Treating Arthritic Joints

Arthritic Joints – “a bit of wear and tear”

Pain from stiff and degenerative, “worn” joints, can be quite debilitating and interfere massively with your activities of daily living. Physiotherapy can help significantly to reduce:

  • pain
  • swelling
  • stiffness

With the aim to allow you to return to the activities you would normally enjoy. My approach is simple. Look at what the patient in front of you can do now, consider what that patient would like to do in the immediate short term and then consider the longer term. A joint protection programme is decided upon beginning with the acute treatment of pain, swelling and stiffness followed by a strengthening regime to help regain functional activity. How would you expect to be treated? An example of an arthritic knee is outlined below.

Example: The Arthritic Knee

At the first treatment, I need to find out quite a lot about the condition by a series of questions about the following.

History of the present condition

A subjective measure of your pain and dysfunction.

  1. How long have you been suffering?
  2. How do you feel the knee is letting you down?
  3. When is at its worst and what helps ease it?

Past medical history

Any other medical conditions that may influence the treatment of your affected knee. Have you had a previous injury to the arthritic knee?
Social history.  The sorts of activities you like to do that may be affected by your condition.

Physical examination

Objective measures are taken that include:

  • Active range of movement: How you can bend and straighten the knee.
  • Passive range of movement: how far I can passively move your knee for you without discomfort.
  • Strength: How strong are the muscles around your knee and whole lower leg
  • Muscle bulk: a measure of the size of your leg muscles.
  • Function: How good is your walking pattern [gait]. Can you squat or perform a step up, climb stairs or play bowls for example?
  • Accessory movement stability: a couple of tests to see if the supporting structures of the knee, the ligaments, are doing their job.

Problem list

A list of your main problems is drawn up. For example:

  1. Pain: 8/10
  2. Early morning stiffness [EMS]: 5+ mins
  3. Walking 10+ increases pain
  4. Decreased muscle bulk [with actual measures]
  5. Unable to deliver a ball in short mat bowling.

Treatment plan

A treatment plan is then devised to tackle these problems.
Short term objectives [STO] Between us we decide on some achievable STO,s that match the problem list

  1. Reduce pain to 3/10
  2. EMS < 1 min
  3. Walk dog 20” without pain

Long term objective [LTO]

A longer-term aim is agreed and a target set.
For example – “A return to bowls 4 to 6 weeks please”

Treatments. The actual treatment itself can comprise a variety of different techniques and approaches to suit the individual patient. The evidence says ‘There is strongest evidence to support the use of exercise to improve pain, function and quality of life.‘ Ref 1.

The combination of therapies shows the best treatment for arthritis. ‘An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis.’ ref 2.

A typical treatment programme for an arthritic knee would include:

  • Pain relief; A choice of heat, cold therapy or electrotherapy modalities including transcutaneous nervous stimulation [TENS], Interferential therapy or short wave diathermy.
  • Passive mobilisation: I will loosen the knee up for you.
  • Muscle strengthening. Simple exercises using body weight or external resistance to get the muscles functioning strongly.
  • Functional activity: You will be encouraged to try gentle exercises such as static bike or even swimming. Eventually a return to bowls!

Home exercise programme.

You will be given a series of exercises to perform at home to help you maintain the improvements you have made. These will not be too demanding or time-consuming. Hopefully, they will help keep you away from people like me!

Phil Pask

Ref 1. Outline of research into arthritis and physiotherapy

Ref 2. Exercise therapy intervention provides short-term as well as long-term benefits