OSTEOARTHRITIS (DEGENERATIVE JOINT DISEASE)
DEFINITION
– Osteoarthritis is a non-inflammatory Degenerative disorder of joints characterized by articular cartilage Degeneration and new bone formation ( osteophytes ).
• Risk factors
– Abnormal mechanical loading ( e.g., Instability, menisectomy )
– Obesity
– Occupation ( E.g., farmers )
– Infection
– Heriditary
• Classification
1) Primary : It is mainly due to wear and tear changes occuring with aging or obesity or overuse.
2) Secondary :
– Due to predisposing causes like,
√ Trauma
√ infection
√ Rheumatoid Arthritis etc.
• Pathology
– OA is a Degenerative non inflammatory condition affecting,
√ Articular cartilage
√ Bone
√ Synovial membrane
√ Capsule
√ ligament
√ Muscle
• Clinical features
√ Pain
√ Swollen joints due to Synovitis.
√ Stiffness
√ Deformed joints e.g., genu varun deformity at knee.
√ Ligamentous instability
√ Crepitus is felt
√ Restricted movements
√ Joint effusion
√ Muscle spasm, musle weakness or wasting.
• Radiological classification
Stage 1 – Bony spur only
Stage 2 – Narrowing of joint space, less than half of normal joint space
Stage 3 – Narrowing of joint space more than half of normal joint space.
Stage 4 – Obliteration of joint space
Stage 5 – Subluxation
• Investigation
– Blood tests : normal
– Radiological features
√ Cartilage loss
√ osteophytes
• Physiotherapy management
* General principles of treatment
√ Prevention
√ Pain control
√ Prevention of further damage
√ Improvement in ROM
√ Improvement in strength , endurance and muscle function
√ Improvement in functional status of involved joint.
* Treatment
1 ) Pain control:
(a) Electrotherapy modalities
– Acute phase : Superficial heating modality or cryotherapy
– Ultrasound , TENS, stimulations are also affective.
(b) Hydrotherapy
– Useful when the weight bearing joints are affected.
(c) To reduce Compressive force on joint : Rest in proper position, splints or joint distraction by mechanical or manual traction , CPM or functional bracing.
2) Improvement of muscle power , endurance and tone :
– PRE ( progressive resistive exercise )
– Strong ,sustained repeated session of Isometrics
– Holding or sustained muscle contraction in static mid range position of isotonics.
3) Improvement in ROM:
(a) Active free relaxed rhythmic movements to improve ROM and to promote relaxation.
(b) Relaxed passive movements to mobilize stiff joints.
– Hydrotherapy
– PNF techniques
– Mobilization and manual therapy techniques.
4) Improvement in functional independence :
– Proper guidance to relieve compression over the affected joint.
– Providing assistive aids , Modified supports , orthoses, ergonomic advice on the performance of ADL’s and special shoes with inserts .
• Common sites of OA and their management :
1. Hip
2. Knee
• PT management for OSTEOARTHRITIS of hip
* To control pain
– Acute phase : Ice massage, ice-packs in resting Position.
– Gentle intermittent traction
– Deep heating modalities : Ultrasound, TENS, Interferential currents etc.
* Joint mobilization
– Relaxed ROM swinging exercise initially.
– Progress to small range assisted free active movements by ped-o-cycle, or stationary cycle .
– Maitland low grade mobilization techniques.
– Hydrotherapy to promote relaxation , to improve mobility , strength and confidence.
– PNF techniques .
* Muscle strengthening
– Controlled Isometrics can be done repeatedly without causing pain .
– Strengthening exercises for knee flexors, extensors , ankle dorsi and plantar Flexors.
* Gait re-education.
• Pt management for OSTEOARTHRITIS of knee
* Self care and self help
√ Avoid frequent standing and sitting
√ Avoid long walk
√ Avoid unsupported climbing
√ avoid sitting in unarmed chairs
√ Unsupported squatting and kneeling should be avoided
√ avoid cross leg sitting
√ Avoid walking with carrying heavy weights.
* To control pain
– Acute phase : TENS, Ultrasound, hydropack, pulsed diathermy.
– Chronic pain : deep thermotherapy.
* Exercise program
√ Isometrics :
– Speedy Isometrics to quadriceps and hamstrings.
– Slow and sustained Isometrics helps to reduce pain and to improve strength.
√ Speedy active relaxed free movements
√ Isokinetic exercises
√ SLR : It can be made effective by simultaneous Isometrics to Quadriceps with foot is held in Dorsiflexion.
√ Hamstring stretching
√ Posture, gait and assistive devices like cane, crutch , orthoses .
√ Wedge insole provides relief by reducing compressive forces on the affected compartment on bearing weight and also reduces excessive tensile force on opposite compartment.
•Healthy Lifestyle.
Tips for OsteoArthritis
Include like foods milk of rich in Calcium and vitamin D ,Dairy prods.
darker the Green vegetable more calcium they contain
Exception spinach contains oxalic Acid which inhibits Calcium Absorption.
Include Antioxidants like
Foods rich in Vitamin C ,E and A. Best food sources for Vitamin C are citrus fruits, Melons, peppers ,berries.
Include soya in diet. Exercise Regularly inorder to improve the circulation which brings Vitamin. And minerals to the bones. (walking)
Reduce cholestrole levels to Normal if high.
Garlic works against the enzyme that damage cartilage
Include Nuts the Die
Avoid caffeine consumption.
Avoid Refined and processed foods.
Protein Intake must be moderate.
Avoid smoking
Limit Alcohol
Include oily fish in Diet for omega-3
Acidic foods should be Avoided.
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BY PHYSIOFEEDS.
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