Arthritis is a common condition affecting your joints and other tissues. The Arthritis Society Canada reports that 1 in 5 Canadians are living with the disorder. Arthritis can cause pain, degeneration, inflammation or swelling in the joints and restrict movement, impact your ability to stay mobile and active and lessen your quality of life. Despite typically affecting older adults, arthritic conditions can develop in people of all genders and of any age.
Arthritis pain can make it difficult to conduct your daily activities. Inflammation or degeneration (breakdown) of your joints can cause joint pain when moving. This pain may impact your ability to do things you enjoy. Living with arthritis and arthritic pain can be very discouraging and impact your everyday life, jobs and financial resources, and relationships. However, the good news is that there are many ways to cope with and mitigate these problems!
Physiotherapists are trained healthcare professionals with expertise in movement assessment. Physio teams can work with your healthcare providers to help you return to or maintain an independent and active lifestyle. Your physiotherapist can improve their understanding of your arthritic condition, functional limitations and capabilities, personal goals and other important information and work with you to develop an individualized treatment plan for pain relief.
2 common types of arthritis we see at our clinics
Arthritis is an overarching term that encompasses many different conditions. While the presentation of arthritis depends on the specific arthritic condition, the most common signs and symptoms of arthritis may include pain, stiffness, swelling, redness, tenderness, warmth, and a decreased range of motion in the affected joint. Symptoms may be mild for some individuals while severe for others, discomfort may be constant or intermittent, and the impact on daily activities is specific to the affected individual. Different arthritic conditions can come about in various areas from different underlying causes. For example, excessive uric acid in your body can cause gout. Conversely, many types of arthritis do not have a known cause; however, you may be more likely to develop arthritis if you work a physically demanding job or play sports that put repetitive strain on your joints, have specific viral or autoimmune infections or conditions, or if you have a family history of arthritis. Some other risk factors for arthritis include:
- Age - As you get older, your risk of developing arthritis increases.
- Lifestyle - Detrimental habits (e.g. smoking, sedentary behaviours or inactivity) can increase arthritis risk.
- Sex - The majority of arthritic conditions are more common in individuals who are biologically female.
- Weight - Any factor that increases the strain on your joints can increase the likelihood of developing arthritis, including being overweight or obese.
Two of the most common conditions seen at REP Physio clinics include osteoarthritis (OA) and rheumatoid arthritis (RA).
What is it?
Osteoarthritis (OA) is the most common type of arthritis. OA is recognized as “wear and tear” arthritis or degenerative joint disease. OA is a common condition developed with aging. The Arthritis Foundation states that all tissue components of the joint can be affected by OA, including the synovium, ligaments, cartilage, fat, and bone. OA is a progressive disease that causes inflammation within the joint, cartilage degradation and altered bone shape. The body responds to wear and tear by laying down new, healthy tissue to replace the damaged and degenerated tissue. When the body’s repair process can no longer keep up with tissue breakdown, OA can begin to develop. Healthy cartilage provides cushion and reduces friction between bones as joints move; however, damage or degeneration of the cartilage can result in increased friction between bones, grinding, and degeneration of the underlying bone. These physical changes can result in inflammation, pain and restricted mobility in the affected joints and impact your overall quality of life.
OA can be present in any joint. However, OA is most commonly present in the hands, knees, hips, lower back, and neck. OA typically develops very slowly over time. Individuals over the age of 45 at a higher likelihood of developing symptoms, but it is not an inevitable disease. Factors such as a prior joint injury can cause a more rapid rate of OA development and development at a much earlier age. OA has no cure, but treatment options are available to maintain your mobility, good quality of life, reduce pain and stay active.
What can be done to help?
OA has no cure, but treatment options are available to maintain your mobility, good quality of life, reduce pain and stay active. Physiotherapy teams can provide individuals living with OA with various services, treatments, and education to help them cope with their condition.
When meeting with your physical therapist, they will assess your unique condition, symptoms, and functional capacity. By getting to know you and your body, your physio can tailor a treatment plan that best suits your individual care needs. As a rule of thumb, symptoms and physical function should guide the management of your OA. Additionally, the NICE guidelines for OA management state that the core treatments for this condition are therapeutic exercise and weight management (if appropriate), along with information and support.
