Previous Page
TECHNICAL ARTICLE
What Is OA? The National Institute for Health and Clinical Excellence defines OA as: “A syndrome of joint pain accompanied by varying degrees of functional imitation and reduced quality of life”. The commonest joints affected are the hand, knee, hip and foot.
You do not need an X-ray to diagnose OA, and it is likely if: l Aged 45 or over l Over 3 months pain that gets worse with use l Morning stiffness in the joint(s) of 30 minutes or less.
OA used to be called “wear and tear”, but in reality is an active process causing damage to bone, cartilage, joint lining, ligaments and muscles. The ongoing and cyclical nature of the condition has led to the new term of “tear, flare and repair”. Tear refers to patient-related factors such as obesity, joint overuse or trauma, flare refers to the body’s inflammatory response, and repair refers to the repair processes that go on within the joint. Problems arise when “tear” insults are repeated and ongoing, leading to suboptimal repair and more persistent joint pain and disability.
As a REPs member you may be the first person to discuss their MSK problems. You are a vital part of the information giving and self-management paradigm.
Treatment For OA
Despite NICE guidelines being published in 2008, many people are not being given the core treatments of: l Education, exercise and weight loss interventions l Simple pain relief measures
In a survey of 8000 people with OA, less than 50% said that they had received any information on exercise by their GP.
What Can You Do? Reassurance is key. Many people with joint pain avoid exercise as they feel it will make things worse. Part of your approach is reassuring them that this is not the case, and that in fact exercise will improve their symptoms, through increased muscle strength and joint stability. Most patients with OA will not need surgery and increasing disability over time is not inevitable. It is important to manage client expectations – muscle strengthening takes time and patients may not see effects for up to three months, so encouragement to “keep going” is vital otherwise they will lose confidence and stop exercising. Arthritis Research UK produce several high-quality patient information resources and exercise sheets available on their website that can be downloaded. Alternatively, booklets can be ordered free-of-charge to where you work.
General aerobic exercise (such as walking or swimming) and specific muscle strengthening and core/balance exercise have been shown to be beneficial particularly in knee OA. It also has benefits for cardiovascular and mental health. Weight loss of 6kg or more in people with knee OA reduces disability.
Good footwear that reduces instability of the foot is important, and people with OA often need wider fitting shoes and trainers. Arch supports for those with flat feet will help restore normal biomechanics and put less strain on knees, hips and ankles. Looking at clients footwear and heel wear pattern can be very
Keep a look out for the OA addition to REPs Level 4 Specialist Instructor coming soon, you should ensure that you have this before working with OA clients.
THE AUTHOR
Dr Inam Haq is Associate Medical Director at Arthritis Research UK, works as a consultant rheumatologist in Brighton and is Director of Undergraduate Studies at Brighton and Sussex Medical School. He
has a particular interest in increasing knowledge and skills of health and exercise professionals to help educate people with musculoskeletal disease.
ANSWER THE FOLLOWING QUESTIONS ONLINE TO EARN CPD POINTS Please log into the members’ area of the REPs website to give your answers
Q1
Q2 Q3
How many days off work annually are lost due to musculoskeletal problems? a) 1.4 million b) 7.6 million c) 12.2 million
Osteoarthritis commonly affects what joint? a) Ankle b) Knee
c) Shoulder
In obese people, what is their increased risk of getting osteoarthritis of the knee? a) 8 times b) 25 times c) 14 times
15
useful to help in these discussions. Regarding pain relief, paracetamol is a simple and safe first-line treatment but you should ensure they see a health professional to discuss this in more detail. Encourage your clients to see a health care professional as there may be other things that can be done to help them, including medication or assistive devices such as splints or walking aids.
It is important at all times to remember that the “one exercise fits all” approach is not appropriate. A client-centred approach focusing on their ideas, concerns and expectations and tailoring exercise to their daily activities will be more likely to achieve results.
Fibromylagia syndrome, a syndrome associated with chronic widespread pain and fatigue without evidence of joint damage also responds in some patients to a tailored exercise programme including aerobic and strength training.
Conclusion
As discussed arthritis and MSK conditions are common, and exercise and education are key treatment strategies. As a REPs member you have a role in helping people with MSK problem engage and persist with exercise as a treatment, by helping to dispel the myths around it and providing advice and resources that will empower the client to manage their condition actively.