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Osteoarthritis vs. the natural aging process

by Pam Honeyman BSc. BHSc. P.T., on-site physiotherapist and ergonomist.

While osteoarthritis (OA) is the most common type of arthritis and an almost universal condition in the elderly, it is fortunately usually only a mild condition. In many cases, effective prevention or treatment can enable you to continue with physical activities later in life.

What is osteoarthritis?

As we drift past the age of forty, our joints change with the stresses of a weight-bearing life. It’s a natural law called Wolfe’s Law which states: bones form in relation to the stresses placed upon them. This is the reason why weight bearing exercise is important in the prevention and treatment of osteoporosis.

Joints are the place where two or more bones connect. The surfaces between the bones are lined with cartilage. Cartilage absorbs the shock of the joint motion and can become thin and worn, causing the bony surfaces to rub against each other. Unlike some other forms of arthritis, OA involves little or no inflammation. It is most commonly observed in the back, knees, hips and hands.

Described as the wear and tear kind of arthritis, OA was originally thought to be caused by excessive stress to the joints from excessive pressure on the joint from high-impact and repetitive activities. But recent studies suggest that regular exercise does NOT make us more vulnerable to OA. For example, research studies do not indicate a correlation of presence of knee OA in long distance runners. In fact, regular exercise can increase the functional capacity of people with OA. When we use a joint the pressure created causes fluid and waste products to seep out of the cartilage. When the pressure is removed the fluid returns with oxygen and nutrients. Healthy cartilage is dependent on the joint being used.

The OA Process

Over the years, the cartilage naturally tends to become thinner, which reduces the protective cushioning between the bones. Initial indications of OA are stiffness and recurring pain in the joints. The symptoms often are present in the morning or after sitting in one position for an extended period. Less common symptoms are redness or heat in the joint, as well as great difficulty moving a joint. With time, the damage to the joint may increase.

The effect of OA on an individual is varied. Even if a joint is permanently changed, some people may experience few or no symptoms or experience mild and infrequent pain episodes often exacerbated by increased activity or a physical trauma to the affected joint. The most common causes of OA are aging, injury to a joint, overuse of a joint, prolonged bad postures and obesity.

X-rays are usually used to diagnose OA and often the accompanying report gives a frightening description of the status of the joint. For example, when age-related changes are observed in a back x-ray of a middle aged individual, the report often indicates degenerative disc disease (DDD). This diagnosis unfortunately can have profound negative effects on patients. The person may believe they are now vulnerable to advancing pain and stiffness for their remaining life, feel hopeless and do little to prevent further changes and stop activities that they enjoy. X-ray changes are NOT always indicative of pain and dysfunction. Often if DDD is present, it is due to the natural aging process and not a dire consequence. For example, as we age, we naturally wrinkle. The medical diagnosis for this condition is not called degenerative skin disease.

Treatment

Physiotherapists are experts in the assessment, and treatment of the symptoms of OA. Usually the pain and loss of movement seen in an OA joint follows a predictable pattern and the physiotherapist is trained in how to treat and prescribe a programme to help you to:

- Reduce pain (which may reduce amount of pain medications prescribed)

- Maintain or increase joint range of motion, and improve joint lubrication and nutrition.

- Improve strength, flexibility, balance and endurance.

- Improve poor posture.

- Improve independent function.

Physiotherapists can also provide useful information about continuing on with your sporting activities or suggesting alternative activities, recommend shoe wear, postural and sleeping positions, as well as show you how to pace yourself in your activities to avoid pain and aggravation to the joint. Physiotherapists are also knowledgeable when to refer to the family physician if a joint may require additional care or surgical intervention.

Other ways to help one manage their OA symptoms are:

Let pain be your guide…don’t keep ignoring the discomfort and push too much, never overdo an exercise or activity. There is NO truth to the expression, “no pain, no gain!

Minimize overstressing a joint, adapt good body mechanics (i.e. proper lifting technique.

Maintain a healthy body weight.

Use a splint or walking aid if needed.

--Pam Honeyman

For more information please contact Pam Honeyman BSc., BHSc. P.T., /CAFCI (acupuncture certification) , Registered Physiotherapist

Procare Rehabilitation, 890 Yonge St Suite 600, Toronto (Yonge and Davenport - 2 blocks north of Bloor) 416 324-2240

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