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By: Richard Hubler, PT, DPT, OCS, FAAOMPT<\/strong><\/h3>\nSince May is National Arthritis Awareness Month, I would like to take some time to focus this blog on osteoarthritis and the positive impact that physical and\/or occupational therapy can have on this pathology.\u00a0 According to the Centers for Disease Control and Prevention (CDC) (2018), arthritis affects approximately 54 million Americans.\u00a0 Furthermore, the Cleveland Clinic (2018) estimates that over 16 million Americans are affected by the sub-type of osteoarthritis.\u00a0 Data from the CDC in 2013 revealed that arthritis care resulted in medical costs over $140 billion.\u00a0 There is a clear challenge with this condition, the associated impairments and functional limitations, and the impact on individual\u2019s quality of life.\u00a0 However, there is also an opportunity for therapists and patients to work together and manage the condition and symptoms with conservative care, education, and self-management.<\/p>\n
Osteoarthritis is a sub-type of arthritis that involves the breakdown of articular cartilage (usually under load or repetitive stress).\u00a0 As this condition becomes chronic, it can lead to further cartilage damage, inflammation, and other musculoskeletal system damage (i.e. muscle, ligament, and bone).\u00a0 As this condition progresses, many factors build which usually results in pain and dysfunction.\u00a0 Yet pain and osteoarthritis do not necessarily go hand-in-hand.\u00a0 Yes, it is true that many patients with osteoarthritis experience pain, but it doesn\u2019t mean that these patients need to suffer from pain.\u00a0 There is a wealth of research that shows that muscle strength is linked to pain and dysfunction in patients with osteoarthritis (meaning a loss in strength would result in an increase in pain and dysfunction).\u00a0 For therapists, there is also a wealth of research that shows the positive impact that strengthening and aerobic exercises can have on patients with osteoarthritis.<\/p>\n
A major component of the successful conservative management for osteoarthritis should focus on appropriate strengthening exercises for the involved musculature.\u00a0 Likely involved musculature would include:\u00a0 quadriceps and gluteal strengthening exercises for knee osteoarthritis, gluteal and hip flexor strengthening exercises for hip osteoarthritis, and scapular stabilizers and rotator cuff strengthening exercises for shoulder osteoarthritis.\u00a0 Along with appropriate strengthening exercises, complimentary interventions strategies may include aerobic exercise, manual therapy, kinesiology taping, and modalities.<\/p>\n
A study by Deasy et al. (2016) examined trends of hip muscle strength in patients with symptomatic knee osteoarthritis.\u00a0 The notable findings of the review and analysis showed the most correlation of loss of hip abduction strength with symptomatic knee osteoarthritis.\u00a0 The important hip abductors to focus on in therapy are the gluteus medius (glute med.) and gluteus minimus (glute min.).\u00a0 These two muscles provide lateral stability and stabilize the pelvis during single-leg stance and during the stance phase of gait.\u00a0 A study by Ganderton et al. (2017) provides a review of some of the common therapeutic exercises that have appropriate activation of these gluteal muscles.\u00a0 The authors concluded that a hip hitch or hip hike was an exercise that showed good activation of these muscles and would likely be tolerated in a symptomatic population.\u00a0 Other exercises that have been shown to be effective for gluteal activation may include step-ups, lateral step-ups, single-leg stance, \u201cmonster walks\u201d, and variations of the clamshell.<\/p>\n
A commonly utilized intervention for osteoarthritis is manual therapy.\u00a0 Many therapists utilize manual therapy techniques to improve range of motion, however newer research shows that these techniques may also be valuable in reducing pain.\u00a0 A study by Courtney et al. (2016) examined the effects of joint mobilizations on pain modulation in patients with symptomatic knee osteoarthritis.\u00a0 In this study, mobilization techniques were utilized for 2 sets of 3 minute bouts.\u00a0 The results showed improvements in pain modulation following the application of joint mobilization manual therapy techniques.\u00a0 This is important for therapists to know, because it gives us the information to show that manual therapy can be used not just for loss of motion, but also to help reduce pain and symptoms.<\/p>\n
Another commonly utilized conservative intervention for osteoarthritis is kinesiology taping.\u00a0 In general, research seems to support taping as more of a short-term benefit compared to long-term.\u00a0 However, just because something only provides a short-term benefit doesn\u2019t mean it\u2019s not beneficial for patients.\u00a0 A study by Aydogdu et al. (2017) examined the effects of kinesiology taping for the quadriceps muscle group in patients with knee osteoarthritis.\u00a0 The taping technique that was utilized is shown in the picture below.\u00a0 Results showed that the patients that received kinesiology taping had a reduction in pain and overall improvement in functional status following the intervention.\u00a0 Now, don\u2019t get me wrong, I do not think that kinesiology taping is the end all be all of treatments, but I do think it can serve a purpose in a multi-modal intervention plan of care (and there is some research to support that!).<\/p>\n
![\"Osteoarthritis,](\"http:\/\/l_new.local\/wp-content\/uploads\/Taping-Picture-1024x730.png\")
(Image from Aydogdu et al. 2017)<\/p>\n
\u00a0So as I realize this blog is getting longer and longer, I hope you have found a good benefit in reading it.\u00a0 For people with arthritis that have pain and\/or symptoms:\u00a0 You are not alone!\u00a0 Motion is lotion!\u00a0 Make sure to stay moving, adopt some light exercises to start and then progress as it is comfortable.\u00a0 A light walking program that starts to progress toward 30 minutes (total accumulation) per day for about 5 days per week can be a great addition to the conservative management.\u00a0 For therapists:\u00a0 Don\u2019t scare your patients towards pain.\u00a0 Show these patients compassion and empathy.\u00a0 Remember to balance your treatments, but good strengthening exercises are probably the best to work toward.\u00a0 Use manual therapy, taping, and modalities to help make other things more comfortable in the short-term.\u00a0 If you are not familiar with some of these interventions, look to build your treatment toolbox by taking continuing education courses.\u00a0 I love when I learn new techniques that work quickly with my patients.\u00a0 It not only makes my treatments easier, but my patients get better (as usually quicker!).\u00a0 Thanks for taking the time to read this blog post!\u00a0 Hope you enjoyed!<\/p>\n
To register or learn more about my course, “Evidence-Based Rehab Strategies for Joint Replacement,” click here<\/a><\/strong>!<\/p>\n <\/p>\n
References:<\/p>\n
https:\/\/www.cdc.gov\/features\/arthritisawareness\/index.html<\/a><\/p>\n
(Image from Aydogdu et al. 2017)<\/p>\n<\/p>\n
References:<\/p>\n
https:\/\/www.cdc.gov\/features\/arthritisawareness\/index.html<\/a><\/p>\n