Osteoarthritis

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Osteoarthritis

Article by J.Ferguson, I.Kelly

What is Osteoarthritis?

Osteoarthritis is one of the most common forms of arthritis. Some people refer to it as degenerative arthritis.

What Causes Osteoarthritis?

Everyday “wear and tear” steadily damage your joints. The joints show signs of wear: joint cartilage becomes thin, extra bony spurs grow in response to joint stress, and joint motion lessens. In advanced stages, osteoarthritis can be painful, functionally limiting and depressing.

Osteoarthritis Cure?

Unfortunately, there is no cure for osteoarthritis. But the good news is that there are some better ways to manage your osteoarthritis and slow the degeneration process. Better arthritis management will result in making your life easier and more comfortable. Physiotherapy is a significant part of making your life living with osteoarthritis less painful, comfier and keeping you active.

Physiotherapy has been shown by research to reduce the pain and disability associated with arthritis, especially knee osteoarthritis.

http://dx.doi.org/10.1136/bjsports-2016-096458

Seek the professional and helpful advice of your physiotherapist to start enjoying life again today!

Your Osteoarthritis Diagnosis

X-rays are the most straightforward test to confirm osteoarthritis. An experienced practitioner will have an excellent idea of whether you have osteoarthritis when they examine you.

How Does Osteoarthritis Affect Older People?

As you age, most people develop some degree of osteoarthritis. Wear and tear of our joints may occur due to ageing, injury, prolonged microtrauma, overuse of bones, or excess weight. Permanent bony changes occur and will exist even when there are no painful symptoms.

Your degree of suffering varies. Whereas some people may be symptom-free others may suffer continuous disabling pain. The most common is mild or intermittent pain provoked by episodes of increased use or minor trauma.

The joints most commonly affected are the weight-bearing joints: hip, knee, ankles, feet and spine. However, osteoarthritis can affect any joint in the body and is common in the hands and shoulders. Severe cases may require surgical treatment, but most will respond very well to physiotherapy and medication prescribed by your doctor.

Osteoarthritis Symptoms

You can suspect osteoarthritis if you experience one or more of the following symptoms:

  • joint pain or tenderness that intermittently returns
  • stiffness, particularly early morning stiffness
  • joint swelling or deformity
  • noticeable joint heat and redness
  • joint movement is painful or difficult.

Osteoarthritis Related Conditions

General Arthritis Information

What is Arthritis?

Rheumatology Conditions

Rheumatoid Conditions – Overview

Osteoarthritis Conditions

Osteoarthritis – Overview

Spine
Peripheral Joints

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FAQS About Pain

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.

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Pain

Pain is the built-in alarm that informs you something is wrong! Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation. Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. When there is an injury to your body, these tiny cells send messages along nerves into your spinal cord and then up to your brain. In general, pain receptors are classified according to their location. Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain. It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.

Pain messages travel slower than other nerve stimulation.

Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present. Three types of nerves are concerned with the transmission of pain: A-beta fibres, which have a large diameter and are myelinated A delta fibres, which have a small diameter and also have myelinated sheaths. C fibres have small diameters and are non-myelinated (slowing their conduction rate) and are generally involved with the transmission of dull, aching sensations. Nerves with large diameter conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate. One method of easing your pain is to provide your nervous system with high speed "good feelings" such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machines) utilises to provide pain relief.

Nerve Pain

Nerve pain is pain that is caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the common type of pain that is due to an injury. This is known as nociceptive pain.

What Causes Nerve Pain?

nerve pain Neuropathic pain is caused by a problem with your nerves themselves, which sends pain messages to the brain.

What is Nerve Pain Symptoms?

Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.

What Causes Nerve Pain?

Various conditions can affect your nerves and cause nerve pain. Common sources of nerve pain include:
  • Shingles (post-herpetic neuralgia).
  • Trigeminal neuralgia.
  • Diabetic neuropathy.
  • Phantom limb pain following an amputation.
  • Cancer.
  • Multiple sclerosis.
  • Chemotherapy.
  • HIV infection.
  • Alcoholism.
  • Other nerve disorders.

Nerve Pain & Nociceptive Pain

You can suffer both nerve pain and nociceptive pain simultaneously. Both pain types can be caused by the same condition.

Nerve Pain Treatment

Nerve pain is less likely than nociceptive pain to be helped by traditional painkillers such as paracetamol, anti-inflammatories and codeine.  However, other types of medicines often work well to ease the pain. Nerve pain is often eased by anti-depressant or anti-epileptic medicines. Please ask your doctor for more advice.

Pain Links

Pain & Injury

Tens Machine

What is a TENS Machine?

Chronic Pain

Recent research has helped to shed more light on the changes that occur in your body with chronic pain.

What is Normal ‘Protective’ Pain?

