What is arthritis?
Arthritis is a term that relates to changes in the structure of a joint that may be associated with pain. Osteoarthritis is the most common form of Arthritis and the leading cause of pain, disability and early exit from the workforce for Australians. Common joints affected are the hip, knee, spine, shoulder and ankle. This may cause symptoms of pain, stiffness and swelling of the affected joint or joints. This is caused by inflammation of the bone that underlies the cartilage (cushioning of the joint). Joint pain often leads to activity limitation, sleep disruption, emotional distress and loss of quality of life.
People’s beliefs about their joints can have an important impact on how they use their body. Although, there is often a poor link between changes on an X-ray and symptoms, there is a common belief that the symptoms of Osteoarthritis are solely due to joint damage such as loss of cartilage and degeneration caused by wear and tear. People are often told that their joint has worn out and that they have ‘bone on bone’. The belief that Osteoarthritis is caused by ‘wear and tear’ can result in concerns that weight-bearing activities will increase joint damage and therefore, pain. This can have a strong impact on activity levels, social, work and leisure participation, as well as emotional wellbeing.
Contrary to popular belief, current research describes Osteoarthritis as a ‘whole person condition’, in which the person’s pain experience is influenced by several biological (thigh muscle weakness, findings on the scan, inflammation), psychological (low confidence, unhelpful beliefs, stress, depressed mood), social (work and sport demands), and lifestyle (poor sleep, low or excessive levels of physical activity, carrying excess belly fat, poor diet) factors that can create inflammation, that make the joint sensitivity, swollen, stiff and sore.
How common is it?
Osteoarthritis is the most common joint disorder worldwide, affecting approximately 10% of the population. In Australia, Osteoarthritis affects 2.2million people (9% of the population), and is projected to affect 3.1 million by 2030. Osteoarthritis is more common in people over the age of 45. However, younger adults can present signs and symptoms of Osteoarthritis; this tends to be more common in those who have suffered traumatic joint injuries such as a knee sprain that caused a tear of the Anterior Cruciate Ligament (main ligament in the knee joint).
Risk factors for arthritis:
There are several factors that relate to osteoarthritis such as previous traumatic injury or surgery to the joint, having had multiple steroid injections to the joint, carrying excessive belly fat, muscle weakness, inactivity or over-activity and depression.
Other factors known to be a risk factor for osteoarthritis can include: having a negative mindset about the joint (“my knee is bone on bone and exercise will damage it further”), high levels of stress, worries or anxiety, low mood, fear of pain and or movement, avoidance of movement and activity, resting too much, carrying excessive weight (especially around the belly). These factors can cause changes to the nervous system and the bodies chemistry making the joint’s structures very sensitive. Overprotecting the joint by not using the body part (avoidance of lifting the shoulder or weight-bearing on the sore leg) can also be unhelpful, create unnecessary tension and joint sensitivity, leading to more pain.
What usually causes a joint to flare-up?
Pain flare-ups are common and can be debilitating and scary. Surprisingly, flare-ups are usually predicted by things like being run down, unwell, inactive, stressed, doing unaccustomed activity and not sleeping well…not by damaged tissue within the joints.
Myths about arthritis:
✖ Arthritis always causes pain and disability
✖ Arthritis gets worse over time
✖ Arthritis pain is caused by joint damage
✖ Exercise and loading arthritic joints makes them worse
✖ Arthritic joints need to be rested
✖ Arthritic joints need surgery to treat the pain
Facts about arthritis:
✔ The amount of arthritis on a scan is a poor predictor of pain and disability
✔ There are multiple individual trajectories of arthritis
✔ Belly fat, muscle weakness, protective muscle guarding, lack of confidence of using the joint are stronger predictor of pain and disability than joint changes on a scan
✔ Exercise that gradually loads the joint is not harmful for the joint
✔ Moving the joint and strengthening the muscles around the painful joint reduces pain and improves functional capacity
✔ Getting fit, strong and normalising the way you move helps
✔ A 10% reduction of body weight (if you are over-weight) results in a 50% reduction in pain!
Treatment of arthritis:
Physiotherapy plays an important role in the treatment of Arthritis. At Body Logic Physiotherapy we have world-leading clinical researchers in the treatment of Arthritis (link to POS, JP). Our approach to treating Arthritis is centred at the person, their health and their goals. The treatment aims at improving quality of life and the joint’s health by targeting modifiable factors that influence the person’s pain experience.
The first and most important thing for us is to take time to hear your story and pain experience in your own words. We want to know how your pain feels to you and how it impacts on all aspects of your life so we can help you get back doing what you like. We will also ask you about your sleep, activity levels, your lifestyle and goals, so we can help you get healthy and get back doing things that are important to you. We will also screen you to ensure the pain isn’t caused by serious health problems.
Following this we will conduct a comprehensive examination. This will usually involve looking at where you hurt, how sensitive your body is to touch and movement, we will look at your ability to relax and move your body as well as assessing your strength and fitness if this is indicated. The examination and treatment will be tailored to each person’s pain and sensitivity levels.
Based on all the information from the examination we will explain to you in simple language the factors that are contributing to your pain, and discuss the best treatments options available to you. Current guidelines recommend the provision of personally-relevant education, prescription of targeted exercise therapy and physical activity aligned with patient’s goals; and weight loss.
At Body Logic we are not interested in ongoing band-aid treatments. Treatments such as manipulation, massage, needling, medication, injections often only provide short-term pain relief. We know that the best way to manage joint pain is to help you understand why you have pain, and get you back in control, moving, active and living again. It’s really important to get you fit, confident and strong as this results in pain relief and increased functional capacity. We are interested in coaching patients to develop confidence to exercise and engage in regular physical activity, this can be done either in a group environment or in an individualised manner. For knee and hip arthritis, we offer the GLA:D program. We also encourage patients to adopt healthier lifestyles including weight loss when appropriate.
People with osteoarthritis can often present other health conditions such as cardiovascular disease, type 2 diabetes, depression, sleep apnea and obesity. Therefore, a team approach including GP, Physiotherapist, Dietitian and Psychologist may be necessary to co-manage this condition and its health impact.
At Body Logic Physiotherapy we aim to coach people to get back in charge of their joints and their health.