Physiotherapy for Arthritis

Physiotherapy is the primary treatment approach for hip and knee arthritis

Hip and knee arthritis (osteoarthritis) is very common in older Canadians, with about half of us having knee arthritis by the time we are 70, and one fifth having hip arthritis.  Osteoarthritis of the knee and hip are not just associated with aging. They can also occur in people as early as their 20s or 30s.

Many people use medication to manage their symptoms. While this can be temporarily helpful, medication is often not a long-term option and has not been shown to improve function. Current research tells us that our joint cartilage needs a certain amount of ongoing “healthy” load to function properly. Exercises that target correct alignment of the joints and strengthen the muscles that support the hip and knee can decrease pain and improve function. Education supports individuals with arthritis enjoying an optimal lifestyle by building:

• an understanding of the disease process,
• recognition of the importance of regular physical activity,
• strategies for self-management
• knowledge of best evidence for other treatment options

When pain is significant and causing a lot of changes in function, other physiotherapy approaches for pain management are very helpful. These include electrical stimulation, acupuncture, therapeutic ultrasound, taping, and advice rebracing.

There is strong evidence that supports the value of a structured program of key exercises and education in contributing to significant improved daily function and quality of life for those of us with hip/knee arthritis. Best practice guidelines for the treatment of hip and knee arthritis now recommend education and exercise as the first line of treatment for ALL people experiencing symptoms, even in early stages. Without education and guidance, most people are uncertain of what activities to do and how to exercise safely.

What happens in a joint with arthritis?

We once thought that arthritis occurred from wear and tear on a joint over the lifespan, and that everyone would eventually get some degree of arthritis as they aged. While the causes of arthritis are still not fully understood, we now know that moderate use of normal joints over the lifespan does not increase the risk of developing arthritis.

The development of arthritis actually begins before symptoms are ever felt. It starts with problems with the articular cartilage and the underlying bone -subchondral bone – in our joints. Articular cartilage is a thin layer of resilient tissue that lines the ends of every bone in a joint. It allows smooth movement of the bones on each other, and provides shock absorption. One of the first changes to occur in the arthritic process is a disruption in the natural ongoing repair activities of articular cartilage. This leads to thinning, and eventually destruction of the cartilage accompanied by thickening of the adjacent subchondral bone. Changes in the structure of subchondral bone may actually contribute to further cartilage deterioration as arthritis develops. This process eventually involves the whole joint, including the bone, ligaments, and other joint structures. Ultimately, there is narrowing of the space between the bones, extra bony growth around the joint, and painful loss of range of motion and strength. In the hip and knee, this can cause significant problems with mobility, daily function, and participation in and enjoyment of life.

What are the causes of osteoarthritis?

Triggers of the osteoarthritic processes are:

• ligament injury to the joint
• repeated high loads or twisting stresses that cause damage to joint cartilage
• abnormal joint alignment or joint instability
• decreased supporting muscle strength
• systemic disorders that affect the health of articular cartilage

Women, unfortunately, are more likely to experience arthritis. With increasing age, joints are more likely to experience arthritis because they are more likely to have experienced the type of mechanical stresses that contribute to the arthritic process. There is evidence that the risk of developing arthritis can be inherited.

The GLA:D program

GLA:D (Good Living with Arthritis: Denmark) was developed by Danish researchers to help reduce hip and knee arthritis symptoms through appropriate exercise and education with accurate information. GLA:D Canada oversees the training of instructors and the provision of this program in Canada. In order to be certified as a GLA:D instructor, health care providers must undergo specific training that incorporates evidence based facts about osteoarthritis and about the appropriate exercise approach. The GLA:D approach consists of:

• a standardized, structured program of exercises to strengthen and mobilize the lower limb.
• exercises that target correct alignment of the joints, while strengthening muscles that are key to supporting the hip and knee.
• supervised small group exercise sessions twice weekly for six weeks plus two education sessions.

GLA:D is being offered in multiple centres across Canada with very good outcomes including decreased pain, increased activity levels and delayed joint replacement surgery.

Best Health Physiotherapy has been offering the GLA:D approach to hip and knee arthritis to our community since May, 2018. Use the contact form on this page to find out more and to reserve your spot in the class.