What happens in an osteoarthritis assessment
We are going to guide you through a fairly typical osteoarthritis assessment.
The patient profile might be someone mid fifties in age who is worried about their knee. They have been very active throughout their life probably playing pennant-level tennis for many years before developing knee trouble. Their ability to compete becomes slowly diminished over the years and now they play just an occasional social game. When they play, their knee is sore and they are hobble for days.
They will have an osteoarthritis assessment to see what treatment options are available.
What an osteoarthritis assessment involves
Each osteoarthritis sufferer is individually reviewed. This is to understand the factors that contribute to the history of their osteoarthritis, and what factors we can correct to improve pain. Only after a good understanding is achieved can an optimal plan be created to improve the person’s situation.
The osteoarthritis assessment begins even before the patient has entered the doctor’s room. Watching them get out the chair and walk toward the room will provide an indication of their strength.
In most cases, muscle strength – particularly the quadriceps (front of the thigh) and gluteal (posterior) muscles – can be improved via exercise interventions such as the GLAD program to improve pain and function.
Watching the patient walk may also reveal alignment abnormalities. These generally occur progressively as knee arthritis progresses to a more advanced stage and will show in either a knocked-knee or bow-knee pattern. Either of which could indicate that certain dynamic knee braces may be of benefit.
Once in the examination room, a more formal biomechanical assessment may be used to assess factors above and below the knee including the feet. For instance, heel wedges might help to ease the weight pressing down on the most arthritic part of the knee.
Your history plays a part
Then it is important to get an understanding of the historical factors that led to this point. Many patients blame sport for their osteoarthritis. The reality is that, in most cases, the sport itself is not responsible. Usually it is the injuries sustained while playing sport that are associated with the progression to osteoarthritis. In many cases the patient may have acute meniscal tears (the meniscus is cartilage in the knee) that required surgery.
If part of the medial meniscus removed because the tears could not be repaired then cartilage adjacent to where the meniscus was removed wears more quickly.
Previous treatments should also be explored as they are often predictive of what treatment options each person will or will not respond to. The person’s exercise history is important in helping understand what condition each person hopes to return to, and how well they are adapted to the sport/exercise of their choice.
What surprises many people is the important role your general medical history plays in osteoarthritis, in particular your hormonal and metabolic status.
For instance, a female patient going through menopause has significantly reduced oestrogen levels. Low oestrogen impacts cartilage directly (as well as the surrounding tendons, ligaments and bone) meaning any positive adaptations are slower to occur.
Metabolic and inflammatory factors can be very important in persistent inflammation with osteoarthritis, and may be amenable to lifestyle and nutritional treatments.
Obesity is misunderstood
Obesity should always be addressed. Contrary to common thought, obesity is not just a load-related issue. It is also related to the pro-inflammatory state of some overweight people. Some people are more prone to inflammation.
Talking with the patient, it was easy to establish that they had a healthy and positive relationship with exercise. Exercise is one of many behavioural factors that will impact the likelihood of a positive outcome to osteoarthritis treatment.
A highly motivated patient who wants to return to tennis and happy to engage in both active and passive treatments is more likely to get the best outcome.
A large part of any osteoarthritis assessment is removing fear from the equation, there is a tremendous amount of misinformation about “limiting” exercise in established osteoarthritis.
Eat well, sleep well, move well
Finally, it is important to discuss simple lifestyle factors that can have a profound impact on osteoarthritis and how people perceive pain in osteoarthritis.
Nutrition is a hot topic and many people want to talk about the “anti-inflammatory” diet for knee pain. There are multiple approaches that can be considered that have some evidence-base, these include low-carbohydrate approaches, the Mediterranean diet and the anti-inflammatory diet to name just a few.
Sleep patterns can also be considered, as poor sleep correlates strongly with increased pain perception, as well as increased systemic inflammation in some cases.
Activity levels are known to be important across all chronic diseases now, and the saying ‘motion is lotion’ could not be truer than in osteoarthritis.
In the past, treatment options for OA were limited to drugs or a joint replacement. Now there is a more wholistic path for OA sufferers, including the options detailed here. This new approach provides hope that osteoarthritis can be managed more effectively so that you can participate more fully in an active lifestyle. Start your journey by making an appointment to see Matt at MSCC….