Physical Therapy Guide to Osteoarthritis
"Arthritis" is a term used to describe inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.
An estimated 27 million Americans have some form of OA. According to the Centers for Disease Control and Prevention, 1 in 2 people in the United States (US) may develop knee OA by age 85, and 1 in 4 may develop hip OA in their lifetime. Until age 50, men and women are equally affected by OA; after age 50, women are affected more than men. Over their lifetimes, 21% of overweight and 31% of obese adults are diagnosed with arthritis.
OA affects daily activity and is the most common cause of disability in the US adult population. Although OA does not always require surgery, such as a joint replacement, it has been estimated that the use of total joint replacement in the US will increase 174% for hips and 673% for knees by the year 2030.
Physical therapists help patients understand OA and its complications, provide treatments to lessen pain and improve movement, and offer education about obesity and healthy lifestyle choices. Research has shown that light to moderate activities such as walking, biking, and swimming can provide more benefits than harm to your joints, and promote weight loss. One study showed that just an 11-pound weight loss reduced the risk of OA in the women studied.
More Information on Osteoarthritis:
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What is Osteoarthritis?
Your bones are connected at joints such as the hip and knee. A rubbery substance called cartilage coats the bones at these joints and helps reduce friction when you move. A protective oily substance called synovial fluid is also contained within the joint, helping to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves.
The cause of OA is unknown. Current research points to aging as the main cause. Factors that may increase your risk for OA include:
- Age. Growing older increases your risk for developing OA because degeneration and aging of the cartilage and synovial fluid increases over time.
- Genetics. Research indicates that some people's bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
- Past injury. Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
- Occupation. Jobs that require repetitive squatting, bending, and twisting (eg, construction, landscaping, childcare) are risk factors for OA. People who perform jobs that require prolonged kneeling (eg, miners, flooring specialists) also are at high risk.
- Sports. Athletes who repeatedly use a specific joint in extreme ways (eg, pitchers, football linemen, ballet dancers, runners) and those who engage in high-impact joint loading done in a repetitive manner (eg, running, jumping, landing on hard surfaces) may increase their risk for developing OA later in life.
- Obesity. Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.
How Does It Feel?
Typically, OA causes pain and stiffness in the affected joint. Common symptoms include:
- Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
- Stiffness in the joint after sitting or lying down for long periods
- Pain during activity that is relieved by rest
- Cracking, creaking, crunching, or other types of joint noise
- Pain when you press on the joint
- Increased bone growth around the joint that you may be able to feel
Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of inflammation. Please consult a doctor if you have swelling, redness, and warmth in or around a joint.
How Is It Diagnosed?
Osteoarthritis is typically diagnosed by your doctor using an X-ray, but there are signs that may lead your physical therapist to suspect you have OA. Joint stiffness; difficulty moving; joint cracking, creaking, or crunching; and pain that is relieved with rest are typical symptoms. Physical therapists often use the American Academy of Rheumatology criteria for diagnosing knee OA, which lists the presence of pain, plus at least 3 of the following 5 criteria:
- Age >50 years
- Stiffness <30 minutes
- Crepitus (a grinding/crunching sound emitted from the joint with movement)
- Bone tenderness
- Bony enlargement
How Can a Physical Therapist Help?
Physical therapist treatment has proven to be an effective treatment for OA, and may help you avoid surgery and use of prescription painkillers. Although the symptoms and progression of OA are different for each person, starting an individualized exercise program and addressing risk factors can help relieve your symptoms and slow the condition's advance.
Your physical therapist may:
- Perform a thorough examination to determine your symptoms.
- Observe what activities are difficult for you.
- Design an individualized exercise program to address your specific needs and improve your movement.
- Use manual (hands-on) physical therapy to improve movement of the affected joint.
- Offer suggestions for adjusting your work area to lessen the strain on your joints.
- Teach you aerobic and strengthening exercises to improve your movement and overall health.
- Design and teach you a home-exercise program to improve your strength and movement.
- Teach you an exercise program for safe weight loss, if you need to lose weight to ease pressure on your joints.
