By Fatima Suleiman Halilu and Maryam Bashir Galadanci
Osteoarthritis (O.A), popularly known as a degenerative joint disease (DJD) is commonly defined as the gradual ‘’wear’’ and ‘’tear of the protective tissues at the end of bones that occurs over time with aging. Recent research and clinical evidence have shown that O.A is beyond ‘’ wear’’ and ‘’tear’’ and is an interplay of Physical, biological, and mechanical factors that affects the repair of joint cartilage (protective soft tissue for shock absorption) and surrounding structures leading to changes in joint structures. It is the most common type of arthritis and a major cause of pain in the elderly.
Osteoarthritis affects over 520 million people globally. According to research, there has been a 48% increase in osteoarthritis cases from the year 1990 to the year 2019 and the figures are expected to rise in the coming years. It is a major cause of disability in developing and developed countries and is expected to increase as the population ages. In age groups below 50yrs, men are more often affected, while in the older population the disease is more common in women with a ratio of 2:1 (due to a decrease in sex hormones with menopause). Research on the prevalence of O.A in Africa remains scarce, but a study carried out in South Africa revealed 55.1% of those affected in the urban population and about 87.2% in the rural population are adults aged 65 and above. A certain study on reported cases in healthcare facilities in Nigeria estimated that about 3.3 -7.1% of the population of the country have O.A. This figure is however believed not to be the true value of the cases in the community as there is still little awareness of the condition and more research needs to be carried out.
Osteoarthritis can affect any joint, but the most commonly affected of them are the weight-bearing joints (knee, hip, and spine). With aging over time and repetitive weight bearing on these joints, they start to deteriorate in function. Knee O.A accounts for about 60% of diagnosed O.A cases.
There are two types of O.A: Primary O.A and secondary O.A. The causes of primary O.A are still unclear but genetics is believed to play a role in it. Secondary O.A is caused by s specific triggers that exacerbate cartilage breakdown. Examples of such triggers are joint, injuries, metabolic and inflammatory diseases, Inactivity, and Abnormal mechanical forces.
Signs and symptoms include Pain, stiffness, limitations in movement, a snap/crackle and pop Sound (crepitus) while moving the joints, Muscle weakness, Mild Swelling, tenderness and decreased quality of life. Some joint-specific symptoms might also set in.
Risk factors include Age above 45, Female gender, Overweight or Obesity, Genetics, Trauma or injury to the joints, repetitive stress, sports injuries, joint malalignment, Bone deformities, Occupations that involve certain repetitive movements like bending and prolonged standing, and living a sedentary lifestyle.
Complications that might arise due to O.A include Loss of muscle bulk(atrophy), joint instability, joint deformity, balance impairments and fall risks, neurological symptoms, disability, and depression.
Osteoarthritis is diagnosed through detailed patient history taking, physical examinations, and some special tests. An X-ray may sometimes be done to determine the extent of changes in the affected joint or to eliminate other similar conditions like gout arthritis. CT and MRIs are rarely done. Lab tests might also be carried out if there is a need to rule out conditions like septic arthritis and rheumatoid arthritis.
Osteoarthritis is a chronic, progressive lifelong condition that cannot be cured. Symptoms can, however, be managed conservatively and the disease progression slowed down through the use of medications, supplements, intra-articular injections, diet, lifestyle adjustments, weight loss, and Physiotherapy. In severe cases, joint replacement surgery might be required.
The World Health Organisation recommends Physiotherapy as the first line of management for osteoarthritis. Physiotherapists are specialized health care professionals concerned with improving human function, and movement and maximizing physical potential. On September 8th each year, World Physiotherapy (formerly the World Confederation of Physical Therapy, WCPT) marks World Physiotherapy day as a day to celebrate the profession worldwide and create awareness of health issues concerned with the profession. The 2022 World Physiotherapy theme is ‘’Osteoarthritis and the role of Physiotherapy’’.
