2008-05-30 / Columnists

SJEH Wellness Corner

Physical Therapy May Heal With Osteoarthritis Of The Knee
Commentary By Farhat Shaikh, PT, MSPT St. John's Episcopal Hospital

Osteoarthritis is the most common type of arthritis, affecting more than 20 million Americans. A progressive disorder of the joints, it is caused by gradual deterioration or destruction of joint cartilage, the slippery tissue that covers the ends of the bones in a joint, resulting in the development of bony spurs and cysts at the margin of the joints.

Most affected are the weight-bearing joints including the lower back, hips, and, most especially, the knees.

Healthy cartilage allows bones to glide over one another and acts as a protective cushion between bones, absorbing energy from the shock of physical environment, particularly in a weight-bearing joint like the knee. As the cartilage is worn away, the bones under the cartilage rub together, causing pain, a grinding sensation, swelling, and loss of motion of the joints. Over time, the gradual, uneven breakdown of the cartilage may lead to joint deformity.

Typically osteoarthritis has been considered an inevitable part of aging caused by simple wear and tear on the joints. However, recent research shows that it is the end result of several different factors that can contribute to cartilage damage. Today the disease is classified as either primary or secondary osteoarthritis.

Primary osteoarthritis results from wear and tear of healthy joints and a reduction in the ability of the joint cartilage to repair itself as part of the aging process. Because the knees are the body's primary weight-bearing joints, they are among the joints most affected by osteoarthritis. Obesity also increases the pressure on the knee joints, causing further strain to the cartilage. Secondary osteoarthritis results from chronic, repeated strain from work or sports, problems with anatomy (for example, being bowlegged), metabolic conditions, or sudden injury to the knee joint.

Usually, osteoarthritis comes on slowly. Early in the disease, joints ache after physical activities like standing, walking, going up and down the stairs, getting in and out of chairs and bathtubs, and playing sports. If left untreated it can cause severe debilitating pain even at rest, swelling, muscle weakness, and deformity, making it impossible to carry out routine activities of daily living and workrelated duties.

Effective management of osteoarthritis requires a treatment plan tailored to the patient's individual needs, life style and health, and usually includes ways to manage pain and improve function. Physical Medicine and Rehabilitation professionals can help by developing an individual treatment plan that may include an exercise program, joint care and energy conservation techniques, weight control, medication and the use of assistive devices such as a cane or walker for safe ambulation.

Research shows that exercise is one of the best treatments for osteoarthritis. Exercise actually helps to decrease pain, increase flexibility, maintain one's weight, improve heart conditions and blood flow, improve one's mood and outlook, and promote general fitness. The amount and type of exercise will depend upon the individual patient's condition. Consulting with a physical therapist helps determine which is the best and most effective exercise.

Modalities used by Physical Medicine and Rehabilitation specialists such as ultrasound, electrical stimulation, hot or cold packs, massage, and hydrotherapy can relieve pain, swelling, and stiffness. Some patients with knee osteoarthritis may benefit from special insoles or cushioned shoes that help to redistribute your weight and reduce joint stress.

Osteoarthritis patients who are overweight or obese should lose weight. Weight loss can reduce stress on weight-bearing joints and limit further injuries. A healthy diet and regular exercise can help reduce the weight.

Managing osteoarthritis can be challenging. By actively participating in their own care, people with osteoarthritis have a better chance of achieving a rewarding life style. Research shows that these people also tend to enjoy a better quality of life. For more information about how Physical Medicine and Rehabilitation may help you, please call 718-869- 7774.

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