Disease Burden and Primary Care
Osteoarthritis affects approximately 2.2 million Australians, or 9.3% of the population. 12% of females and 6.8% of males had osteoarthritis according to ABS statistics in 2018. The deterioration of joint surfaces leads to acute and chronic pain, physical limitations and sometimes even mental health issues, which often require intervention and management. These issues for many Australians result in withdrawal from physical, social and community activities, and may even lead to a loss of independence.
The Australian Burden of Disease study (2022) found that osteoarthritis contributed 19% of all musculoskeletal disease burden. Expenditure on health services for osteoarthritis management exceeds $3.5 billion annually, in addition to productivity losses due to pain, loss of function and early retirement associated with the condition (Australian Institute of Health and Wellness 2019).
Osteoarthritis was also the most common musculoskeletal reason for patient presentation to hospital in 2020-21, being responsible for 34% of all musculoskeletal hospitalisations. Osteoarthritis can also predispose one to, and be exacerbated by, various other comorbidities.
Primary care for osteoarthritis aims to slow progression of the disease and reduce the likelihood of hospitalisation, via a combination of diet and exercise, often in conjunction with analgesic/anti-inflammatory medication.
Exercise and Physiotherapy for osteoarthritis
Exercise is crucial for the long-term management of joint health, musculoskeletal function and health in general. Regular exercise has been shown to have protective effects against the development of osteoarthritis, slow the progression of existing osteoarthritis, and improve symptoms associated with it. It can also help in the management of various comorbidities.
Exercise for osteoarthritis management should involve low impact strength-based resistance training, to improve strength and motor control/biomechanics without causing further irritation to the joint. Contrary to popular thought, studies have shown that lifting weights (when done appropriately) has a protective effect against the deterioration of joint cartilage, which delays the onset and slows the progression of osteoarthritis. Resistance training has also been shown to improve function, and activity participation, delay or avoid surgeries and reduce pain in patients with osteoarthritis. Other means of resistance training besides lifting weights include using bands or tensile springs to add resistance to various movements.
Additionally, mobility work and stretching should be performed to maintain range of motion and manage stiffness in osteoarthritis patients. Other physiotherapy treatments (such as myofascial release or soft tissue massage) can be used as an adjunct in the short term to assist with pain management and improve ease of movement.
Although nothing can be done to reverse arthritic changes in joint surfaces, a regular, appropriately-designed, progressive exercise regime can slow the changes, and provide clinical benefits to patients in spite of the presence of osteoarthritis, leading to lifestyle improvements. It is also the central component of rehab following, and “prehab” beforehand, for patients who do require surgeries such as joint replacements. Those who perform a prehab and rehab program experience better outcomes and a higher rate of success with joint replacement surgeries than those who do not.
Stephan Panagos
Physiotherapist, Evado Studios Hawthorn