Osteoarthritis and Exercise

Original Editor - Nupur Smit Shah

Top Contributors - Nupur Smit Shah, Shaimaa Eldib and Lucinda hampton  

Introduction[edit | edit source]

Osteoarthritis is a common form of arthritis and it leads to a major health economic burden. It commonly occurs in weight bearing joints such as hip and knee , with knee joint being more often involved.[1]It also involves the hand.

In osteoarthritis, initially there is molecular derangement (interrupted joint metabolism) followed by anatomical and physiological derangements such as cartilage degeneration, osteophyte formation, bone remodeling, joint inflammation and loss of normal function. Clinically the patients present with pain and stiffness in affected joint. Morning stiffness is also present.[2] The overall risk of this condition is more in obese population and even those who had previous joint injury. It has been proved that knee joint pain is reduced when obese patients undergo weight reduction.[1]

Therapeutic exercise is defined as bodily movement prescribed to correct impairment, improve the function of musculoskeletal system and maintain a state of well being. It is prescribed to the patients of osteoarthritis irrespective of age, comorbidity, severity of pain or disability.[3]Therapeutic exercises(type/ dose) are decided by the physical therapist based on the need of the patient.[3]The exercises are decided depending on age, weight, basic fitness level, severity of the disease and comorbidities. Optimal exercise prescription will lead to exercise adherence reduce the risk of symptom flare up and maximize the outcome.[3]

Exercises have beneficial effect on the patients of OA. It can improve in terms of muscle strength, mobility, coordination as well as help to relieve pain.[4]The patient can become improve their functional status by doing exercises on regular basis. Usually weight bearing and non weight bearing exercises are given. It helps in prevention too.

Physiotherapy In Osteoarthritis Of Weight Bearing Joints[edit | edit source]

  • Land based stationary bike enhances the total leg muscles. Tip toe , isometric quadriceps, hamstrings and gluteal muscles, dynamic quadriceps strengthening such as SLR, heel drags, high sitting knee extension, hip abductor muscle strengthening are proved to be effective in reducing the symptoms of OA.[5]
  • Low contact sports are effective to manage OA, it prevents maximum joint stress and improves muscle strength and joint stability. High contact sports are avoided.
  • Mind and body exercises such as Tai Chi and yoga are also prescribed.[6]
  • Gait aids can be recommended.
  • Cryotherapy can be used as an adjunct along with land based exercises.[7]
  • Education on weight management has to be provided.
  • In electrotherapy, Transcutaneous Electrical Nerve Stimulation is applied.[8]

Aquatic Exercises and Osteoarthritis[edit | edit source]

The exercises which are performed in water are known as aquatic exercises or hydrotherapy. It has various advantages in comparison to land based exercises. Blood circulation is improved by constant water temperature and hydrostatic pressure, it reduces the tension of soft tissue contracture. It even helps in reducing muscle spasm and fatigue. Muscle strengthening is promoted as water resistance acts in opposite direction of the body motion, which needs greater muscle activity. The buoyancy reduces the weight bearing which helps in reducing the degradation of the joints. It also give a soothing environment for osteoarthritis patients who are reluctant towards exercise.[9]

OA Hand[edit | edit source]

Osteoarthritis of hand is a common musculoskeletal disease. Its prevalence is rising rapidly with increasing age. It is usually occurs in 1st carpometacarpal joint. [10]The clinical features are hand pain, stiffness, reduced grip strength and compromised functional status. The primary goal of a physiotherapist will be to manage pain and improve the functional status by working on strength of the muscles.[11]Hand orthosis are strongly prescribed.[10]

EULAR recommendations for Hand OA[edit | edit source]

The patient characteristics that are consider most important include, age, type of pain, level and type of disability, mechanical factors, expectations of patients, the severity of damage, presence of erosions and inflammation.

References[edit | edit source]

  1. ↑ 1.0 1.1 Funck‐Brentano T, Nethander M, Movérare‐Skrtic S, Richette P, Ohlsson C. Causal factors for knee, hip, and hand osteoarthritis: a Mendelian randomization study in the UK biobank. Arthritis & rheumatology. 2019 Oct;71(10):1634-41.
  2. ↑ Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. Jama. 2021 Feb 9;325(6):568-78.
  3. ↑ 3.0 3.1 3.2 Burgess LC, Wainwright TW, James KA, von Heideken J, Iversen MD. The quality of intervention reporting in trials of therapeutic exercise for hip osteoarthritis: a secondary analysis of a systematic review. Trials. 2021 Dec;22(1):1-0.
  4. ↑ Mazor M, Best TM, Cesaro A, Lespessailles E, Toumi H. Osteoarthritis biomarker responses and cartilage adaptation to exercise: A review of animal and human models. Scandinavian journal of medicine & science in sports. 2019 Aug;29(8):1072-82.
  5. ↑ Raposo F, Ramos M, Lúcia Cruz A. Effects of exercise on knee osteoarthritis: A systematic review. Musculoskeletal care. 2021 Dec;19(4):399-435.
  6. ↑ Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SM, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage. 2019 Nov 1;27(11):1578-89.
  7. ↑ Dantas LO, Jorge AE, da Silva Serrao PR, Aburquerque-Sendin F, de Fatima Salvini T. Cryotherapy associated with tailored land-based exercises for knee osteoarthritis: a protocol for a double-blind sham-controlled randomised trial. BMJ open. 2020 Jun 1;10(6):e035610.
  8. ↑ Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SM, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage. 2019 Nov 1;27(11):1578-89.
  9. ↑ Dong R, Wu Y, Xu S, Zhang L, Ying J, Jin H, Wang P, Xiao L, Tong P. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?. Medicine. 2018 Dec;97(52).
  10. ↑ 10.0 10.1 Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020 Feb;72(2):220-33.
  11. ↑ Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, Haugen IK, Herrero-Beaumont G, Jonsson H, Kjeken I, Maheu E. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the rheumatic diseases. 2019 Jan 1;78(1):16-24.
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