Arthritis Is Not a Stop Sign

Hello everyone, my name is Dr. Allan Buccola, PT, DPT. I am a physical therapist, and owner of Impetus Physical Therapy in Greensboro, NC. I specialize in sports rehab, injury prevention, and wellness, and I am one of the top clinical running experts in the Southeast.

Today's post is all about dismantling myths about arthritis and educating everyone on how to cope and thrive with this very common ailment. Arthritis is a naturally occurring phenomenon, found among many species, and having been found on human bones going back hundreds of thousands of years, if not more.

Arthritis literally means 'joint inflammation,' but its important to note that the inflammation in the joint involves more than just the bony parts, and in fact has been shown to affect other soft tissue such as the cartilage and the joint capsule, long before bony changes are found.

Only recently did arthritis become such a colloquial term, gradually becoming more and more affiliated with pain and dysfunction. I hope that after reading this post, you feel empowered to become more active and functional in your daily life.

As a disclaimer, this post is intended to serve as education solely. Being that I have not examined you, I am in no way able to mete out medical advice, especially not in this capacity. So onward! 

Knee Arthritis is an everyday topic

Knee OA is growing in prevalence in the US, and is commonly associated with progressive decline in daily function and quality of life. More recent evidence suggests that it is associated with higher rates of morbidity and chronic disease.  The majority of individuals with this condition will rely almost solely on pharmacological measures for treatment.  

Thanks to a steadily growing body of research, Physical Therapy can offer a variety of evidence-based conservative treatment options that can help delay the progression of disease, manage pain, and improve quality of life.

 

characteristics of knee Arthritis 

In the presence of knee pain, the value of xray imaging in the diagnosis of osteoarthritis is becoming increasingly irrelevant.  According to one study that investigated symptoms in subjects with bony changes identified on xray film, pain was a complaint in only 47% of individuals.

Conversely, only 15% of 1000 cases of knee pain correlated with radiographic evidence of OA. Another study revealed that in patients with both radiographic and symptomatic knee OA, increases in pain did not correlate with degenerative joint changes.  

As a clinician that helps reduce knee pain daily, I can't stress enough the importance of the question above. Too many times have I received a patient with a diagnosis of knee arthritis, that their physician qualified with xrays, wherein the patient had very different factors generating their pain...factors likely unrelated to those bony changes. 

Likely the most reliable diagnostic tool remains Altman’s Criteria which rely on patient reports of symptoms for accurate diagnosis. Altman’s Criteria include: 1. morning stiffness and pain that resolve in less than one hour; 2. bony enlargement; 3. crepitus (crackly noise) with motion. Patients with arthritis also typically report pain that gradually worsens with prolonged activity.

As Americans live with knee arthritis over a long period of time, additional discomfort is likely to occur. These persons are likely to experience muscle atrophy (shrinking), loss of strength, and thus are likely to develop even more knee pain. These secondary reports of pain are often disregarded as more “arthritic pain,” misdiagnosed, and poorly treated. 

MINIMIZe your RISK FACTORS

Although arthritis is a naturally occurring phenomenon that occurs as we age, progressive cases with advanced tissue changes are associated with certain lifestyle factors that are easily modified. 

DIETARY RISK FACTORS

  • High levels of vitamin C are associated with a decreased risk. Osteoarthritis development has also been linked to low levels of vitamin D, and vitamin K, as well as chronically elevated blood sugar.

  • Moderate to high consumption of beer is associated with increased risk, whereas wine consumption is related with decreased risk.

PHYSICAL ACTIVITY

  • Sports and other high impact activities can increase risk when performed with high frequency, and/or for prolonged periods.

  • Occupations that involve high-volume lifting (> 4 hours/shift) and torque increase risk. 

  • Greatest risk comes from joint trauma (chronic dislocation or motor vehicle accidents) 

  • Light or moderate physical activity does not increase risk.

OBESITY

  • Leptin, a hormone secreted from adipose (fat) cells is a regulator of bone growth at the hypothalamic (brain center) level; obesity results in up-regulation of bone growth that is excessive.

  • Waist circumference is positively correlated to knee osteoarthritis, which means in the general population, the bigger a person's waistline is, the more likely that person is to have knee OA. 

  • Adiposity (and BMI) correlates with greater reports of pain from knee OA. This is likely due to the inflammatory effects that fatty tissue has on the body.

  • Authors of one study stated that as much as 50% of knee replacements in elderly US women can be attributed to obesity.

OTHER

  • There is weak evidence to indicate that the use of estrogen replacement therapy may have a mild protective role in the progression of knee OA. Estrogen is another hormone that has a complex role in the regulation of bone metabolism.

  • Arthritic pain that precedes degenerative changes can be predictive of degenerative changes. This pain typically begins 2-3 years before bony changes can be detected with xray imaging. 

How can knee OsteoArthritis affect me?

Because arthritis causes discomfort, the old thinking led patients to cease physical activity and become increasingly sedentary. We now know that this links arthritis with higher levels of mortality and disease, even though it doesn't have to. Individuals with knee OA typically present with decreased muscle mass, lower bone mineral density, and are at higher risk for falls and fractures.

Knee OA is related to major gait changes. Knee OA increases all causes of morbidity. One Chinese study revealed that persons with symptomatic OA experienced death rates nearly twice as high as the control group with asymptomatic (radiographic-only) knee OA. Three other studies present data showing that patients with symptomatic knee OA are more likely to die from complications with NSAIDs (like Aspirin or Ibuprofen) and COX inhibitors. 

White et al. published several papers attributing increased death rates related to knee OA, citing greater functional limitations and disability, lower levels of physical activity, and higher rates of cardiovascular disease. Increased rates of cardiovascular disease and dementia. This is not meant to scare. Many of these factors are directly related to a cessation of activity. Physical therapy can help keep you active with knee OA, and Impetus makes it easier than before. 

INTERVENTIONS FOR KNEE ARTHRITIS

Physical therapy is a non-invasive treatment option. Physical therapists do not utilize injections, perform surgeries, or prescribe medications, but the treatment options that we do offer can do the following:

  • reduce joint stiffness

  • maintain joint mobility

  • improve quality of life

  • limit the progression of pain or disease

  • provide patient education for self management

  • Address muscle weakness or imbalances

Staying Active is Critical 

Above all, recent research resonates one idea: remaining active is an important component of maintaining quality of life and functional independence. One study suggests that limiting activity during flare-ups has no benefit. In persons with knee OA, activity level and level of function are highly correlated. Another study found that patients with the highest level of physical activity delayed progression of the disease. 

This same study posits that high levels of physical activity were not associated with the development, nor the advancement or knee OA. If you are experiencing knee pain, contact us or another qualified specialist in movement related dysfunction today! We can help you start feeling better immediately! Knee arthritis is not the end. If anything, it's just another reason to stay active. 

Keep moving! 

-Allan 

Be sure to check out www.ImpetusPT.com and Like us onFacebook: https://www.facebook.com/ImpetusPT 

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