At REP Physio, our professionals will work with you to tailor therapeutic exercise to your unique needs (e.g. aerobic fitness, local muscle strengthening. It is crucial to understand that joint pain may initially increase when starting your exercise program; however, regular and consistent exercise is beneficial for long-term joint health. Long-term adherence to therapeutic exercise routines will increase benefits, reducing pain and increasing your functional capacity and quality of life. By strengthening the muscles surrounding the arthritic joint(s), you can lessen the demands on the joint and provide proper alignment during movement. Manual therapy is recommended only for individuals experiencing hip or knee OA when performed alongside a therapeutic exercise protocol. Research evidence is not robust enough to support manual therapy alone as an effective treatment for OA.
People living with OA that are living in larger bodies and are overweight or obese should receive education on the effect of excess weight on OA symptom exacerbation and that weight loss can and will reduce pain and improve their overall quality of life and physical capabilities. Our team at REP Physio can help educate and support you in your weight management, help you choose a weight loss goal and advise on a means to achieve it. While any amount of weight loss will benefit OA symptoms, losing 10% of your body weight has a more positive impact on your health and OA than losing 5%. Our team can also educate individuals with lower extremity OA on the benefit of devices such as walking aids (e.g. walking sticks).
Pharmacological management is largely outside of a physical therapist's scope of practice. However, if non-pharmacological management strategies fail to relieve pain, a physio may recommend speaking with a healthcare provider. Alternative treatments may include intra-articular corticosteroid injections, topical, oral, or transdermal anti-inflammatory and pain-relieving medications. Your physio will educate you on the risks and benefits of these treatments based on a literature review of clinical evidence. For example, the NICE guidelines for OA indicate that intra-articular corticosteroid injections only provide short-term relief of 2 to 10 weeks.
What is it?
Rheumatoid arthritis (RA) is an autoimmune condition that causes inflammation and painful joints. RA occurs when the immune system mistakenly attacks the healthy synovial cells of the joints (the joint lining). This attack releases inflammatory chemicals, impacting the synovium’s ability to produce fluid and keep the joint moving smoothly. This results in an inflamed, thickened synovium and articular symptoms like pain and tenderness, redness, warmth, reduced range of motion and joint swelling. RA typically affects the hands, knees, or ankles and commonly affects both joints on either side of the body (e.g. both hands). RA can significantly limit a person’s ability to move the affected joint and occasionally causes problems elsewhere (e.g. eyes, cardiovascular system, lungs).
Biological females are more likely to have RA than biological males. RA typically develops in middle age individuals and has a genetic component, meaning that you are at a higher risk for developing RA if a family member has RA.
Early stages of RA may not present with redness or swelling in the joints, but tenderness and pain are likely to occur. According to the Arthritis Foundation, the following symptoms may be indicative of RA:
- The same joints are affected bilaterally (on both sides of the body)
- Small joints (e.g. wrists, some joints in the hands and feet) are usually the first affected.
- More than one joint is affected.
- 30 minutes or longer of morning stiffness
- Joint stiffness, tenderness, pain or swelling lasts for > 6 weeks.
The Arthritis Foundation indicates that individuals with RA can experience high levels of fatigue and potentially a low-grade fever. Symptoms may be intermittent, and flares (heightened inflammation and symptoms) can last for days to months..
What can be done to help?
RA treatment goals may include:
- Putting the disease in remission by halting inflammation or reducing it as much as possible
- Treat to target - target remission or other objectives, aiming for few or no signs/symptoms of active inflammation
- Relieve symptoms
- Reduce long-term complications and prevent joint and organ damage
- Improve function, overall well-being and quality of life.
RA treatment requires a mix of pharmacological and non-pharmacological interventions, indicating a need for a multidisciplinary inter-professional healthcare team. From a physical therapy standpoint, movement is medicine. While exercise may be the last thing you want to do when feeling fatigued and in pain, research shows that RA symptoms can be relieved through exercise and regular activity can improve day-to-day function.
