Are you constantly bothered by aches and pains, think it just comes with age and that there is nothing you can do about it? It may be arthritis. Arthritis is not a single ailment. In fact, more than 100 different conditions can affect the joints and their adjacent bones, muscles and tissues. They are classified into various major types of arthritis, depending on whether or not inflammation, infection or bleeding is the major component. All of these types of arthritis are completely different with different presentations, symptoms and treatment so in a true arthritis there should be inflammation of the joints and should be some joint damage. Different types of arthritis can affect different age groups, some more than others. Usually, when someone refers to arthritis they refer to osteo arthritis or osteo arthrosis. There are many reasons and many different variety of arthritis. Rheumatoid arthritis and psoriatic arthritis are autoimmune diseases in which the body is attacking itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation.
The most common form of arthritis, osteoarthritis is also known as degenerative joint disease. Osteoarthritis develops in a joint when cartilage, the smooth shiny tissue that lines and cushions the ends of the bones inside a joint, begins to break down.
This can happen from:
- Prolonged "wear-and-tear" as we age
- Prior injury or damage to the joint from trauma or infection
- Cartilage that is altered by other diseases or is genetically weak.
There is emerging evidence that abnormal anatomy including obesity may contribute to early development of osteoarthritis. However, in most cases we simply don't know what causes it.
Unfortunately, damaged cartilage cannot heal to become normal again, though tremendous research is underway developing methods to restore damaged cartilage.
However, in most cases we simply don't know what causes it. Unfortunately, damaged cartilage cannot heal to become normal again, though tremendous research is underway developing methods to restore damaged cartilage. When the cushioning system of the joint is lost, the bones may grind painfully against each other. The joint can begin to stiffen, and movement is impaired. Though it is called arthritis no real inflammation is responsible for the joint damage so the term arthrosis rather then arthritis is gaining popularity. This is the leading cause of disability in people over the age of 55.
Pain is the main characteristic of arthritis. Osteoarthritis is classically worse at night or following rest. Many people despite having severe osteoarthritis changes in a joint, they experience very little, or no pain at all. This is what we will try to explain. Knee pain is just a symptom, it does not necessarily mean arthritis, and even x-rays shows some arthritis changes. If we take one hundred people walking on the street, same age and sex, and x-rays were taken of them all, every one of them would show some arthritic changes but very few of them complain about pain. Pain in the knee may come from other sources. For example, if a knee is not tracking properly it can cause pain which can be resolved manually.
For this article we will consider the most common type arthritis, osteo arthritis, of hip & knee joints
The goals of any treatment plan for OA include:
Controlling pain and other symptoms Improving your ability to function in daily activities Slow the disease's progress
Most treatment plans will include a combination of the following elements:
Physical and occupational therapy
In severe cases, when the therapies above don't work, surgery may be considered. Today, the only effective treatment for broken cartilage is a knee replacement, and most doctors do not recommend this until almost all the cartilage is gone and knee pain is so severe that it disrupts a person's life. Besides medication, physical occupational therapy can play an important role in management of osteoarthritis.
Physical therapists have a depth of knowledge of musculoskeletal problems, the knee is no exception. As there is no cure, management is a better term.
Controlling pain: Modalities like hot/cold packs, ultrasound, and e-stem e.t.c are usually used to control pain & swelling.
Low Level Laser therapy has a significant and dramatic affect on pain, inflammation & swelling.
Controlling biomechanical contributing factor
Stresses to the joint are reduced while joint movement and alignment are improved. Think of it like a car whose wheels need to be properly balanced and aligned in order to decrease wear and tear and help them to last longer. Due to the way the hips, knees and ankles are aligned, most osteoarthritis occurs in the middle part of the knee first. In order to decrease pressure in this area and slow the progress of osteoarthritis, an unloading knee brace may be used. Similarly, a lateral wedge foot insert may be worn in the shoe. By tilting the ankle, the forces at the knee are modified so that the middle portion is unloaded. Some people have tried using knee wraps such as neoprene sleeves. It is thought that improved proprioception allows for better control over the area, thereby improving function.
Strengthening is important since muscles help protect joints by controlling motion, thereby decreasing pressure on the joint. In knee osteoarthritis, the muscles of the thigh (quadriceps) usually require strengthening. Quadriceps is responsible for straightening the knee and, therefore, is important in controlling the movement of this joint. Like strengthening, Proprioceptive training allows for better control of joint motion, which helps with joint shock absorption. By having a better sense of where the joint is in space, one is able to move the body with more control and therefore more safely.
Use of walking devices:
We have seen people often refuse to use walking aids thinking that this is a sign of old age or disability but walking or gait aids such as a cane or a walker are used to help unload the joints. This improves function as well as slowing down joint damage and progression of disease.
Occupational therapy helps with activity modification with creative ideas and helps with energy conservation. The goal is to use available activity and energy as efficiently as possible in order to maximize work that can be done. Examples include taking more breaks and grouping tasks so that unnecessary walking is minimized.
Analgesics, topical analgesics, and NSAID can be used to aid in treatment. Most people with osteoarthritis will use drug therapy to ease the symptoms of the disease. Most drugs focus mainly on relieving pain, but some are targeted at other symptoms and slowing disease progression.
Injectable glucocorticoids are steroids that are injected into the joint for fast, targeted pain relief. Single injections can relieve pain and swelling and appear to be safe, but many studies show that repeated injections can damage joints and delay healing. Most doctors will recommend having no more than three injections into the same joint in a lifetime.
A study presented at the Annual Meeting of the American Academy of Orthopedic Surgeons shows that Synvisc injections are as effective as steroid injections in controlling the pain of damaged cartilage in the knee. Synvisc costs around $5000, compared to five dollars for steroids. Synvisc (the brand name for hylan is a gel that is injected three times into the knee to serve as a padding to cushion broken cartilage. The benefits of gel last only up to about six months
Key to successful arthritis management
Having a diagnosis does not mean you have to live with pain. A single method of management does not work like only medicine or injection. Individualized programs need to be established and followed.
The great outdoors provide op¬portunities to burn extra calories.
Increase your Range
Range-of-motion exer¬cises are a good way of keeping muscles and ligaments flexible and strong.
Every extra pound adds 4 times the stress to your knees.
Calcium rich foods keep your bones sturdy, and Vitamin C and other antioxidants reduce the risk of os¬teoarthritis and other diseases. At Synergy Therapeutic Group we find all contributing factors and take a holistic approach to produce amazing results! Give us a call to see what can be done about your pain.
When I started four weeks ago my pain was a 9, and I had difficulty getting up and down the stairs. It was very painful to do my daily activities. I couldn't even shop. Now I am excited to shop and do the things at home. Now I have my pain down to about a 1 or 2 and I am now sleeping throughout the night.