Normally pain is good. It informs you about potential or actual damage to your body’s tissues. Nociceptor nerve cells in the tissues of your body, react to strong stimuli such as pressure, heat, cold or chemicals. These nociceptors send a message to the spinal cord, which then forward another message up to the brain. Your brain then processes these messages and produces a coordinated response to escape whatever is causing the tissue damage.

What is ‘Pathological’ Pain?

Research has shown that changes occur in your body at all levels of pain processing. These changes include:

Changes at the Injury Site

At the site of the injury, your peripheral nerve becomes much more easily excitable.  This means that it takes far less of a stimulus to cause it fire off. In some cases, even a gentle brush against the skin is enough to fire off the pain pathway. Unfortunately it is not just the damaged nerves that become more excitable, but also the neighbouring nerves, which means even further amplification of the nerve messages. Some nerves can also start firing off spontaneously, which means that they do not need a stimulus to fire off.

Changes in your Spinal Cord

In the dorsal horn of the spinal cord, changes occur in some of the cells that receive the nociceptor messages. These changes lead to greater sensitivity to the spontaneous nociceptor messages mentioned previously. Changes can also occur in some cells that leads to a ‘memory’ developing between two cells, which leads to an amplified response in the neighbouring cell.

Changes in your Brain

Usually, your brain can decrease the level of pain you experience through releasing natural opioid hormones. When you suffer chronic pain, changes occur in the midbrain which actually increase the nociceptive messages. This means you’ll perceive even more pain. Chronic pain messages stimulate parts of the brain involved in emotion, fear and feelings. This may help explain why conditions such as depression, sleep disorders and pain catastrophising are linked in with chronic pain. We also know that chronic pain leads to atrophy or ‘shrinking’ of parts of the cortex and midbrain. Brain-stimulating activities may help to limit this ageing.

Do You Need More Information about Chronic Pain?

If you need more information about your pain or how to best manage your chronic pain, please consult the advice of your physiotherapist. Your physiotherapist is an highly trained at helping you to understand and reverse the changes that occur with chronic pain.

Pins and Needles - Paraesthesia

What Causes Pins & Needles?

A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.

Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can be a sign of permanent nerve compression. Please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically.

The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.

Common Causes of Pinched Nerves

The most common forms of nerve compression are in the spinal joints where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.

How Can You Fix "Pins and Needles"?

If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness" or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.

More info

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What is a TENS Machine?

TENS is an abbreviation of Transcutaneous Electrical Nerve Stimulation.

Transcutaneous means "across the skin". In simple terms, a tens machine stimulates your nerves via an electrical current through your skin. A TENS machine is an electronic medical device. A TENS machine may assist you in modest short-term pain relief.

The use of a TENS machine should be as one part of a pain management program under the guidance of your doctor or healthcare practitioner. Please consult your healthcare practitioner before using a TENS machine.

How Does a TENS Machine Provide Short-Term Pain Relief?

what-is-a-tens-machine

Researchers believe that TENS controls pain in one of two ways:

Sensory Level Stimulation - The Gate Control theory of pain means that the electrical input of the TENS machine interferes with the transmission of pain signals, by blocking the neural "gate" through which the pain travels.

Motor Level Stimulation - The goal of motor level stimulation is to cause the release of the body's opiate-like substances to achieve pain relief.

Further Reading

Johnson M. 2014, Walsh DM et al. 2009, Nnoaham KE, Kumbang J. 2008, Watson 2008, Andrews JR et al. 2004

IMPORTANT

Use your TENS machine only as directed. A TENS machine and EMS machine are electronic medical devices.  Always read the label and instruction manual. A TENS machine may assist you in modest short-term pain relief. Consult your doctor/healthcare professional before use and if symptoms persist.

TENS Machine FAQs

What is a TENS Machine?

TENS is an abbreviation of Transcutaneous Electrical Nerve Stimulation. Transcutaneous means "across the skin". In simple terms, a tens machine stimulates your nerves via an electrical current through your skin. A TENS machine is an electronic medical device. A TENS machine may assist you in modest short-term pain relief. The use of a TENS machine should be as one part of a pain management program under the guidance of your doctor/healthcare practitioner.

How does a TENS Machine provide Short-term Pain Relief?

Pain is thought to be controlled by TENS in one of two ways: Sensory Level Stimulation - The Gate Control theory of pain means that the electrical input of the TENS machine interferes with the transmission of pain signals, by blocking the neural “gate” through which the pain travels. Motor Level Stimulation - The goal of motor level stimulation is to cause the release of the body’s own opiate-like substances to achieve pain relief.

TENS Machine FAQs

IMPORTANT
Use only as directed. A TENS machine and EMS machine are electronic medical devices.  Always read the label and instruction manual. A TENS machine may assist you in modest short-term pain relief. Consult your doctor/healthcare professional prior to use and if symptoms persist.

Why Do Physiotherapists Prescribe You Exercises?

The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose. Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.

What Exercises Should You Do?

Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person. You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage. It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs. The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescription Drugs?

Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not! Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional. So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.

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Sports Injuries

Body Parts

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