Healthcare professionals (e.g. physio) can prescribe therapeutic exercise and address specific joints or body parts affected by RA. An individualized therapeutic exercise program is crucial for those who have been inactive or those suffering from the symptoms of RA to recover joint function. According to the American College of Rheumatology, people with RA will benefit from moderate-intensity, weight-bearing exercise. In addition to pain relief, exercise can reduce RA-related small-joint damage and bone loss and has no proven increase in disease activity or pain. UK clinical guidelines recommend drug treatment alongside physiotherapy and occupational therapy for RA management.
At REP Physio, our team will work with you to develop a therapeutic exercise program tailored to your specific needs. While RA is a chronic disease with no known cure, a tailored treatment plan can improve social participation and symptoms, prevent disability and increase functional physical capacity. A typical physiotherapy program for patients with RA may include range of motion, aerobic, stabilization and coordination exercises. Physiotherapists will start RA patients with a moderate-intensity exercise program and progress to high-intensity, to improve aerobic capacity, strength and endurance (if possible). Individual assessments will inform the prescribed parameters of exercise (duration and intensity).
Your treatment plan will contain an education component to increase your understanding of your condition, how it affects your routines, and how to adjust your movement patterns and behaviour to manage your RA, flare-ups, and set goals. Your physio will use outcome measures to keep track of your RA progression/regression and current status. Your physical presentation will inform any program alterations.
Reducing pain in arthritic joints: steps you can take
It is challenging to know where to begin when managing painful, arthritic joints. Thankfully, there are resources available and steps you can take to reduce pain and increase your quality of life. A good starting point is to educate yourself on the type of arthritic condition you have and which areas of your body are affected, build a support system of healthcare professionals, friends and family, and keep your team informed of any changes in symptoms. Working with healthcare professionals, such as physical therapists, can help develop your therapeutic exercise program tailored to your needs.
The following four tips can help you manage your arthritic pain in your everyday life.
- Follow your healthcare provider’s instructions. This may include taking prescription or over-the-counter medications to keep inflammation as low as possible, specific nutrition protocols, and watching for red flags or flare-ups.
- Remain (or get) physically active. Arthritis commonly causes individuals to avoid physical activity and exercise due to various factors, such as unpleasant pain during movement, psychological stress and fear of working through fatigue or worsening your condition. However, avoiding physical activity due to fear or perception of pain reinforces neurological associations between movement and symptoms. The research on arthritis and activity states that keeping your joints moving and maintaining an active lifestyle can increase endurance and strength, reduce loads on the joints, and reduce the intensity of pain experienced. Regular physical activity can increase your energy levels, reduce stiffness and improve your ability to perform your daily activities.
- Manage your weight. Being overweight or obese can increase the demands on load-bearing joints, increasing wear and tear. Body weight management is crucial when dealing with arthritic conditions where inflammation and degeneration are the main culprits of perceived pain. In addition to increased pressure on the joints, adipose (fat) tissue releases inflammation-increasing chemical signals through the body. By reducing your body weight, you can directly reduce the strain on your joints and systemic and local inflammation. This can reduce your perceived pain significantly. Eating a well-balanced, nutritious diet and getting regular physical activity can help manage weight. Weight reduction can be a daunting task, but you are not alone. Check with your healthcare provider for helpful guidance or resources.
- Stay positive! Living with chronic pain can take a toll on both your physical and mental well-being. Working on both aspects of your health is integral to having the best outcomes possible. According to the Arthritis Foundation, many individuals with chronic arthritic conditions noticed a significant elevation in pain-coping ability when maintaining a positive outlook and attitude. Some recommendations for keeping a positive attitude include: doing things you enjoy, spending time with family and friends, and staying busy. If you feel you would benefit from additional support, talk to your healthcare team about options such as breathing techniques, meditation, or hypnosis for pain relief.
Common physiotherapy treatment and related treatments for arthritis
When you attend a physiotherapy appointment at REP Physio, you can expect a visit full of assessment, education, and strategizing to compile a goal oriented individualized treatment plan. We tailor your programming to your specific and unique needs and pull in other resources when necessary or beneficial.