Physiotherapists play a vital role in the management of O.A. Their roles span from preventive, to conservative management to pre-and post-joint replacement surgery management. In the preventive stage, Physiotherapists educate patients, clients, and the general public on, the causes, effects, and risk factors of osteoarthritis. Modifiable risk factors like being overweight/ obese and sports injuries can be addressed and managed by a Physiotherapist. Preventive measures are also given.
The conservative role of physiotherapy in osteoarthritis is aimed at slowing down the disease progression, preventing occurrences in other joints, fall prevention, and management of symptoms like pain, swelling, joint stiffness, joint instability, tenderness, impaired mobility, or balance. Physiotherapy also helps improve muscle strength, joint motion, and flexibility, and encourages participation in daily activities with ease. Additionally, Physiotherapists encourage weight loss and design exercises to cater to that. All this ultimately improves the patient’s quality of life. Methods and techniques applied to achieve this include Range of motion exercises, muscle strengthening exercises, stretching exercises, balance exercises, aerobic exercises, functional activity exercises, manual therapy, joint mobilizations, hot and cold therapy, electrotherapy, hydrotherapy (exercises on water) Muscle energy techniques, use of orthotic devices like a knee brace, splint, neck collar, use of a cane and other mobility aids. The type, frequency, and intensity of the exercises, treatment plan, and materials used are dependent not only on the joint structures and muscles affected or the extent of their affectation but also on other factors like the Patient’s goals, age, gender, occupation, body mass index and the presence of other medical conditions. lifestyle. activity level, exercise tolerance, and sometimes beliefs influence management plans. A well-detailed history taking, physical assessment, investigations, and special tests will help your Physiotherapist design a personalized treatment plan that best suits you. These treatment plans are progressive and will usually get improved or adjusted over time with patient improvement or lack of it. Your Physiotherapist will also advise you on a diet, lifestyle adjustments, coping strategies, proper posture, ergonomic/workplace adjustments, and practices.
In cases where conservative management like Physiotherapy fails or certain symptoms and complications set in, Surgery is required. Physiotherapy plays an important pre-and post-operative role in joint replacement surgeries. In the pre-operative phase, patients are assessed holistically and educated on what to expect after surgery including precautions to take and absolute restrictions. They are informed of symptoms to expect like pain, possible swelling, restricted movement, and muscular weakness and how their Physiotherapists can help address them. Their goals are being put into consideration and they are being taught bed exercises and safe transfer methods.
Physiotherapy may commence a few hours after surgery taking into consideration the general health status of the patient and the type of surgical procedure done. A Physiotherapist would perform a detailed assessment and design an appropriate treatment plan according to patient needs, goals, and capabilities. This aims to promote patient independence, address post-surgical symptoms, prevent complications, improve the general health status of the patient and reduce hospital stay. Strengthening exercises, aerobic exercises for improved cardiovascular function, mobility and transfer training, balance and coordination exercises, and walking re-education are among the strategies employed by Physiotherapists post-joint replacement surgeries. Your physiotherapist will be responsible for training you to make use of assistive aids like a wheelchair, walking frames, and canes, graduating you in stages and eventually weaning you off to encourage functional independence. In-patient discharge rules and outpatient appointment sessions for follow-ups, monitoring, and progression are usually given to patients. This has proven to improve the outcome of surgery.
For consultations, and more information about Physiotherapy and Osteoarthritis, contact the nearest Physiotherapist to you. Also, check www.world.physio/wptday and https://nsphysio.org/.
MYTHS VS FACTS:
| MYTH |
FACT |
| O.A is a disease of old age |
While most cases of O.A are diagnosed from ages 45 and above, younger people do get O.A |
| Exercises and activities worsen O. A |
While certain movements, exercises, and activities might worsen O.A symptoms, a carefully planned exercise regimen by a qualified Physiotherapist can help manage the symptoms of O.A and improve quality of life. |
| O.A is caused or triggered by cold weather |
There is no evidence that cold weather causes O.A. However, people are more likely to be inactive during cold seasons. This triggers O.A symptoms in an already affected joint |
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Fatima Suleiman Halilu PT, and Maryam Bashir Galadanci PT, are members of Kano State Chapter of Nigeria Society of Physiotherapy (NSP)
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