Osteoarthritis: Current Science and Optimal Treatment

Osteoarthritis (OA) is the most common musculoskeletal condition and can affect any synovial (moving) joint in the body. It is most frequently found in the spinal joints of the neck and low back, the knee, the hip and the hands. Most people by the age of 65 have some evidence of OA. Further, OA parallels only cardiac disease as the leading cause of disability in the US.

The current understanding of OA by the scientific community has evolved from the days when OA was viewed as a disease that selectively targeted the articular cartilage. OA is a condition that really affects the entire joint. OA is now viewed as essentially the result of a mechanical breakdown of joints due to an imbalance between the integrity of the joint, and the type and amount of loading on the joint. Factors that increase an individual’s risk of developing OA include the certain occupations that involve repetitive, stressful body movements, traumatic joint injury, and being overweight or obese.

Unfortunately, standard medical care has not kept up with this new perspective on OA. Typical medical care for OA almost always starts with the prescription of non-steroidal anti-inflammatory medications (NSAID’s). Although these medications can help to control pain in the acute stages of the condition, they do nothing to address the underlying mechanical problem of OA.  It is also more likely that when people take NSAID’s, they do less to modify the loading strategies on their joints because the medications are controlling their pain. So they are likely to continue the activities that may be contributing to their condition, and the integrity of the joints may continue to decline. When medication no longer controls the symptoms of OA, medical care often moves to injections. These certainly can help in the short-run, but again provide no long-term solution.  Finally, when those stop working, joint replacement is pursued, which is viewed as the “gold standard” for treatment.

This occurs even though clinical guidelines for OA management consistently recommend a course of conservative care, including physical therapy, as a first line treatment approach for OA as well as weight-loss when appropriate.

Physical therapists help people with OA manage their pain through controlled movements of the joints. Through educational interventions, the physical therapist can help patients alter the loading on their involved joint so that it can heal. They prescribe specific exercises to gradually improve the integrity of the joint and improve overall function. There is evidence to support the effectiveness of physical therapy intervention for OA, and there is evidence that suggests that people can avoid the need for surgery with well-timed physical therapy management.

Although there are complex physical and psychosocial aspects contributing to the pain experience of OA and there is no doubt joint replacement helps to improve the quality of life for many people at the end-stage of OA, the current science supports physical therapy as optimal care, especially during the early stage of OA. 

Marcia Miller Spoto, PT, DC, OCS