You’re fifty-five years old and your knee has been bothering you off and on for the last three years. It has progressed to the point that you finally decided to visit the doctor. After an hour in the waiting room and a set of x-rays, the doctor has his report. You have osteoarthritis (OA), or “bone on bone” as the doctor puts it. It’s a progressive disease and there is nothing you can do about it. The doctor suggests taking an anti-inflammatory medication to help with the pain, trying to lose some weight, and staying active. If none of that helps, you can get a brand new knee in a few years. Some variation of this conversation happens everyday as OA affects an estimated 30 million Americans. That number would rise quickly if you included those who have not been officially diagnosed.
What is OA?
Osteoarthritis is a progressive, degenerative disease that leads to destruction and inflammation of all components of a joint. Pain is experienced when the two bones of a joint rub together, a result of the wearing away of the cartilage covering bones. This is why you often hear OA described as “bone on bone” by many doctors. OA is multifactorial, tied closely to an individual’s weight, activity level, previous injury, and other factors. If the pain from OA becomes unmanageable, a joint replacement may be indicated. This is typically the last course of action following physical therapy and possibly medication injections to relieve the pain.
Who gets OA?
Symptomatic osteoarthritis is common in individuals greater than 65 years old, but often occurs earlier, especially if you have a previous injury to that joint. (For example – After suffering a back injury and undergoing medical imaging in high school, this author was told that he had the beginning of OA in his lower back.) Due to the nature of the disease everyone will have some degree of OA in their lifetime. What we focus on in physical therapy is alleviating the symptoms that often accompany OA, primarily pain. It is common for people to begin experiencing pain or other symptoms of OA in their 40s and 50s, but they are often not officially diagnosed until the disease has progressed to the point of seeking medical attention. The earlier an individual sees a health care provider (like the physical therapists at Mobility Fit!) the more effectively OA is able to be managed.
How do I know if I have OA?
Diagnosis of osteoarthritis is done with medical imaging (X-Ray, MRI), typically after a patient reports one or more of the following symptoms to their health care provider:
- Increased pain with activity, particularly weight-bearing activity such as walking or going up and down steps
- Pain of stiffness in the morning, or after periods of inactivity, that eases in 30 minutes
- Joint sounds (popping, cracking, etc) when moving the joint
- Diminished movement at that joint
- Swelling and other signs of inflammation
These symptoms usually appear gradually over the course of months or years and often cannot be pinpointed to a particular event.
How can we help?
Osteoarthritis is unable to be “cured,” but many treatment strategies aimed at symptom resolution have been proven effective by research, including those delivered by physical therapists. The evidence is strong enough to lead to recommendations for physical therapy as the frontline treatment for OA by the American Physical Therapy Association (APTA), the American Academy of Orthopaedic Surgeons (AAOS), and the Arthritis Foundation, amongst many others. Whether your symptoms are recent, or have been ongoing for years, give us the chance to get you back to pain-free movement again!
What does physical therapy for OA look like?
Your physical therapist will begin with a comprehensive evaluation of your current level of function. We will start by listening to your story about OA, and its effect on you. This is paired with measurement of the motion and strength of the affected joint, along with an analysis of how you move your body as a functional unit. Following your assessment we will examine your results together and develop a plan to get you back moving and doing the things you love!
Below are some of the areas of focus during therapy, each employed by the highly trained physical therapists of Mobility Fit.
Motion: Anytime we are unable to move optimally we place ourselves at risk of experiencing pain and other movement deficits. Since our body is more than the sum of its parts and we must not only restore normal motion to your affected joint, but to your body as a whole. This may require a focus on restoring one area to full, pain-free motion initially, but will end with you learning to move as a functional unit. This restoration of movement will be facilitated by highly skilled implementation of manual therapy, HawkGrips, and dry needling.
Strength: Our joints work much like a suspension bridge, which requires strength oriented in many directions to provide the proper amount of support. When we develop muscle weakness or imbalances we compromise that support system. This leads to an inability to manage the stress placed on our joint during the activities we choose. By strengthening the muscles around a joint we are able to both decrease and more effectively distribute the pressure on our bones, thus resulting in decreased pain. Strengthening at Mobility Fit involves skillful selection and progression of exercises with results amplified by the use of blood flow restriction training.
Home program: Although we enjoy working with all of our clients, we don’t expect you to attend therapy forever. In order to facilitate your recovery and prepare for life without your Mobility Fit therapist, we will design an exercise program for you to complete on the days you don’t see us. Not only will we teach you how to perform these exercises, but we will also teach you how to monitor your own performance and become an expert of your own movement. This will allow you to stay ahead of your OA at every turn, and if you need us again, we will only be one call away!
References
The Arthritis Foundation. (2018). Physical Therapy for Arthritis. The
ArthritisFoundation. Retrieved from https://www.arthritis.org/livingwith
arthritis/treatments/natural/other-therapies/what-is-physical-therapy.php.
Bise, C. (2013). Physical Therapist’s Guide to Osteoarthritis. The American Physical
Therapy Association. Retrieved from https://www.moveforwardpt.com/
SymptomsConditionsDetail.aspx?cid=e46bb793-4cfa-48ec-9821 ceba2d4c54ab.
Brown, G. A. (2013). AAOS clinical practice guideline: treatment of osteoarthritis of
the knee: evidence-based guideline. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 21(9), 577-579.