What is osteoarthritis?
Osteoarthritis, also known as degenerative arthritis, degenerative joint disease, OA, or osteoarthritis, is a form of arthritis caused by inflammation, breakdown, and the eventual loss of cartilage in the joints – the cartilage wears down over time.
Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb the shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage. 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.
Osteoarthritis is a progressive disease; signs and symptoms gradually worsen over time. There is no cure. However, available therapies may help with pain and swelling (inflammation), as well as keeping the patient mobile and active. Experts say that patients who take steps to actively manage their osteoarthritis are more likely to gain control over their symptoms.
Any joint in the body may be affected. However, the disease is most likely to affect the patient’s:
- Lower back
When you hear someone saying they are suffering with osteoarthritis they will often say that they have:
- Pain which is worse when they move a joint or at the end of the day.
- Stiffness of a joint after rest which wears off after they get moving.
- A grating or grinding sensation (crepitus) when you move.
- Swelling and tenderness of the joint which may be hard or soft.
- Not being able to use your joint normally.
Osteoarthritis is the most common form of arthritis in the UK. Osteoarthritis is a very mis-understood condition. Many people believe that it cannot affect you until you are much older. The truth is that ‘wear and tear’ can affect your joints as early as your late 20s. Factors such as a poor posture, bad lifting technique, lack of exercise and an accumulation of old injuries can predispose to early osteoarthritis.
- More than 6 million people in the UK have painful osteoarthritis in one or both knees. Prevalence increases with age with 1 in 5 adults aged 50–59 to almost 1 in every 2 adults aged 80+ having painful osteoarthritis in one or both knees.
- More than 650,000 in the UK have painful osteoarthritis in one or both hips, three quarters of whom are aged over 65. A further one and a half million have X-ray evidence of hip osteoarthritis (but may not have any symptoms).
- Osteoarthritis is most commonly found in the spine.
- There are almost 8.5 million people with X-ray evidence of osteoarthritis of the spine in the UK. Unlike other sites, it is more commonly found in men than women (by a ratio of 3:2). Back pain is the most frequently occurring symptom.
- One third of people aged 45 years and over in the UK have sought treatment for osteoarthritis
- 8.75 million people in the UK have sought treatment for osteoarthritis
- Women are more likely than men to have sought treatment for osteoarthritis
- Osteoarthritis increases between the ages of 45 and 75 years, of those aged 75 years and over, 49% of women and 42% of men have sought treatment for osteoarthritis.
The knee is the most common site in the body for osteoarthritis, followed by the hip. Osteoarthritis in the knee and hips can make walking, standing and sitting extremely painful.
Osteoarthritis is more common among females than males, especially after the age of 50 years. Most commonly, it develops in people aged over 40. Younger people may also be affected; usually after an injury or as a result of another joint condition.
Some people say that osteoarthritis is an inevitable part of ageing. This is untrue. There are people well into their nineties who have no clinical or functional signs of the disease.
Symptoms of arthritic pain/arthritis
Typically, osteoarthritis comes on slowly. For many, the first signs are joints that ache after physical work or exercise. The pain may be moderate and come and go, without affecting the ability to perform daily tasks. Some people’s osteoarthritis will never progress past this early stage. Others will have their osteoarthritis get worse. The pain and stiffness of more severe osteoarthritis may make it difficult to walk, climb stairs, sleep, or perform other daily tasks. Common symptoms include:
- Pain in a joint that is worse after activity or toward the end of the day
- Swelling or tenderness in one or more joints
- Problems moving affected joints
- Stiffness – more severe on waking up in the morning, and improves within 30 minutes when the individual starts moving about. You may also experience it after periods of inactivity such as sitting
- Flare-ups of pain and inflammation after use of the affected joint
- Crunching feeling or sound of bone rubbing on bone (crepitus) when the joint is used
- Referred muscle pain
- Affected joints are larger than usual
- After not moving the joint for a while pain and stiffness may worsen
- Joints are warm
- Loss of muscle bulk
- The affected joints will have a limited range of movements
The knees, hips or hands are most commonly affected.
Osteoarthritis in the knees – Because knees are primarily weight-bearing joints, they are very commonly affected by osteoarthritis. If you have osteoarthritis in your knees, you may feel that these joints are stiff, swollen, and painful, making it hard to walk, climb, and get in and out of chairs and bathtubs. In most cases both knees are affected, unless the osteoarthritis was caused by an injury (or another condition). The patient will experience pain when walking, especially uphill or upstairs. Knees may lock into position, making it much harder to straighten the leg. The knee may make a soft, grating sound when used.
