What is osteoarthritis?

This sheet has been written for people affected by osteoarthritis (OA). It provides general information to help you understand how osteoarthritis affects you and what you can do to manage it. It also tells you where to find further information and advice.

About OA

Osteoarthritis is a disease that affects the whole joint including bone, cartilage, ligaments and muscles.

Osteoarthritis may include:

1. Inflammation of the tissue around a joint

2. Damage to joint cartilage – this is the protective cushion on the ends of your bones which allows a joint to move smoothly

3. Bony spurs growing around the edge of a joint

4. Deterioration of ligaments (the tough bands that hold your joint together) and tendons (cords that attach muscles to bones).

Osteoarthritis can affect any joint but occurs most often in the knees, hips, finger joints and big toe. Osteoarthritis can develop at any age but tends to be more common in people aged over 40 years or those who have had joint injuries.

Osteoarthritis is different to osteoporosis. Osteoporosis is a condition where the bones become fragile and brittle, causing them to break more easily.

What are the symptoms?

The symptoms of osteoarthritis vary from person to person. Your symptoms will also depend on which joints are affected. Osteoarthritis tends to come on slowly, over months or even years. The most common symptoms are pain and stiffness of the joints. These sensations are usually worse with activity initially but can be more constant in later disease. These symptoms may affect your ability to do normal daily activities, such as walking, climbing stairs and opening jars. Other symptoms may include clicking noises, grating sensations, or a loss of flexibility in a joint.

What causes it?

Research shows there are some things that may put you at more risk of developing osteoarthritis in certain joints, such as:

knees: being overweight; having a previous knee injury; jobs involving kneeling; climbing and squatting

hips: being overweight; having a previous hip injury; jobs involving lifting heavy loads (including farming); a family history of OA

hands: a family history of osteoarthritis; repetitive use or previous injuries to the hands; being overweight

How is it diagnosed?

Your Physiotherapist or Doctor will diagnose osteoarthritis from your symptoms and a physical examination. An x-ray may show the narrowing and changes in the shape of your joint. However x-rays do not diagnose how much trouble you will have. An x-ray that shows joint damage does not always mean you will have a lot of pain or problems. On the other hand your joint may be very painful despite x-rays being normal. Blood tests are only helpful to rule out other types of arthritis.

What will happen to me?

The impact of osteoarthritis on your normal activities and lifestyle depends on which joints are affected. However the outlook for most people with OA is very positive. For many people OA will be mild and not cause major problems. Osteoarthritis of the hip and knee can sometimes cause severe disability and surgery to replace joints may be necessary. Joint surgery is usually only an option if less invasive treatments, such as weight loss, exercise, and medicines, have failed to control your symptoms.

Is there a cure for OA?

Currently there is no cure for osteoarthritis. While there are treatments that can effectively control symptoms, you should be wary of products or therapies that claim to cure OA.

What treatments are there for OA?

Treatments for osteoarthritis vary depending on which joints are affected and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. Each treatment has its own benefits and risks. Your doctor may need to trial several different treatments before finding the one that is right for you.

In general terms, treatment usually includes:

1. A weight loss program, if you are overweight an exercise program tailored to your condition and ability

pain relief, using medicines such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), as well as newer psychological approaches devices such as braces, walking sticks, and insoles, joint replacement surgery, if your symptoms are no longer controlled with other therapies, including weight loss.

Why Exercise is GOOD for Osteoarthritis:

How can an Exercise Professional HELP your Osteoarthritis:

How to start exercising:

If you have done little exercise or muscle strengthening in the past, or need motivation or confidence, it is recommended you see a physiotherapist or exercise physiologist. These health professionals can help design a program that’s right for you and help you stay on track. A health insurance fund or Medicare may cover some of these visits.

Recommended physical activity for adults with osteoarthritis

What type of exercise is best?

The best type of exercise program for someone with OA depends on their overall health, what activities they like to do, which joints are affected, and how badly affected these joints are. Research has shown that strengthening exercise seems to be just as effective as aerobic exercise, such as walking.

Strengthening exercises are best combined with aerobic, range of motion and stretching, and functional balance exercises to form a complete exercise program.

It is especially important for people with OA that exercise is not high impact, such as running, as high impact exercises are likely to cause increased joint pain.

Many health clubs, swimming pools and community centres offer exercise programs for people with physical limitations including OA.

Starting an exercise program

Starting a new exercise program can be overwhelming, but just remember to start gradually and to make it as enjoyable as possible. For people with OA, there are a few additional things to remember:

Ask your physiotherapist, exercise physiologist, doctor or personal trainer to devise a program that best suits you.

A physiotherapist, exercise physiologist or personal trainer can help set up and progress an exercise program, teach you how to exercise safely within your limits, teach you how to avoid pain and injury and advise what sort of exercise is best for your joints.

Begin slowly and progress gradually

Aim for a gradual progression in exercise intensity, complexity and duration. Here are a few suggestions when starting a new program:

Stretch and warm up with range of motion or gentle stretching exercises.

