Osteoarthritis: What It Is, Symptoms, Prevention
Osteoarthritis is a set of mechanical abnormalities that lead to joint degeneration, mainly affecting the articular cartilage and subchondral bone. Symptoms include joint pain, tenderness, stiffness, blockage, and swelling of the joint. The causes can be various, including hereditary, developmental, metabolic, mechanical reasons that lead to the destruction of cartilage. The loss of cartilage leaves the bone exposed, thus making the joint unable to cope with the loads it can receive in everyday life. The joints most affected are those that receive the most loads such as the spine, hip and knee, but this does not mean that it can not occur in other joints.
Osteoarthritis is categorized into:
Primary osteoarthritis: It is a chronic degenerative process associated with aging, but it is not necessarily caused by it, as it is observed in older people without signs of degeneration.
Secondary osteoarthritis: Caused by other factors which include: Injuries to the joints (such as the anterior cruciate ligament), surgery, joint instability, obesity, various inflammatory diseases, etc. These factors affect the function of the cartilage and the way it receives loads, gradually leading to its degeneration. Secondary osteoarthritis occurs at a much younger age than primary osteoarthritis.
Cases of osteoarthritis are mostly over 50 years old, often people are obese and are mostly women. Younger people diagnosed with osteoarthritis may have a history of strain on the knee joint, such as a fracture, an older injury, or a specific anatomical morphology.
Symptoms begin mildly and increase steadily, with periods of remission often lasting months. Changes in muscle synergies occur and trigger points of pain in periarticular muscles. In the case of unilateral arthritis, atrophy of the quadriceps muscle is characteristic. The joint is often swollen due to swelling and increased amount of synovial fluid and thickening of the synovial membrane.
The clinical picture includes pain in the knee joint. The pain is usually located in front of the patella, in the intervertebral space, behind the iliac cavity and often in the calves. In the early stages of the disease, the pain appears during exercise and goes away with rest. As the disease progresses eventually, the pain settles and increases. The person now complains even after the end of the exercise. Advanced pain can be reported even during sleep. At the end of the exercise, the wear pieces mentioned cause hymenitis. The pain is not due to the degeneration of the cartilage as they are not ribbed. The pain seems to be mainly due to follicular fibrosis and vascular congestion. The pain does not allow the person to act normally and makes the movements difficult, thus reducing the functionality of the joint.
Osteoarthritis is characterized by stiffness in the joint. The person has the feeling that the knee “stuck” during movement. Stiffness occurs after periods of joint immobility. In the early stages of the disease the stiffness lasts only a few minutes. As the disease progresses, the stiffness becomes more intense and they settle, reducing the normal trajectory ranges and causing the joint to lose its normal movement.
Over time, the person eventually obeys the needs of the joint and finds it difficult to sit deep, climb stairs and even walk. The functionality of the individual as a whole without realizing it, decreases. He no longer walks often, abstains from activities that pleased him and changes his quality of life.
By palpating the area, in addition to swelling and thickening, one can understand the osteophytes around the bones of the joint, especially in the femur. When moving on your knees with osteoarthritis, you notice the characteristic sound of a patella. This is because the articular cartilage that lubricates the joint has degenerated and the bones are rubbing against each other.
At the beginning of the disease the X-ray does not show significant diagnostic evidence. Radiographic findings are typical of degenerative joint diseases (stenosis of the joint, thickening of articular surfaces, hypochondriac cysts, osteophytes). At the beginning, small osteophytic treatments are presented in the middle part of the tibial joint, in the upper and lower pole of the patella and in the tops of the medial spines, which thus become more acidic. On x-rays with the patient standing up in the upright position, the narrowing of the inner intervertebral space and the degree of deformity are better seen.
Active people with frequent moderate-intensity exercise, create a good musculoskeletal system that can properly absorb the loads of everyday life seems to play an important role, also moderate activity helps move the synovial fluid and provide nutrients to the cartilage. In addition, the reduction of body weight (in cases of extra pounds), the correct recovery of possible injuries, are important elements that help prevent the disease.
The goals of the physical therapy program are as follows:
Pain reduction. Various natural means (electrotherapy, iontophoresis, ultrasound, etc.), but also special mobilization techniques available to the physiotherapist can help reduce pain and reduce the inflammatory response.
Fight stiffness and regain elasticity. Specialized exercise is also the answer to this symptom as prolonged immobilization exacerbates stiffness.
Muscle strengthening – improving coordination – balance. Exercises to improve the strength but also the balance and coordination of the affected limb are important to implement so that the limb can cope as best as possible with daily challenges.
Increase functionality. The ultimate and basic goal is to reach the individual at the highest possible functional level in order to carry out his daily activities with the least possible restriction. Thus, in the restoration, everyday activities are simulated, such as walking, climbing, descending stairs, etc. depending on the patient’s habits. This process starts early and depending on the margins that the disease gives us. It is a learning process, including ergonomic interventions.
Dandy D., & Edwards D., (2010). Essential Orthopedics and Trauma, 5th edition, (translation – editing from English by: Korres D., Xenaki Th.,) Parisianou Scientific Publications, Athens: Chapter 1 pages 7-11, 24-27, chapter 16 pages. 273 – 279.
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