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Introduction
Osteoarthritis (OA) is a prevalent condition, particularly among older adults, characterised by the change of joint cartilage over time. This condition can lead to pain, stiffness, and impaired movement, significantly impacting quality of life. While there is no cure for osteoarthritis, evidence strongly supports physiotherapy can help to reduce pain and improve function, and in some resolve symptoms all together. This blog will explore the benefits of physiotherapy for osteoarthritis, focusing on exercise, the challenges of exercising with pain, the importance of weight management, and the role of coaching and support in achieving better outcomes.
The Role of Physiotherapy in Osteoarthritis Management
Physiotherapy is a cornerstone of OA management, offering a non-invasive approach to alleviate pain, improve joint function, and enhance overall well-being. The National Institute for Health and Care Excellence (N.I.C.E) guidelines emphasise the importance of exercise, education and advice, and weight management as first-line treatments for OA, with physiotherapy playing a crucial role in each of these areas. N.I.C.E have previously referred to the ‘osteoarthritis treatment target’ which I feel is a nice visual to encapsulate treatment options and the order in which these options should be prioritised.
Exercise: The Foundation of OA Management
Exercise is one of the most effective interventions for managing osteoarthritis. It helps maintain joint mobility, strengthens muscles around the affected joints, and improves overall physical function. A further thing that exercise can help with which is rarely touched on is improvements in psychology, attitude and confidence. I commonly treat patients who are worried and fearful of movement. Understandably, people with OA don’t want to do more harm or damage to their joint but this is a misconception that can helpfully be challenged when exercise is introduced in a sensible and gradual way. According to the N.I.C.E guidelines, all patients with osteoarthritis should be encouraged to engage in regular physical activity, regardless of age, comorbidity, or pain levels.
Link to N.I.C.E. Guidelines for Osteoarthritis: https://www.nice.org.uk/guidance/NG226
The Challenges of Exercising with Pain
Despite the clear benefits, exercising with osteoarthritis can be challenging, especially for those experiencing significant pain and for those who may not have exercised very much in the past. The fear of exacerbating pain or causing further damage often deters individuals from engaging in physical activity. However, avoiding exercise can lead to a cycle of increased pain and disability due to muscle weakness, joint stiffness, decreased mobility and confidence.
This is where physiotherapy becomes invaluable. A physiotherapist can design a personalised exercise program tailored to the individual's needs, considering their pain levels, physical abilities, and overall health status. Research shows that individualised exercise programs, when supervised by a physiotherapist, lead to better adherence, reduced pain, and improved functional outcomes compared to generic exercise advice.
Types of Exercises Recommended
The types of exercises recommended for OA patients include aerobic exercises, strength training, and flexibility exercises. Aerobic exercises, such as walking or swimming, improve cardiovascular health and aid in weight management. Strength training focuses on building the muscles around the affected joints, providing better support and reducing the load on the joints. Flexibility exercises, including stretching and range of movement activities, help maintain joint mobility and reduce stiffness.
Weight Management: A Crucial Component
Weight management is another critical aspect of osteoarthritis care. Excess body weight increases the load on weight-bearing joints, such as the knees and hips, accelerating the progression of OA and exacerbating symptoms. The relationship between obesity and osteoarthritis is well-documented, with studies indicating that even modest weight loss can lead to significant improvements in pain and function.
The Link Between Obesity, Metabolic Syndrome, and Osteoarthritis
Beyond the mechanical impact of excess weight, obesity is also associated with metabolic syndrome—a cluster of conditions including insulin resistance, hypertension, and dyslipidaemia (high cholesterol). This contributes to widespread systemic inflammation. This inflammation can worsen OA symptoms and may even play a role in the disease’s progression. Addressing metabolic syndrome through lifestyle interventions, including exercise and weight loss, is therefore a vital strategy in managing osteoarthritis. Understanding the role of widespread systemic inflammation explains why weight loss is still recommended for those who have OA in less weight bearing joints like the thumb and shoulder. Given, that metabolic syndrome increases the risk of high blood pressure, high cholesterol and diabetes the suggested approach to managing OA will be helping more than just your joint pain.
