Friday, 12 September 2014

OSTEOARTHRITIS

OSTEOARTHRITS AND ITS PHYSIOTHERAPYTREATMENT  
 Arthritis is a general term that means inflammation of the joints. Osteoarthritis, commonly known as wear and tear arthritis, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight-bearing joints of the hips, knees, and spine. It also affects the fingers, thumb, neck, and large toe.
wear and tear arthritis, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight-bearing joints of the hips, knees, and spine. It also affects the fingers, thumb, neck, and large toe.


Osteoarthritis -- also called OA -- usually does not affect other joints unless previous injury , excessive stress or an underlying disorder of cartilage is involved.

Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a "shock absorber." The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).

Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.

WHO GETS OSTEOARTHRITIS?

 The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20s and 30s can get osteoarthritis, although there is often an underlying reason, such as joint injury or repetitive joint stress from overuse. In people over age 50, more women than men have osteoarthritis.

WHAT ARE THE SYMPTOMS OF OSTEOARTHRITIS?


Symptoms of osteoarthritis most often develop gradually and include:



  •     Joint aching and soreness, especially with movement
  •     Pain after overuse or after long periods of inactivity
  •     Stiffness after periods of rest
  •     Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)
  •     Joint swelling
  •     Muscle weakness.
  •     Reduced range of motion and loss of use of the joint.
  •     Cracking and creaking.
  •     Sleep problems.
  •     A grating or grinding sensation (crepitus) – Your joint may creak or crunch as you move.
  •     Not being able to use your joint normally


What causes osteoarthritis?


While the exact cause of OA is unknown, joint damage can be due to repetitive movement (also known as "wear and tear"). It can also begin as the result of an injury. Either way, with OA there's erosion of the cartilage, the part of the joint that covers the ends of the bones.

    Cartilage acts as a shock absorber, allowing the joint to move smoothly.
    As cartilage breaks down, the ends of the bones thicken and the joint may lose its normal shape.
    With further cartilage breakdown, the ends of the bones may begin to rub together, causing pain.
    In addition, damaged joint tissue can cause the release of certain substances called prostaglandins, which can also contribute to the pain and swelling characteristic of the disease.

Here are some factors that may increase your risk of developing OA:


  • Age
Age is the strongest risk factor for OA. Although OA can start in young adulthood, in these cases, it is often due to joint injury.


  • Gender
OA affects both men and women. However, before age 45, OA occurs more frequently in men; after age 45, OA is more common in women.

Joint injury or overuse caused by physical labor or sports
Traumatic injury to a joint increases your risk of developing OA in that joint. Joints that are used repeatedly in certain jobs may be more likely to develop OA because of injury or overuse.


  • Obesity
The chances of getting OA generally increase with the amount of weight the body’s joints have to bear. The knee is particularly affected because it is a major weight-bearing joint.


  • Joint Alignment
People with joints that don’t move or fit together correctly, like bowlegs, dislocated hips, or double-jointedness, are more likely to develop OA in those joints.


  • Heredity
An inherited defect in one of the genes responsible for manufacturing cartilage may be a contributing factor in developing OA.
Osteoarthritis diagnosis

If you experience joint pain, stiffness, and/or swelling that won't go away, you should make an appointment to see your doctor. Your doctor will be able to determine if you have arthritis and, if so, what type.

When you see your doctor about your symptoms, he or she may ask questions about when and how you started experiencing them. The doctor will probably give you a physical examination to check your general health, and examine the joints that are bothering you.

DIAGNOSIS
  You may also need other tests to help confirm the diagnosis of OA and determine the extent and severity of joint damage. Some of these may include:

    X-rays. X-rays can help the doctor determine whether you have OA or rheumatoid arthritis (RA). A series of X-rays obtained over time can show how fast joint damage is progressing. X-rays of the affected joints can show cartilage loss, bone damage, and extra bone growth (known as bone spurs) that can develop on the surface of normal bones.
    Joint Aspiration. If your doctor is still uncertain about the diagnosis or suspects that you may have an infection, he or she may perform joint aspiration. In this procedure, your doctor withdraws and examines synovial fluid (a liquid that lubricates the joint) from affected joints using a needle.

If you are experiencing some of these symptoms, the sooner you talk to your doctor, the sooner you may get diagnosed and get treatment.

