StettlerLocal.com December 1, 2021 - Contributed by Rhonda Missikewitz, Physiotherapist
Having just finished a course on osteoarthritis this past weekend, I was reminded how many myths and misunderstandings exist about arthritis. According to Arthritis Canada, over 20% of adults have arthritis, the large majority being osteoarthritis (OA), and of those, primarily knee and then hip. OA is a progressive disease that affects the structures of our joints with the final stage, including significant cartilage loss and changes in the underlying bone. Because it is so common, we often just accept it as a part of aging and something we need to live with, wrongly assuming there is nothing beyond drugs that can be done to manage it.
It is true that age is a risk factor, along with sex, and heredity. Females over 60 years with a family history are leading the way. There is little we can do about our sex, age, or genes. However, the other risk factors include previous joint injury, obesity, and muscle weakness (1), and we do have some control over these! Injury prevention is never foolproof, though a proper warm-up pre-activity, good muscle balance (including the strength and length of our muscles), and proper training go a long way. Physiotherapists can help with all of this. Research indicates that arthritis is more likely to show up in an injured joint as early as 10-15 years after injury. (1) A couple of Alberta physiotherapists are leading the way internationally, addressing injury prevention for knees in young female soccer players as this is a demographic that has traditionally sported plenty of knee injuries at a young age (2). While knee injuries and surgeries are nice to avoid for a number of reasons, these researchers are approaching this intervention specifically to decrease the start of OA on these athletes as early as in their mid-twenties. Injury prevention is obviously a great place to start for all of us and our children regardless of age, sex, or sport!
Addressing the global pandemic of obesity is important not just for the prevention of OA but also for the progression of OA. Research indicates that even the loss of 2kg can have a significant effect on pain and function. (1) The more weight that is lost, the greater the impact, but when you struggle with chronic, daily pain, every ounce counts! What plays an even more important role than weight, however, is STRENGTH. Muscle weakness of the quadriceps is actually a better indicator of early OA than x-ray results.(3) Sadly, when people have pain, they often feel they need to rest what hurts and avoid using that joint. This leads to more weakness and perpetuates the cycle. The truth is that proper education, specific strengthening, and neuromuscular exercises can make a big difference in progression, pain, and quality of life, and if done early enough, can even delay or prevent the need for surgery. (3)
The last myth I'll bust is that you need a referral from your doctor to see a physiotherapist about your arthritis. Physiotherapists are primary health care providers. We have had direct access (meaning no referral needed) since before I started practicing in 1996 and are the experts in these sorts of conditions. A study in 2008 showed 90% diagnostic and treatment concordance between a physiotherapist and an orthopedic surgeon. (4) We are well trained to assess, diagnose and treat and can generally get you in much faster than a family physician. We have great relationships with both family physicians and orthopedic surgeons and will refer back and forth as needed.
1. BMJ Best Practice Osteoarthritis, May 2017
2. Whittaker et al., Aug 2015 - Phy Ther Sport
3. Petterson et al., March 2008 - Med Sci Sports Exerc.
4. Aiken, McColl, July 2008 - Journal of Interprofessional Care
Rhonda Missikewitz, BSc.P.T., GunnIMS, CPMA
Physiotherapist/Owner
Performance Health & Fitness Centre
phone: 403-742-4533
fax: 403-742-4530
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