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Not today, OA (osteoarthritis)

Writer's picture: Dr. Kira UnderwoodDr. Kira Underwood

Leah has worked all of her life to get to where she is today. She loves her career as a successful business executive and is financially doing well. Her husband of 5 years is more of a creative type, balancing out Leah’s type-A personality. They are knocking down one trip after another on their bucket list and love traveling more than anything. She has always worked out, had a balanced diet, and keeps the wine to 1 glass in the evenings to come down from the day. At 51 years old, she has been lucky enough to stay healthy and is loving life. Until her hip pain started. It seemed to come out of nowhere. She just felt stiff in the mornings or after sitting at her desk for a while. Eventually the groin pain got so bad, she called me. After our initial physical therapy evaluation, all signs pointed to osteoarthritis of her hip joint.


Osteoarthritis (OA) is the most common chronic joint disorder and one of the leading causes of global disability. According to the Centers for Disease Control (CDC), by 2040 over 1 in 4 US adults will have doctor-diagnosed OA. You can get OA in your hips, knees, ankle joint, joints in your spine called facet joints. There are many types of arthritis, which literally means inflammation (-itis) of the joint (arthro-). Examples include OA, rheumatoid arthritis, gout, juvenile arthritis, psoriatic arthritis, fibromyalgia and lupus. OA is the most common type by far, currently affecting more than 32.5 million US adults.


What is OA?

Pain and sometimes swelling in a joint(s) characterized by a decrease in cartilage between two bones. Often OA affects one joint more than the other side (i.e., right knee more than the left), limits range of motion, increases stiffness especially in the morning or after sitting for a while, and tends to have flare-ups or acute exacerbations if irritated usually by an activity.


How is OA is diagnosed?

Via radiographic imaging (i.e., x-rays) revealing minimized joint space, osteophytes (bone spurs), thickening of the bone (subchondral sclerosis), and cysts. PTs are also trained to use tests, measures and patterns of symptoms to identify if OA is likely the cause your pain.


What are the risk factors?

  • Females

  • Over age 50 - prevalance continues to increase with age

  • Prior injury, trauma, or surgery to the joint (50-90% of ACL injuries progress to OA!)

  • Obesity

  • Genetics

What is not a risk factor for OA?

Running, sports, and exercise! The concept of “wear and tear” of our joints is outdated. Research and science now indicate that is a false narrative. With the exception of contact sports with high injury rates, the physical activities of running, jumping, playing sports, and exercise in general is not only safe but encouraged for prevention of OA and even treatment.


What can you do if you have OA?

OA is progressive and degenerative in nature; there is no “cure”. However, there are actions you can take as a first line of defense which will increase your function, independence, and strength as well as decrease pain and fall risk.

  • Education. Pay attention to what activities cause a flare up as well as what eases pain. Read and learn about OA by the various, evidence-supported resources out there. See below for links to the CDC and various high-quality journal articles. Finally, talk to a healthcare professional who knows about OA like a physical therapist.

  • Weight loss and nutrition. If you’re overweight or obese, losing weight can reduce the physical load off of your joints. Making sure you avoid extreme fad diets and making long-term healthy lifestyle choices is key. A diet focused on lean protein, lots of veggies, a little fruit, and saving sugary processed foods as a special treat is a great start. A registered dietitian can help guide you. Or Weight Watcher’s is another affordable option for guided weight loss.

  • Physical activity. There’s a saying in rehab - “motion is lotion”. This means movement increases fluid in your joints resulting in improved quality and range of motion in your joints. The type of physical activity and exercise depends on your ability, preferences, accessibility, and what feels good. In general, OA responds especially well to low-impact, non-weight bearing activities like swimming, yoga, and the stationary bike.

  • Physical therapy (PT). PT can provide an individualized program to help provide education on OA and work with you to manage your symptoms. An individualized program can increase strength, improve balance to maximize function and keep you doing the things you love to do.

The second line of defense includes working with your PCP or orthopedic surgeon for more aggressive treatments such as oral pain and anti-inflammatory medications and corticosteroid injections. If all else fails, total joint replacement or other surgery may be indicated.


Take-aways:

  1. Osteoarthritis is extremely common and, to an extent, a normal part of aging.

  2. Diagnosed by X-rays (gold standard), OA is degeneration of the cartilage between two bones. But PT can help identify if OA is the likely culprit as well.

  3. Risk factors include being female, over 50, prior joint injury, obesity, and family history.

  4. If you have osteoarthritis with pain, actions you can take to decrease your symptoms include weight loss, physical activity and exercise, and physical therapy. General education about OA will also help.

Leah was able to get on a PT plan of care to address the impairments identified - weakness in the gluts, tight hip flexor muscles from sitting all day at work, and limited range of motion in her hip. We were able to set her mind at ease by identifying the problem, the solution, and plan of action to get to her goals. She is not 0/10 pain 100% of the time; but the pain is minimal to none most days and she just returned from a trip of a lifetime in Asia.


If these risk factors and symptoms sound familiar, schedule a PT evaluation to find out if OA is causing your pain and what you can do about it today.


Sources:


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