Physiotherapy and Weight Loss
Physiotherapists can provide guidance on safe and effective exercises for weight loss, particularly for individuals with osteoarthritis who may struggle with traditional exercise due to pain or mobility issues. By combining aerobic exercises with strength training and low-impact activities, physiotherapy not only aids in weight management but also improves joint function and reduces OA symptoms.
The Importance of Support and Coaching
Living with OA can be overwhelming, and the journey to manage the condition often requires more than just medical advice. Research has shown that individuals who receive ongoing support and coaching are more likely to adhere to treatment plans, maintain regular exercise, and achieve better health outcomes compared to those who do not have such support.
In my role as an Advanced Physiotherapy Practitioner, I often see patients who are considering more invasive options like injections and surgery with the perception that physiotherapy or exercise hasn’t worked. Often, they will have been given an exercise program by their GP or printed off a list of exercises from their physiotherapist with no ongoing support and feel it hasn’t worked. The bottom line is trying to exercise with pain is difficult, getting the principles of strength and conditioning correct is hard, and the reality of engaging properly in a rehabilitation program whilst balancing this with everyday life will see ups and downs in your symptoms. It makes sense that having someone to guide you through this challenging process at regular intervals would be beneficial.
Vitally, prior to considering invasive interventions, which are appropriate for some, you want to be very confident that you have genuinely exhausted all conservative treatment options first.
Benefits of Coaching in Osteoarthritis Management
Coaching, whether provided by a physiotherapist or other healthcare professionals, helps patients set realistic goals, overcome barriers to exercise, and stay motivated. It also provides a platform for education, where patients can learn more about their condition and the importance of lifestyle modifications. Studies indicate that structured programs that include regular follow-ups and personalised coaching lead to greater improvements in pain, function, and quality of life.
The Evidence for Physiotherapy in Osteoarthritis
Multiple studies over the past two decades have highlighted the efficacy of physiotherapy in managing OA. A 2018 systematic review and meta-analysis found that exercise therapy, particularly when supervised by a physiotherapist, significantly reduces pain and improves function in patients with knee OA. Another study published in 2020 demonstrated that combining weight loss with exercise interventions resulted in superior outcomes compared to exercise alone, highlighting the importance of a comprehensive approach to OA management.
Furthermore, research supports the notion that personalised care, including one-on-one physiotherapy sessions and tailored exercise programs, leads to better adherence and outcomes than generic advice. Patients who receive individualised care are more likely to experience significant improvements in pain, mobility, and overall quality of life.
Conclusion
Physiotherapy plays a pivotal role in the management of osteoarthritis, offering evidence-based strategies to alleviate pain, improve joint function, and enhance quality of life. By focusing on exercise, weight management, and providing ongoing support, physiotherapists can help individuals with osteoarthritis navigate the challenges of living with this condition. The N.I.C.E guidelines highlight the importance of these interventions, and the robust body of research over the past two decades confirms their efficacy. For those living with osteoarthritis, engaging with a physiotherapist can be a transformative step toward better health and a more active, pain-free life.
If you’re struggling with osteoarthritis, consider seeking the support of a physiotherapist to guide you through personalised exercises, weight management strategies, and provide the coaching needed to achieve the best possible outcomes.
References
NICE. Osteoarthritis: care and management. Clinical guideline [CG177]. February 2014. Updated December 2020.
Bennell, K. L., Dobson, F., & Hinman, R. S. (2014). Exercise in osteoarthritis: Moving from prescription to adherence. Best Practice & Research Clinical Rheumatology, 28(1), 93-117.
Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet, 393(10182), 1745-1759.
Messier, S. P., et al. (2021). Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis: The IDEA Randomized Clinical Trial. JAMA, 325(3), 210-223.
Uthman, O. A., et al. (2013). Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ, 347, f5555.
Messier, S. P., Mihalko, S. L., Legault, C., Miller, G. D., Nicklas, B. J., & DeVita, P. (2013). Intentional weight loss for overweight and obese patients with knee osteoarthritis: is more better? Arthritis Care & Research, 65(5), 668-676.
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