- Recommend simple lifestyle changes that will help keep the weight off.
In cases of severe OA that are not helped by physical therapy alone, surgery, such as a knee or hip replacement, may be necessary. Your physical therapist will refer you to an orthopedic surgeon to discuss the possibility of surgery.
Can This Injury or Condition Be Prevented?
The development of OA cannot be completely prevented. The best way to slow the onset or progression of OA is to choose a healthy lifestyle by avoiding obesity and participating in regular physical activity or exercise programs.
Workers or athletes who perform repetitive movements that put pressure on specific joints can seek guidance from a physical therapist on proper movement techniques and muscle strengthening to help lessen joint strain, and prolong joint health.
Workers and athletes, as well as older adults, also should learn proper balance and movement techniques to lower their risk of falling and causing injury to a joint.
Real Life Experiences
Estelle is a 65-year-old executive assistant who sits for long hours at work. In recent months, she has noticed stiffness and pain in her right knee when getting up from her desk. Over the previous few weeks, Estelle has felt more pain in her knee when performing everyday tasks like going up and down stairs, or bending to open a file drawer. Her walks to and from the bus on her commute home have become more challenging due to her knee pain. She now has an increasingly hard time getting up and moving in the morning, due to pain and stiffness. Her friend suggests that she see a physical therapist.
At her first visit, Estelle’s physical therapist reviews her overall medical history, and asks her to describe her current symptoms, when and how they started, and her current level of activities. She notes that Estelle is limited in a number of key daily living activities. She conducts a full physical examination, and notes stiffness and limited range of motion in the right knee, as well as bone tenderness. Considering Estelle’s age and her reported incidence of pain, her physical therapist diagnoses knee OA.
Based on Estelle’s current condition and her personal goals, her physical therapist develops a plan of care to help ease her pain and stiffness and get her moving again. She first works with Estelle to help her gain some lost range of motion in her knee area. She applies manual (hands-on) therapy to gently increase movement in the knee area, and teaches Estelle gentle exercises to strengthen the muscle around her knee without increasing her pain.
Because Estelle’s physical therapist knows the importance of cardiovascular fitness and weight management, she has her ride a stationary bike at her physical therapy sessions, and recommends that she begin a low-impact aerobic or aquatic program at her local gym. She also designs a home-exercise program for Estelle, which she adjusts as Estelle’s strength and movement improve.
Over the next couple of months, Estelle notices an increase in motion and flexibility in the knee area, and reports that she feels much less pain when performing her daily living tasks. She has grown more comfortable and consistent with exercising at her local gym, and with her home-exercise program.
At work, Estelle now finds that she can rise from a chair pain free, and perform her office tasks with much more flexibility. Following her physical therapist’s advice, she makes sure that she gets up from her desk regularly to move about and “stretch her legs.”
Just this week, Estelle decides she’ll walk to a bus stop 2 blocks farther away from work, just for the fun of the added exercise!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat OA, regardless of the affected joint. However, you may want to consider:
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
- A physical therapist who specializes in the treatment of osteoarthritis.
You can find physical therapists with these and other credentials by using Find a PT, the online tool by the American Physical Therapy Association that can help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have osteoarthritis.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of hip osteoarthritis and hip replacement. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Esser S, Bailey A. Effects of exercise and physical activity on knee osteoarthritis. Curr Pain Headache Rep. 2011;15(6):423–430. Article Summary on PubMed.
Urquhart DM, Tobing JF, Hanna FS, et al. What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011;43(3):432–442. Free Article.
Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. 2010;18:1372–1379. Free Article.
Cibulka MT, White DM, Woehrle J, et al. Hip pain and mobility deficits—hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2009;39:A1–A25. Free Article.
Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–1213. Free Article.
Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785. Article Summary in PubMed.
Deyle GD, Allison SC, Matekel RL, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85:1301–1317. Free Article.
Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Arthritis Rheum. 2004;50(5):1501–1510. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Christopher Bise, PT, DPT, MS. Reviewed by the editorial board.