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Ask the Physical Therapist: Arthritis: Understanding A growing problem affecting our clients, parents and those we care about. Part 1

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Written by Chris Gellert, PT, MPT, CSCS, CPT

Osteoarthritis(OA), the most common form of arthritis, a potentially devastating joint disease, affects some 27 million adults per year and is on the rise. OA typically occurs in the hands, knees, spine and hips affecting a multitude of joints.1
Obtaining a detailed history by the physician, via x-ray, where individuals will complain of symptoms of stiffness, low-grade inflammation and pain, makes diagnosis.
The pathohysiology involves a combination of mechanical, cellular and biochemical changes. The interaction of these processes leads to changes in the composition and mechanical properties of the articular cartilage. Cartilage is comprised of water, collagen and proteoglycans, In healthy cartilage there is continual remodeling that occurs as chrondocytes(cartilaginous cells) that replace macromolecules lost through degradation. In Osteoarthritis this process is disrupted leading to degenerative changes and abnormal repair response.2 The exact etiology is unknown. Risk factors include joint injury, obesity, mechanical stress, history of immobilization and trauma.
In Part 1 of this post, I am going to provide an overview of Osteoarthritis, pathophysiology of arthritis, risk factors, medical treatment and the different types of Arthritis.
Treatment
The most effective form of treatment is education. Individuals should be thoroughly educated about the natural course of osteoarthritis beginning with the family physician and followed by the health professional(physical therapist) and personal trainer. A "team" approach is ideal and in the last decade this collaborative approach is not only becoming more popular but more effective.
Various medications are discussed with the patients by their physicians including NSAIDS(non-steroidals) including ibuprofen, naproxen, cyclooxygenase inhibitors(celebrex) and vioxx. Sterioid injections are another treatment option but are only able to be administered three times per year. Prolonged use of steroid injections can predispose an individual to osteoporosis. Physical therapy has proven to be an effective treatment approach to reduce pain through education, soft tissue/manual therapy, stretching, modalities, and specific exercises that will reduce the load to the specific joint affected.
In the next section, the most common types of Arthitis will be briefly reviewed.
A Brief Overview of the Types of Arthritis
1.Arthritis(Degenerative Disc Disease)/O.A. 3 " Is defined as a slow, progressive degeneration of joint structures, which can lead to loss of mobility, function, chronic pain and deformity. " The most commonly involved joints are the hip, knee and the spine. " Osteoarthritis is the single most common joint disease and is divided into two classifications: primary and secondary. a. Primary osteoarthtitis is a disorder of unknown cause and the cascade of joint degeneration events associated with it are to be related to a defect in the articular cartilage. b. Secondary osteoarthritis has a known cause, which may lead to trauma, infection, hemathrosis and osteonecrosis.
2. Rheumatoid Arthritis " Rheumatoid arthritis is a chronic, systemic inflammatory disease. " Systems that may be involved include the cardiovascular, pulmonary, and gastrointestinal systems.
3. Juvenile Rheumatoid Arthritis " Juvenile rheumatoid arthritis is a chronic inflammatory disease that can range from a mile illness to a severe, destructive arthopathy with significant extra-articular manifestations. Still's disease, a form of JRA, may affect a number of joints, but is characterized chiefly by a systemic manifestation.
4. Ankylosing Spondylitis " Ankylosing Spondylitis is an inflammatory condition of the axial skeleton including the sacroiliac joints, costoverterbral joints and the intervetebral disk articulations. " This can ultimately lead to a fibrosis, calcification and ossification of the involved joints.
5. Psoriatric Arthritis " Psoratric arthritis is a inflammatory disease afflicting a small percentage of people who have psoriasis. This joint disorder is associated with radiographic evidence of bone erosion and joint destruction. " Psoriatric arthritis tends to progress slowly, and for those most afflicted is more of a nuisance than a disabling condition.
In part 2, I am going to review each type of arthritis more in depth, review effective training strategies/exercises that can benefit those afflicted and exercises that are to be avoided. Lastly in part 3, I will review ways of managing, prevention strategies, other interventions such as yoga, tai chi, pilates and wholistic training methods to help clients' improve their quality of life.
References
1.Lawrence RC, Delson DT, Helmck CG et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheumatology. 58(1) pgs: 26-35. 2008.
2 Hinton et al. Osteoarthritis: Diagnosis and Therapeutic Considerations. Journal of American Family Physician. 65(5) Pgs: 841-849. 2002.
3 Goodman and Boissonault. Pathology implications for the Physical Therapist. W.B. Saunders Company. Philadelphia. Pgs: 660-671. 1998.
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Chris Gellert, PT, MPT, CSCS, CPT is uniquely both an experienced physical therapist and personal trainer with over 19 years experience. He is a passionate author, dynamic presenter, entrepreneur, and committed to continual learning. View his Author's Profile and other articles published in Personal Trainer Today.





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