TREATMENT


There is no cure for osteoarthritis, but there are medications to help relieve pain, when needed. The doctor may recommend physical therapy (PT) or occupational therapy (OT) to help improve strength and function. When pain is severe and frequent or mobility and daily activities become difficult, surgery may be considered.

Self-Care

Staying physically active and maintaining a healthy weight are the keys to living well with osteoarthritis. Too little movement can lead to stiffness and weak joints. Losing one pound can take four pounds of pressure off your knee joints.  Overall fitness improves health in many ways. Strong muscles protect joints. An OA management plan also involves eating a nutritious diet, managing stress and depression, and getting a good balance of rest and activity each day.

Improved pain and overall patient well being

DIAGNOSIS


Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis. The typical changes seen on X-ray include:


  •     joint space narrowing
  •     subchondral cyst formation
  •     subchondral sclerosis (increased bony formation around the joint)
  •     osteophytes
  •     Plain films may not correlate with the findings on physical examination or with the degree of pain


OSTEOARTHRITIS TREATMENT


Lifestyle modification (such as weight loss and exercise), physical therapy and analgesics are the mainstay of treatment.


GOAL OF OSTEOARTHRITIS EXERCISES


Main aim of Osteoarthritis Exercises are to reduce pain, improve function, and prevent disability, all with the ultimate goal of improving quality of life. There are many ways that these goals can be achieved through exercise programs, as discussed below.


  •     Muscle Strengthening
  •     Improving Flexibility and Joint Motion
  •     Improve Aerobic Functioning
  •     Weight Loss

OSTEOARTHRITIS EXERCISES

There are mainly three kinds:


  •     Range-of-motion: To maintain normal joint movement and relieve stiffness. These make the joints flexible.
  •    Strengthening exercises: To increase the strength of muscles that support the joints affected by arthritis.
  •     Aerobic or endurance exercises: They improve cardiovascular fitness, control weight and improve overall body function.



OSTEOARTHRITIS EXERCISE PLAN



  •     Start under supervision of a physical therapist or a qualified athletic trainer.
  •     Apply heat to sore joints before you begin exercising.
  •     Begin exercising with stretching, flexibility and range of motion exercises.
  •     start strengthening exercises slowly with small light weights or resistance band.
  •     Increase the difficulty of your exercise routine slowly.
  •     apply cold packs to sore joints and muscles after osteoarthritis exercises.
  •     ease off exercise programme and talk to your health care provider if your joints get            painful, inflammed or red.

HOW OFTEN SHOULD YOU EXERCISE?




  •     Range-of-motion: Either daily or every alternate day.
  •     Strengthening exercises: Every alternate day.
  •     Endurance exercises: For 20 to 30 minutes three times a week.

Range-of-motion Osteoarthritis Exercises
  • Strengthening exercises
  • Isometric exercises
  • Isotonic exercises
  • Isokinetic exercises
  •     Quad sets: while in a seated position, with legs fully extended in front of you, make a muscle with your thighs trying to push the back of your knee down towards the floor. Hold for 10 seconds, relax and then repeat.
  •     Wall slide: place your back up against the wall with your hips and knees bent to a 90 degree angle as if you were sitting in a chair. Hold this position for 10 seconds, then come up and relax. Repeat.
  •   Isotonic Quad exercise: sitting in a chair with your feet planted flat on the floor, raise your right leg straight out in front of you. Relax and bring back to the floor. Repeat on the left. As you are able to you can add ankle weights to increase resistance.
  •   Isometric Hamstrings while lying on the floor place heels on surface such as a couch or an exercise ball. Press down using the backs of your thighs and hold contraction for 10 seconds. Relax and then repeat.
  •  Isotonic Hamstrings lying on your belly with a pillow under your abdomen to support your back, bend your knee and bring your foot back towards your buttock. Bring back down to the floor repeat on the other side.
  •   Isometric Glutes Lying down on a flat surface back flat on the floor, bend your knees so that your feet are flat on the floor. Raise your buttocks up off the ground contracting your butt muscles together. Hold for 10 seconds then relax.
  •  Calf muscles Strenthening Using a wall or chair for balance, go up on your toes using your calf muscles hold yourself. Contract for 10 seconds, relax and repeat.

Endurance and flexibility exercises


 Exercise in water, like swimming or water aerobics, relieves weight on stiff or sore joints

Osteoarthritis Exercises reduces joint pain and stiffness, and increases flexibility, muscle strength, and endurance. It also helps with weight reduction and enhances a sense of well-being.


 

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