Start strengthening exercises slowly with small weights (a 1-2 kg weight can make a big difference) and build up resistance gradually over time. Gradually increase the time and intensity of aerobic exercises. Make sure the exercise is appropriate

You don’t want to place undue stress on the joints affected by your OA. Activities that involve high impact, such as running or jumping, may worsen OA, especially in the knees and hips. Instead, try low-impact exercise such as water exercise or cycling. Avoid those activities that involve rapid repetitions of a movement. Seek advice from a physiotherapist or exercise physiologist if you have any questions about the right types of exercise to do.

Ease off if your joints become too painful

Some people may think that if they feel pain during exercise that this is damaging the joint and making the osteoarthritis worse – this is not the case and it can be normal to feel some pain or discomfort during exercise. However, if you feel excessive pain during exercise or prolonged excessive pain for more than a few hours after the exercise, ask your health or exercise professional for advice.

Pain and exercise

Moving the joints during exercise can cause pain and this may turn some people off exercise. Some people may have pain before they exercise, and the thought of making the pain worse may discourage them from exercise. However, if you do feel pain during or after exercise, don’t use this as an excuse not to exercise.

Without exercise, your joints can become even more stiff and painful. Your muscles may become weaker and may not be able to support and protect the affected joints. If you’re in pain, you may feel depressed and this may make you even less like moving or exercising – but if you don’t exercise, you may feel even more pain and more depression.

If you need help, talk to your doctor or a physiotherapist so they can develop an exercise program that is less likely to cause joint pain. Also find specific methods of pain relief which will work best for you before or after exercise.

The following methods may be helpful;

Moist heat, such as hot packs, a bath, sauna or a shower can help relieve pain. Icing the knee may help control knee pain or swelling. You can either use a commercially available ice pack, or make an ice pack yourself but it is important to have a pack large enough to cover the knee joint swelling.

To make an ice pack:

Wet a towel and ring out the excess water. Place crushed or chipped ice or ice cubes on the wet towel and fold the towel over to make a pack. Make the pack on a flat area for a smooth pack. Alternatively 2 large packs of frozen peas can be used (side by side). Place the ice pack on your knee and mould it in place. Check after every 5 minutes for excessive redness, unusual skin reaction or if you feel generally unwell. If none present, continue the application for another 15 minutes.

Hydrotherapy, or water therapy, can decrease pain and stiffness.

Relaxation therapy or meditation can help you deal with pain and reduce muscle tension.

If you are taking pain medication, you could do the exercise shortly after your medication. Talk to your doctor about how best to time your exercise with your medication.

How much exercise is too much

Your exercise program may need to be reduced if you notice pain that lasts more than two hours after exercising, increased night pain, increased joint swelling, abnormal or continuing fatigue, increased weakness or decreased joint function. Consult your doctor, physiotherapist or exercise professional for advice about how to adjust your exercise program.

Become more active in everyday life

In addition to doing specific exercises, it is beneficial for your OA and for your general health to increase your overall levels of physical activity during everyday life.

There are lots of ways to make changes to how you do certain routine tasks that will add up to important increases in your daily activity. Some examples include parking at a far end of a shopping centre parking lot, walking around during TV ad breaks, and going up and down every supermarket aisle. Small increases in daily physical activity levels can add up and make a big difference.

Activity pacing

Many people with OA have a tendency to overdo or push themselves and keep doing an activity until they can’t tolerate the pain any more. This can then result in a prolonged period of rest. After resting and feeling better, the person overdoes it again or decides not to do the activity at all.

This cycle repeated over many times can have negative consequences such as increased tension and anxiety, avoidance of activity and increased symptoms.

A better way is to pace your activities so that you do moderate activity followed by only limited rest. Work out how long you can comfortably do a particular activity and then stop at that time point. More frequent short bursts of activity work best for people with OA. Doing this can help you control the symptoms rather than the other way around.

Exercise doesn’t need to be done in a single session. A 30 minute walk for example can be split into three 10 minute walks. Altogether, aim for 30 minutes of moderate intensity lifestyle activities throughout the day on most days of the week.

References:

painHealth – http://painhealth.csse.uwa.edu.au/ (2015)

Zhang W, Moskovitz R, Nuki G et al. “OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines”, Osteoarthritis & Cartilage 2008;16:137-162.

Williams NH, Amoakwa E, Burton K et al. “The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis”, Br J Gen Pract 2010;60:64-82.

Fransen M, McConnell S. Land-based exercise for osteoarthritis of the knee: a metaanalysis of randomized controlled trials. J Rheumatol. 2009 Jun;36(6):1109-17. doi: 10.3899/jrheum.090058. Epub 2009 May 15.

U.S. Department of Health and Human Services “The Physical Activity Guidelines Advisory Committee Scientific Report” http://www.health.gov/PAGuidelines/Report/pdf/CommitteeReport.pdf