Osteoarthritis in the hips – Osteoarthritis in the hip can causes pain, stiffness and severe disability. Hips both support the weight of the body and enable movement of your lower body. When you have osteoarthritis in your hips, you may also feel the pain in your groin, inner thigh, or knees. Osteoarthritis in the hip can lead to difficulty moving, bending and walking. Anything that requires movement of the hip joint causes problems, such as getting in/out of a car or putting on one’s shoes and socks.
Although pain in the hip is common, some patients with osteoarthritis in the hips experience pain in their knee (and not their hip). Less commonly, pain may be felt in the thighs, ankles and buttocks.
Typically, pain is felt whilst walking, but some people are in pain even when resting.
Osteoarthritis in the hands – When osteoarthritis occurs in hands and fingers, the base of the thumb joint is commonly affected and people experience stiffness, numbness, and aching. Other symptoms of hand and finger osteoarthritis include:
- Heberden’s nodes: small bony knobs that appear on the end joints of fingers
- Bouchards’s nodes: small bony knobs that appear on the middle joints of fingers
Three areas may be affected:
- The base of the thumb
- The top joint of the fingers (closest to the nail)
- The middle joint of the fingers
Fingers may be stiff, swollen and painful. Sometimes bumps may develop on the finger joints. In some cases, finger pain decreases and eventually goes away, while the swelling and bumps remain.
At the affected joints the fingers may bend slightly sideways. Fluid-filled lumps (cysts) may develop on the backs of the fingers; they are often painful.
A bump may develop where the base of the thumb joins the wrist. This may make writing, turning keys and opening jar-tops difficult and painful.
Osteoarthritis in the spine – If you have osteoarthritis of the spine, you may experience stiffness and pain in the neck or in the lower back. Sometimes arthritis-related changes in the spine can put pressure on the nerves, causing weakness or numbness in your arms or legs.
Causes of arthritic pain/arthritis
Process of wear and repair – often inaccurately referred to as the wear and tear arthritis, osteoarthritis should more aptly be called the wear and repair arthritis, because the condition is a slow repair process that the body utilizes to mend joints that have gradually become damaged.
In most cases, the repair process presents no symptoms. However, if there is a particularly traumatic injury to a joint and the body’s ability to carry out proper repairs is undermined, subsequent damage to the affected joint will continue and the patient will experience symptoms.
When there is damage to cartilage – the protective surface that cushions the ends of bones in your joints and allows the joints to move smoothly – osteoarthritis occurs. The smooth surface of the cartilage becomes rough, causing irritation. If the cartilage wears down completely, the bone in the joint may be rubbing against another bone, causing damage and pain.
The joints may become knobbly where the bones start protruding, forming osteophytes (bony lumps). The bones gradually thicken and become broader, making the joints stiffer, less mobile, and painful. If fluid accumulates in the joints they will swell.
Experts are not sure why the repair process breaks down. They believe several contributory factors are involved:
- Injury – a joint may have been previously damaged because of an injury or surgical intervention.
- Overuse – a joint may have been overused after an injury or operation.
- Rheumatoid arthritis – if the joints of a patient with rheumatoid arthritis have been severely damaged, osteoarthritis can occur.
When osteoarthritis has developed because of damage or another condition, it is called secondary osteoarthritis. Secondary osteoarthritis signs and symptoms may take several years after the initial joint damage to appear.
Here are some factors that may increase your risk of developing osteoarthritis:
- Age – Age is the strongest risk factor for osteoarthritis. Although osteoarthritis can start in young adulthood, in these cases, it is often due to joint injury.
- Gender – Osteoarthritis affects both men and women. However, before age 45, osteoarthritis occurs more frequently in men; after age 45, osteoarthritis is more common in women.
- Joint injury or overuse caused by physical labour or sports – Traumatic injury to a joint increase your risk of developing osteoarthritis in that joint. Joints that are used repeatedly in certain jobs may be more likely to develop osteoarthritis because of injury or overuse.
- Obesity – The chances of getting osteoarthritis 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 osteoarthritis in those joints.
- Heredity – An inherited defect in one of the genes responsible for manufacturing cartilage may be a contributing factor in developing osteoarthritis.