Following a thorough assessment, we will have a good understanding of your physical limitations, capabilities, lifestyle, goals, and barriers to recovery. Through this, we can work to build your program. A typical first step is developing a therapeutic exercise program to improve range of motion, strength, flexibility and endurance. Your physical therapy team will educate you on how to perform each movement and how the exercises are beneficial, strategies for self-care, and ensure you feel comfortable performing these exercises at home. Additionally, your physical therapist may determine some lifestyle modifications would support you on your road to recovery. These may include increasing your overall activity level, detrimental habit cessation (e.g. smoking), or building a support network.
As a multidisciplinary rehabilitation clinic, REP Physio offers different services to complement your treatment plan. For example, our in-house dietitian can provide nutrition or weight management strategies if body mass hinders your symptom management. We may recommend referral to our certified personal trainer to help build structured healthy habits through scheduled exercise sessions. Finally, you may benefit from alternative treatment approaches such as acupuncture or massage therapy.
Arthritis can take a toll on both your physical and mental health. As such, our physical therapists may refer you to our resident psychologist for mental health therapy. The psychologist will work closely with you to address your physical and mental well-being and can help you develop coping strategies and pain management techniques from a cognitive-behavioural perspective.
REP Physio providers may also refer you to an allied health professional for medication and pain management. Interventions may include oral medication, topical pain relievers, or pain management injections such as cortisone. Finally, in some cases, clients living with arthritic conditions may be candidates for supportive bracing or splinting referrals.
If you live with chronic pain or an arthritic condition and desire support or guidance, the REP Physio team would be happy to see you.
Arthritis Society. (n.d.). Pain self-management tools. Arthritis Society Canada. Retrieved 2023, from https://arthritis.ca/treatment/pain-management/arthritis-pain-management-guide/pain-self-management-tools
Arthritis: Symptoms, causes, types & treatment. Cleveland Clinic. (n.d.). Retrieved 2023, from https://my.clevelandclinic.org/health/diseases/12061-arthritis#overview
Benefits of exercise for osteoarthritis: Arthritis foundation. Arthritis Foundation. (n.d.). Retrieved 2023, from https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/benefits-of-exercise-for-osteoarthritis
Centers for Disease Control and Prevention. (2020, July 27). Osteoarthritis (OA). Centers for Disease Control and Prevention. Retrieved 2023, from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
Frequently asked questions about living with arthritis. Patient Resources. (n.d.). Retrieved 2023, from https://orthop.washington.edu/patient-care/articles/arthritis/frequently-asked-questions-about-living-with-arthritis.html
Mayo Foundation for Medical Education and Research. (2021, September 15). Arthritis. Mayo Clinic. Retrieved 2023, from https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772
Mayo Foundation for Medical Education and Research. (2022, August 6). Managing arthritis pain. Mayo Clinic. Retrieved 2023, from https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20046440
Osteoarthritis - symptoms, causes, diagnosis & treatments. Arthritis Society Canada. (n.d.). Retrieved 2023, from https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/osteoarthritis
Overview: Osteoarthritis in over 16s: Diagnosis and management: Guidance. NICE. (2022, October 19). Retrieved 2023, from https://www.nice.org.uk/guidance/ng226
Physical therapy for arthritis. Physical Therapy. (n.d.). Retrieved 2023, from https://www.arthritis.org/health-wellness/treatment/complementary-therapies/physical-therapies/physical-therapy-for-arthritis
Rheumatoid arthritis. Physiopedia. (n.d.). Retrieved 2023, from https://www.physio-pedia.com/Rheumatoid_Arthritis
Rheumatoid arthritis: Symptoms, diagnosis, and treatment: Arthritis foundation. Arthritis Foundation. (n.d.). Retrieved 2023, from https://www.arthritis.org/diseases/rheumatoid-arthritis
Tips for managing chronic pain: Arthritis foundation. Arthritis Foundation. (n.d.). Retrieved 2023, from https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/4-tips-for-managing-chronic-pain