FEATURED ARTICLE • MUSCULOSKELETAL PHYSIOTHERAPY
Osteoarthritis: Symptoms, Grading & Physiotherapy Management
Osteoarthritis (OA) is a degenerative joint disorder characterized by breakdown of articular cartilage, new bone formation, joint space narrowing and varying degrees of synovial inflammation. It can cause pain, stiffness, reduced range of motion and difficulty with daily activities.
Definition
Osteoarthritis is a common degenerative joint disorder involving changes in articular cartilage, subchondral bone and surrounding joint tissues.
Etiology and Risk Factors
- Aging
- Obesity or excess body weight
- Genetic predisposition
- Joint overuse or repetitive stress
- Previous joint injury
- Muscle weakness
- Joint malalignment
- Hormonal factors
Pathophysiology
- Cartilage degeneration: contributes to joint space narrowing.
- Subchondral bone changes: contribute to osteophyte formation and sclerosis.
- Synovial changes: can contribute to pain, stiffness and reduced function.
Clinical Features
- Mechanical-type joint pain
- Morning stiffness, commonly less than 30 minutes
- Crepitus
- Tenderness
- Reduced range of motion
- Bony enlargement
- Deformity in advanced cases
- Reduced functional activities
Commonly Affected Joints
- Knee
- Hip
- Hand (DIP, PIP and 1st CMC joints)
- Spine (facet joints)
- Ankle
- Shoulder
Radiological Features
- Joint space narrowing
- Osteophyte formation
- Subchondral sclerosis
- Subchondral cysts
- Deformity of bones in advanced disease
Grading: Kellgren-Lawrence Scale
The Kellgren-Lawrence system grades radiographic osteoarthritis from Grade 0 to Grade 4.
| Grade | Radiological Features |
|---|---|
| 0 | No radiographic features of OA. |
| 1 | Doubtful joint space narrowing and possible osteophytic lipping. |
| 2 | Definite osteophytes and possible joint space narrowing. |
| 3 | Moderate multiple osteophytes, definite joint space narrowing, some sclerosis and possible deformity. |
| 4 | Large osteophytes, marked joint space narrowing, severe sclerosis and definite deformity. |
Differential Diagnosis
- Rheumatoid arthritis
- Gout
- Septic arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Osteonecrosis
- Bursitis
- Tendinitis
Goals of Physiotherapy
- Pain relief
- Maintain or improve range of motion
- Improve muscle strength
- Improve joint stability
- Improve functional abilities
- Weight management
- Patient education
Physiotherapy Assessment
- Subjective assessment: pain, stiffness and function.
- Observation: gait, posture and deformity.
- Palpation: tenderness, warmth and crepitus.
- Range of motion: active and passive movement.
- Muscle strength: relevant muscle groups.
- Functional assessment: WOMAC or Lequesne index when appropriate.
Physiotherapy Management
Management should be individualized according to the affected joint, symptoms, functional limitations and clinical findings.
| Pain Relief | Improve ROM | Strengthening | Functional Training | Education |
|---|---|---|---|---|
| Hot pack | Passive mobility | Isometric exercises | Gait training | Joint protection |
| TENS | Stretching | Isotonic exercises | Balance exercises | Weight control |
| IFT | Joint mobilization | Closed-chain exercises | ADL training | Posture correction |
| UST | Manual therapy |
Exercises for Osteoarthritis
- Quadriceps strengthening: SLR and quadriceps sets.
- Hamstring strengthening: bridging and hamstring curls.
- Hip strengthening: clamshells and side leg raises.
- Aerobic exercise: walking, cycling or swimming as appropriate.
- Range-of-motion exercises: heel slides and wall slides.
Contraindications and Precautions
- Acute inflammation
- Severe pain
- Joint infection
- Unstable fracture
- Severe osteoporosis
Complications
- Chronic pain
- Reduced mobility
- Joint deformity
- Weakness and disability
- Reduced quality of life
Key Points
- Osteoarthritis is a degenerative joint disorder, although inflammatory changes may occur.
- Symptoms and functional limitations vary between individuals.
- Exercise and education are important components of rehabilitation.
- Early, appropriate management can help maintain function and quality of life.
Medical disclaimer: This article is for general education and does not replace an individualized assessment, diagnosis or treatment plan from a qualified healthcare professional.