Treatment of arthritic pain/arthritis
There is no cure for osteoarthritis. Treatment has 4 goals: improve joint function, keep a healthy body weight, control pain, and achieve a healthy lifestyle. You will probably have/need a combination of the following.
Exercise. Too little movement can lead to stiffness and weak joints. Overall fitness improves health in many ways. Strong muscles protect joints, improve posture and help achieve body weight control.
An exercise plan will probably focus on improving the patient’s:
- Flexibility – to help with the range of movement. This will involve gently stretching the joints, making them suppler.
- Strength – to improve muscle tone and strength.
- Fitness – to improve stamina. This may involve swimming, walking or cycling.
Weight control. The more overweight/obese patients are, the worse their osteoarthritis symptoms will be, simply because there is much more weight bearing down on the joints, especially if the affected joints are in the lower limbs.
Rest and joint care. The use of splints to rest a painful joint.
Nondrug pain relief techniques to control pain.
Surgery. Arthroscopy, arthroplasty (joint replacement), arthrodesis (joint fusion), osteotomy (where a bone is cut and re-aligned)
Lifestyle modification. Eating a nutritious diet, managing stress and depression. The use of assisted devices such as using a stick or wearing special insoles which will be issued by an occupational therapist once they have assessed you.
Manual therapy. See How will osteopathy help? below.
How will osteopathy help?
Until very recently osteoarthritis was labelled “wear and tear” and it was thought that very little could be done apart from taking anti-inflammatory and pain medication and later a joint replacement. It has now been renamed “wear and repair” – so what does this mean?
Your body is continually repairing and healing itself, so the question that needs to be answered is “what is stopping my body from healing correctly?” Decreased mobility of the joints and hypertonic, short muscles impede the circulation and drainage to the area which will affect the repair process.
Pain – if something hurts, you avoid the movement that causes it. The body very quickly adapts and compensates and correct movement of the joint with balance of the muscles and ligaments is lost. Compensatory patterns lead to other joints doing more work, which perhaps they are not designed to do, which leads to the osteoarthritis process starting here.
Overall there is a general decrease in exercise, physical work and exercise leading to stiffness and reduced mobility of the joints.
Each joint has a surface area which should be used in its entirety – which requires the muscles to be able to fully stretch and contract, for the correct alignment of those muscles when contracting and relaxing and for the ligaments to be balanced. Trauma, pain, decreased usage of the joint in its full range of movement and prolonged periods of holding the joint in set positions cause muscles to shorten. This then stops the joint being able to be used in its full range and the surface area of the joint
that is actually used becomes decreased. The load bearing on a smaller surface therefore increases and the degenerative process accelerates.
At the Clinic treatment works to increase the range and quality of movement of your joints. This increases circulation and drainage to the area, improves the health of the muscles and allows them to work correctly; increased range of movement to the joint allows more of the joint surface to be used, distributing the weight more evenly.
Decreased pain and increased mobility leads to you feeling better and therefore more likely to be more active whether this this is in the home, out and about or joining an exercise class.
- Decrease pain and disability
- Improve mobility and flexibility
- Improve circulation and drainage to the area, supporting the body’s natural tendency to self-healing
- Address any mechanical imbalances to the body
- Improve wellbeing
- Encourage exercise and weight loss (if needed)
Patients usually feel improvement after their first session of treatment – articulating the joints and working on the soft tissues improves the circulation and drainage to the area reducing swelling and inflammation. It allows the joints to be articulated and muscles stretched improving quality and quantity of movement.
We tend to see patients on a weekly basis for 3 sessions and then reassess how the patient is responding to treatment and what they would like to do now that they see that their symptoms are improving. We recommend that anyone with osteoarthritis has regular treatment to keep them moving properly. This interval can be anywhere between 3 weekly to 4 monthly.
What to do now ……
If you’ve come to this website looking for help, then don’t in silence suffer any longer.
Contact us immediately on 01462 811006 for a consultation and let’s assess your condition.
At the assessment, we’ll take some details from you and build your case history. We’ll discuss why you’ve come to see us and where you have any aches and pains. Then we’ll examine you with the aim of giving you the appropriate treatment.
This will take a little while to complete, but it’s a necessary part of the ethical guidelines we work to. The guidelines are there to make sure everything is done professionally and to a high standard of patient care. I’m sure you agree that’s a good thing!
If you have any questions about what we do and how we do it, call us on 01462 811006 or use the contact form below – and we’ll be happy to help.