Inside every mobile joint of the body and wherever bone will be moving over bone, as in the knee joint example in the picture there is cartilage. Between the femur (thigh bone) and the tibia (shin bone) there is cartilage.  

Cartilage reduces friction in the joint and helps shock absorption in situations such as landing on your feet after a jump. When you are younger and you haven't used and abused your joint cartilage will look like a nice smooth ice rink when a surgeon is having a look at your knee joint under arthroscopy. However as the aging process takes its toll this starts to wear out and it gets pitted and holes form in it. This process of wear leads to inflammation in the joint and sometimes swelling. Furthermore because the cartilage is thinner and the bones are closer together there is now increased load on the bones and as this process carries on bony spurs called osteophytes may develop which will often give the patient a great deal of pain. This process of wear and tear is called osteoarthritis (often shortened to OA); osteo meaning bone, arthro meaning joint and itis being the medical term for inflammation. Osteoarthritis is by far and away the main cause of joint replacements and is becoming a huge problem as our population ages.

Who Is at Risk of Osteoarthritis?

Now, although the actual process and mechanisms of osteoarthritis are reasonably well understood, who is most likely to get osteoarthritis is still a topic of research and much debate. Genetics are thought to have a large influence on whether you are likely to get osteoarthritis and if both your mum, dad and grandparents suffered with osteoarthritis it seems likely that it will also affect you. Weight and BMI is also linked to osteoarthritis and certainly people who are obese and very overweight are more likely to have problems with osteoarthritis. A common question that I get as a physiotherapist seeing people with arthritis is "Why doesn't everyone need a joint replacement at some point because of arthritis?" Well, as discussed above genetics are likely to be important and how your joints wear through your life may well largely be determined by genetic factors. For example if many of your blood relatives have all had arthritis that has required a hip replacement at 70, there is going to be a strong possibility that you too will need a joint replacement. As also mentioned, having a very high BMI (Body Mass Index) has also been linked to arthritis and certainly it makes sense that if you put more weight through a joint it will wear out quicker.

What Treatments are there for Osteoarthritis?

Currently this is a huge area of research and possibly in the future there will be cures for osteoarthritis but for now, all treatments revolve around managing the effects and symptoms of osteoarthritis. This sounds very negative but in fact there is a large body of research that shows that most of the symptoms can be very well managed if patients understand the condition of osteoarthritis. Below are some common methods of managing arthritis:

1. Education: Now I can almost hear some people groaning whilst reading this but calling education a treatment for osteoarthritis is not a cop out! Informing patients of the nature and details of their condition allows them to understand how best to self-manage their osteoarthritis and to understand what factors aggravate things.
2. Bracing: joints such as the wrist, elbow and knee can sometimes respond really well to using a supportive brace. There are many types and to know which brace would be best you would likely need an assessment with a physiotherapist.
3. Anti-Inflammatories: as osteoarthritis is an inflammatory condition it makes sense that anti-inflammatories might help reduce and manage osteoarthritis. If you are thinking of using anti-inflammatories you should seek medical advice first.
4. Supplements: there are a wide range of supplements out there that some people have found helpful with arthritis such as chondroitin but again I would suggest that you should seek medical advice first.
5. Acupuncture: for patients who are struggling to manage the pain from arthritis, acupuncture can be useful and certainly here at ThreeSpires Physiotherapy we have had patients who have experienced relief through acupuncture.
6. Exercise: a large number of studies have shown that exercise and strengthening of the affected joint can help with the symptoms of arthritis. This has been shown to be particularly effective in the knee and hip area. To find out which exercises would be best it would be necessary to have an assessment with a physiotherapist.
7. Physiotherapy: clearly I am biased but physiotherapy can help with management of osteoarthritis in a number of ways including education, knowing which exercises to use, and massage of any sore areas.
8. Steroid Injections: for patients who are struggling to manage the pain and have tried the options above, having a steroid injection can help reduce inflammation and pain.
9. Joint Replacements: for anyone who has tried everything but is still struggling having a joint replacement can be the last option. Orthopaedic surgeons commonly replace hips and knees for patients with severe arthritis.

There are currently being researched other options such as stem cell treatment but as the efficacy of these options is still being researched I think I will leave those alone for now.

I hope that you have enjoyed reading this blog post and found the information about osteoarthritis useful. If you have any questions about osteoarthritis, possible treatments or how physiotherapy might help please get in touch.

 For anyone reading this blog who hasn't come across our site before: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk