You notice it first in small things. The morning stiffness that takes a few minutes to ease off. The catch in the knee on the way up the stairs. The hip that complains after a long walk. Osteoarthritis is the most common reason older Australians come and see a Physiotherapist, and the day-to-day picture is far more workable than the word “arthritis” can sound.
01 · The condition
What osteoarthritis actually is
Osteoarthritis is a long-term condition that changes the way a joint works. The cartilage that lines the ends of the bones, along with the bone underneath, the joint capsule, the ligaments, and the muscles around the joint, all play a part. The change is gradual and usually shows up as pain with activity, stiffness after rest, and a feeling that the joint does not move as freely as it used to.
It is not simply “wear and tear” from too much use. The picture is more interesting than that. Multiple things drive the change inside the joint, including past injury, body weight, mechanical load, low-grade inflammation, and the way bone remodels over time (Mora et al, 2018). Two people with the same X-ray can have very different levels of pain and function. In fact, a number of joints that look arthritic on imaging cause no symptoms at all (Heidari, 2011), which is why the plan is built around the person, not the picture.
The joints most often affected are the knees, hips, hands, and the base of the thumb. Some people have it in only one joint. Others have it in several. The same condition, very different daily experiences.
02 · The people
Who is most affected
Osteoarthritis is the most common form of arthritis in Australia. The Australian Institute of Health and Welfare estimates that around 2.1 million Australians, roughly 8 per cent of the population, live with osteoarthritis. It becomes much more common with age. Arthritis Australia reports that around one in five Australians aged 45 and over has osteoarthritis, and the chance keeps climbing through the older age groups.
The number is forecast to keep rising. Modelling for Arthritis Australia projects around 3.1 million Australians will be living with osteoarthritis by 2040, driven by an ageing population and rising rates of overweight and obesity.
The chance of developing osteoarthritis is higher if you are an older adult, carry extra body weight, or have had a significant joint injury in the past (Heidari, 2011). It is also more common in women than in men. None of these factors is destiny. They shift the odds, but they do not lock in the experience.
03 · The joint
How osteoarthritis changes the joint
A healthy joint is a busy place. Cartilage cushions the bone ends, fluid lubricates the surfaces, ligaments and capsule keep the joint stable, and the muscles around the joint share the load. Osteoarthritis changes several of these structures at once.
Inside the joint, the cartilage gradually loses thickness and stiffness. The bone underneath responds by remodelling, sometimes forming small bony outgrowths called osteophytes. The capsule and ligaments can become more lax. Mild swelling can come and go. Around the joint, the muscles that share the load often weaken, which adds to the symptom load (Mora et al, 2018).
These changes show up in daily life as pain with activity, stiffness after sitting or sleeping, a feeling of the joint giving way, and a smaller range of movement than you remember having. Symptoms usually fluctuate week to week, which can be frustrating but is also a useful clue: the system is responsive to what you do with it.
04 · The plan
What helps manage osteoarthritis day to day
Osteoarthritis cannot be reversed. The underlying joint changes do not undo themselves. The day-to-day symptoms, on the other hand, respond well to a steady plan. Australian guidance from the RACGP guideline for knee and hip osteoarthritis recommends four pillars for non-surgical management, and the same principles apply across most affected joints.
Education. Understanding what is happening inside the joint, and what makes the symptoms worse or better, is the foundation. People who understand their condition tend to manage it more confidently and need less reactive treatment over time.
Exercise. Exercise is a core, first-line treatment for knee and hip osteoarthritis, strongly recommended in the Australian guideline. Land-based strengthening and walking suit most people, and aquatic exercise can help people who find land-based work too painful to start with, especially in the early weeks. The right plan does not make the joint worse, and most people find the joint feels better as the muscles around it get stronger. Our Physiotherapy and Exercise Physiology teams build the plan with you.
Weight management. Extra body weight adds load through the knee and hip with every step, so losing even a small amount tends to reduce the load on the joint and ease symptoms. A registered Dietitian can help you work out an approach that fits your life. Our Dietetics team works alongside Physiotherapy where weight is part of the picture.
Movement and hands-on therapy. Manual therapy and gentle massage can help in the short term, especially when the joint feels stuck or sore enough that you cannot get moving on your own. The bigger gains come from the active work that follows.
These four pillars are also the basis of our group-based Optimum OA program, which incorporates the international GLA:D approach to osteoarthritis and builds on it, combining Physiotherapy, Exercise Physiology, and Dietetics. You can read more about how the Optimum OA program works and what the evidence shows.
05 · The next step
When to see a Physiotherapist
You do not need a referral to see a Physiotherapist for osteoarthritis, and you do not need to wait until the pain is unmanageable. Most people see better results when they get advice early, before they have stopped doing the things they enjoy.
A good first appointment looks at the joint that is bothering you, the joints around it, the muscles that support the joint, your daily routine, the activities you want to keep doing, and the activities you have already given up. Together, you map out the plan and the dose. The plan changes over time as the joint and your goals change.
Optimum Health Solutions has Physiotherapy at fourteen clinics across New South Wales and Tasmania, including Blacktown, Liverpool, and Croydon Park. For people who want a structured small-group option that combines all four pillars, our Optimum OA program runs across most of our locations.
Around 2.1 million Australians are living with osteoarthritis today, and the number is projected to reach 3.1 million by 2040.
